Compulsory Care Research Articles

Ethics as a complement to the legal framework

Management of compulsory care is the source of many legal questions for caregivers who have to make decisions. In the eyes of the texts and case law, the patient is believed as a subject of law. Thus, no act of care can be applied without their free and enlightened consent. In applying the care programme, the patient preserves their freedom, and therefore the freedom to continue or not the care programme. Faced with complex clinical situations, and to avoid uncertain decisions, ethics must make it possible to find the appropriate answers.

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review

ObjectiveThe lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. MethodsThe authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. ResultsWe identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of “COVID+ units”. These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DiscussionFrench mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.

Assurer les soins aux patients souffrant de troubles psychiques en France pendant l’épidémie à SARS-CoV-2

ObjectiveThe lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. MethodsAuthors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. ResultsWe identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DiscussionFrench mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.

Features of Application of Precautionary Measures for Persons Suffering From Mental Disorders: National Dimension

The paper investigates topical issues of application of precautionary measures against persons subject to criminal proceedings for the application of compulsory psychiatric care in the context of international standards and interpretative practice of the European Court of Human Rights (ECHR). The purpose of this paper is to identify and analyse the specific features of applying precautionary measures to a person suffering from a mental disorder based on the materials of generalization of domestic law enforcement practice in criminal proceedings regarding the application of compulsory psychiatric care. Research methods are selected with consideration of the purpose, objectives, and subject of research. General scientific and special methods of scientific cognition (dialectical, statistical, comparative law, analysis, synthesis, generalization) were used in the work. The integrated use of these methods has contributed to an objective and comprehensive scientific study. Based on the analysis of the current legislation and judicial practice, the specific features of application of preventive measures in criminal proceedings regarding compulsory psychiatric care are singled out, namely: a) they are applied to a person suffering from a mental disorder; b) are selected only in criminal proceedings concerning the application of compulsory psychiatric care; c) have a specific purpose conditioned by the presence of a mental disorder from which the person suffers. The specifics of the applying the measures envisaged by Art. 508 of the Criminal Procedure Code of Ukraine (hereinafter referred to as the CPC) allowed to question the legitimacy of the legislative approach as to their allocation to the institution of precautionary measures in criminal proceedings. In particular, it was concluded that in contrast to the general purpose of application of precautionary measures stipulated by Art. 177 of the CPC (concerning the suspect, the accused, the condemned), for the purpose of applying precautionary measures envisaged by Art. 508 of the CPC (concerning a person in respect of whom the application of compulsory psychiatric care is stipulated) are: 1) prevention of risks of their possible illegal behaviour; 2) provision of qualified psychiatric care to them; 3) ensuring the person's safety and the safety of others. In this regard, it should be noted that the position of the domestic legislator on the possibility of applying precautionary measures to persons suffering from mental disorders is subject to reasonable criticism of the legal community. The main argument in this debatable issue is that these persons cannot be subjects to which precautionary measures are applied, as the latter, according to the general rules, can be applied to clearly defined subjects of criminal proceedings – suspects, accused, and convicts.

The contribution of electronic health records to risk management through accreditation of residential aged care homes in Australia

BackgroundThe Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role.MethodsA convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes.ResultsIt appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management.ConclusionsSub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance.

Heroes and Toilers: Work as Life in Postwar North Korea, 1953–1961

Heroes and Toilers: Work as Life in Postwar North Korea, 1953–1961

Outpatient commitment in mental health services from a municipal view

BackgroundOutpatient commitment (OC) is a legal decision for compulsory mental health care when the patient stays in his or her own home. Municipal health-care workers have a key role for patients with OC decision, but little is known about how the legislation system with OC works from the municipality's point of view. MethodThe present study has a quantitative descriptive design using an electronic questionnaire sent to health-care workers in the municipalities that participated. The study included health-care workers from the mental health services in two counties in Norway who have experience with psychosis and OC decisions. ResultsThere were 230 people who received the questionnaire. The sample consisted of various health professionals from both small and large municipalities.The results show which tasks they have in follow-up of patients in the municipalities. ConclusionFrom the municipality's point of view, there are no significant differences in follow-up for patients with or without an OC decision, apart from conversations about medication. An individual plan is rarely used to facilitate follow-up, although this is the statutory right of patients with OC decisions. The health-care workers lack knowledge and education about the OC scheme. The cooperation between municipalities and the specialist health-care services is not clearly defined.

The impact of health care financing on the economic growth: EU countries analysis

This article generalized modern tendencies and actual peculiarities of health care financing. The key aim of the research is to investigate the dynamics of health care financing as a factor of economic growth based on EU countries analysis. Systematization information sources connected with health care financing and its structure indicate that the EU countries analysis of dynamics of health care financing and its impact on economic growth was conducted fragmentary. This issue is still actual both for scholars and policymakers, especially for Ukraine, based on European trends. Investigation in the article is made according to the following stages: 1) introduction and relevance grounding; 2) literary review and identifying the necessity of research in this scientific area; 3) describing methodology, research methods, and current hypothesis; 4) characteristic of research results and confirming the hypothesis of the positive impact of the health care financing on economic growth; 5) making conclusions. Methodological tools of the research methods were structural and comparative analysis, logical generalization, and scientific abstraction. The methods of cross-country statistical and analytical analysis using the Excel 2010 software package for the sample from 14 EU countries for 2009-2018 (limited number of countries and limited data in 2018 relate to the data availability on open website of the EU statistical office) were applied to analyse the structure of health care financing, in particular financing schemes, main providers, and health care functions. The top countries in health care financing were identified. The methods of empirical analysis using the STATA software package for this data sample were used to confirm the hypothesis about the positive impact of the health care financing on economic growth – the GDP per capita. The nature of the analysed indices distribution was estimated based on results of Shapiro-Wilk test. So, Pearson or Spearman correlation coefficient was chosen. The statistical significance and strength of the relationship between the indicators of total expenditure for health care, and in particular government financing and compulsory contributory health care financing, voluntary health care financing, and household out-of-pocket payment for health care and the change of GDP per capita were assessed through a correlation analysis. The time lags of achievement the most statistical significance by this relationship was also identified. The results of the research show that the impact of health care financing on the change of economic growth is very high in 12 from 14 investigated EU countries (with lags of 1–3 years) and high in 2 from 14 countries (with a lag of 1 year). The character of this relationship for the most countries (9 from 14 countries) is direct (positive), and for 5 countries it is inverse (negative). The results of the research will be useful during future fundamental and practical research connected with health care financing and its modelling, for scholars and government officials to reform the health care system and its financial mechanism.

Crushed by the Belgian system: Lived experiences of forensic care trajectories by persons labelled as not criminally responsible

BackgroundCare trajectories of Persons labelled Not Criminally Responsible (PNCR) are often characterized by multiple transitions from one (forensic) mental health service to another and by long periods of admission. So far, little research has been conducted on forensic care trajectories, in particular on how PNCR perceive the trajectories they are subjected to. MethodData were obtained via semi-structured interviews (N = 23) with PNCR in various (forensic) mental health services in Belgium. A maximum variation sampling strategy was applied to recruit a heterogeneous group of PNCR and inductive thematic analysis adopted to analyse the data. ResultsPNCR's experiences about care trajectories in Belgium are marked by an absent voice and passive position in the decision-making process in addition to a lack of support during transitions. Barriers for admission in (forensic) mental health services and the indeterminate duration of care trajectories contribute to overall negative lived experiences. ConclusionAlthough some findings are interchangeable with general mental health care, PNCR's care trajectories differ by their undetermined nature, barriers for accessing care and power dynamics in compulsory forensic care. As concepts from prison sociology, such as tightness, power holders and pain of indeterminacy, seem to be equally relevant for the situation of PNCR, the balance between a criminal justice and mental health approach in forensic mental health care is questioned.

Unaccompanied minors and court mandated institutional care: A national registry-based study in Sweden

BackgroundSweden received, in 2016, 40% of EUs asylum seeking unaccompanied minors (UAM) (individuals less than 18 years of age). Some of these youth end up in a court mandated compulsory-care institution within months upon their arrival. A key concern is the appropriateness of UAMs ending up in an institutional care system which is aimed at youth with significant criminal justice, violence and/or drug problems. A second concern is that UAMs in compulsory care may display behavioral and acting out behaviors while in care due to their history of trauma and confusion regarding being institutionalized. The research question examined is whether UAMs in compulsory care receive more restrictive actions by compulsory care staff compared to their counterparts who are non-UAMs. Materials and methodsThe research team used national compulsory-care registry data from 2014-2016 to compare a range of restrictive actions taken by institution staff between UAMs versus non-UAMs while in care. Differences in the rate of compulsory care restrictive actions reported between UAMs and non-UAMs, while in care, were examined using chi-square test and Poisson regression methods. ResultsA total of 2398 children and youth were placed in compulsory institutional care during the study period, of whom 423 (17.5%) were unaccompanied. The Poisson regression model identified that being subjected to body search, limited body inspection, drug use testing, and care in locked unit were used significantly less often for UAMs individuals compared to non-AUMs. In addition, repeated number of intakes in compulsory care and number of dropouts were lower among UAMs during this time period. ConclusionThe finding of this national registry study revealed that restrictive actions by institutional staff within compulsory care were significantly less common for UAMs versus non-UAMs. This study roughly suggests that the Swedish policy makers overseeing NSBIC need to consider and evaluate other care alternatives for UAMs, in addition to youth compulsory institutional care.

Associations between a risky psychosocial childhood and recurrent addiction compulsory care as adult.

Background:Treatment for substance use disorder (SUD), results, in general, in improvements in terms of both drug use and social functioning. However, there are clients who are in need of repeated treatment. The aim of this retrospective study was to identify, for adults in compulsory care for severe SUD, the association between reporting having experienced a risky psychosocial childhood and repeated entries into the Swedish compulsory care system for SUD.Method:Hierarchical logistic regression and mediation analysis methods were used to analyse data from the Swedish National Board of Institutional Care (SiS) database. The sample included 2719 adults assessed at their compulsory care intake. The study examined the association between history of institutional care, family with SUD or psychiatric problem and repeated compulsory care entries as an adult controlling for main drug, age and gender.Results:In the regression model the factor with the strongest association with repeated compulsory care intakes for SUD, was as a child having been in mandated institutional care (OR = 2.0 (1.60–2.51)). The proportion of the total effect that is mediated through LVU (law (1990:52) the care of young persons (special provisions) act) was 33% for SUD problems in family during childhood, 44% for psychiatric problems in family during childhood, and 38% for having been in foster care.Conclusion:Having been in mandated institutional care as a youth was strongly associated with repeated compulsory care for SUD as an adult. This is concerning since receipt of services as a child is supposed to mediate against the consequences of risky childhood conditions. These adults, as a group, are in need of a well-coordinated and integrated system of extensive aftercare services to reduce the likelihood of re-entry into compulsory care for an SUD.

A Swedish national study: Immigrant-country of birth status and child welfare compulsory care among a sample of parents with risky substance use

BackgroundSweden has a high percentage of foreign-born residents (18.5 %) and one of the highest overdose death rates in Europe. For immigrant parents with risky substance use (RSU), risk factors associated with immigration status (e.g., economic strain and psychological stress) potentially heightening the risk of involvement with the child welfare system (CWS). Using Swedish registry national data, this study explored the relationship between immigration-country of birth status, psychosocial risk factors, and child compulsory care for parents with RSU. MethodsStudy sample consisted of 5932 parents from 65 Swedish municipalities assessed for psychosocial problems (including alcohol and drug use) using the Addiction Severity Index (2007–2017). Stepwise multinomial logistic regression models examined the relationship between immigration-country of birth status (Swedish born, Nordic-born, and non-Nordic born), psychosocial problems, and compulsory care in the CWS. ResultsCompared to Swedish-born parents, parents not born in Sweden, Norway, Denmark or Finland (non-Nordic born parents) had a lower probability of children living in compulsory care (family homes or institutions). However, after accounting for psychosocial problems, immigration status was no longer significantly associated with children’s living arrangements. ConclusionsStudy findings indicate that parental immigrant status (even among parents dealing with RSU) in itself is not a risk factor for compulsory care in the CWS. Moreover, parental employment and health problems posed greater risk for children being in compulsory care. Receipt of targeted services for employment and health problems may help to maintain stable child living arrangements for immigrant parents dealing with RSU.

Negotiating Space in Confined Places – Co-Production of Public Services with Unwilling Users

An expanding body of research on co-production, participation, co-creation and other forms of user involvement in public services has not sufficiently reflected their coercive nature. Coercion, like persuasion, is a central dimension of public administration and a defining element of, for example, compulsory care. It is, however, seldom properly addressed in the literature on co-production. The aim of this study is twofold; to propose a broadened definition of co-production which more adequately reflects the complexities of human services by distinguishing between users (clients) and consumers (social services), and to investigate the relevance and practice of co-production in a non-voluntary setting. Examples of enhanced, participative, consumer, and user co-production were identified based on organizational and individual data from the Swedish government agency responsible for compulsory care for substance abusers. Forms of user co-production at the operational level were highlighted through client records and administrative data concerning transfers to community care – so called Care in Other Forms (COF). COF placements are intricate processes involving many different stakeholders and the analysis revealed how clients actively partake in negotiations on the terms and content of service delivery. The idiosyncrasies of involuntary human services should be considered in future research on co-production.

'We try' - how nurses work with patient participation in forensic psychiatric care.

Patients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it's clinical use in forensic psychiatric care, is an understudied field. To describe nurses' experiences of their work with patient participation in forensic psychiatric care. Managers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi-structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis. Nurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible. Compulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients' rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, 'they try'. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.

Community treatment orders in Western Switzerland: A retrospective epidemiological study

PurposeCommunity treatment orders (CTOs) are legal procedures that authorise compulsory community mental health care to people affected by severe mental disorders. Nowadays, CTOs are regulated in 75 countries, with important variations in terms of legal criteria and practices. In Switzerland CTOs were introduced on the 1st January 2013, following the amendment of the Swiss Civil Code. The aim of this study was to provide a first understanding of the use of CTOs in Western Switzerland in terms of incidence and prevalence rates, population profile, orders duration and reasons for discharge. MethodsIncidence and prevalence rates of CTOs between 2013 and 2017 were estimated. Survival analysis was used to investigate time to CTO discharge and associated factors. Logistic regression was performed to identify factors associated with CTOs’ success as reason for discharge. ResultsCTOs’ incidence rates per 100’000 inhabitants ranged between 4.8 for 2013 and 9.6 for 2017, while their prevalence raised from 4.8 to 19.5. People placed under CTO were mainly male, in their forties, of Swiss origin, single and living independently. Primarily affected by Schizophrenia, schizotypal and delusional disorders (F20-F29), they frequently presented substance use problems, and severe danger for themselves. CTOs were mainly ordered by the guardianship authority as a form of conditional release. The estimated mean time to discharge was almost three years. Not being of Swiss origin and being prescribed to take a medication were associated with longer CTO while living in hospital, as a consequence of a long-lasting hospitalisation, and having a non-medical professional in charge of the order were associated with shorter time to discharge. Neither clinical factors nor legal criteria predicted time to discharge. Moreover, spending more days under CTO increased the likelihood of success at discharge, whereas not being of Swiss origin reduced it. ConclusionsTo the best of our knowledge, no previous studies have examined the CTOs’ implementation in Switzerland. CTOs prevalence increased rapidly despite the lack of evidence on positive outcomes. Our results suggested that once under CTO, it takes a long time for a patient to be released, in case of both positive and negative outcomes.

Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients’ involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients’ experiences and the use of coercion.Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685).Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed.Conclusion: Results suggest that the intervention could decrease the inpatients’ experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.

Court-Ordered Compulsory Psychiatric Care and the Prosecutor’s Control Function

The health care system is responsible for the implementation of court-ordered compulsory psychiatric care. In order to ensure that the health care system fulfills the statutory responsibility for crime protection, the legislature has added a control function to the prosecuting authority. Case law shows that the courts place emphasis on this control function in assessing whether court-ordered compulsory psychiatric care is necessary to protect society. This article highlights the prosecution’s legal remedies and professional prerequisites for fulfilling the control function.

Tvångsvård eller frivillig placering?

Compulsory care or not? Social workers’ discretionary reasoning when children need out-of-home care due to homicidal violence
 The aim of this article is to analyse social workers’ discretionary reasoning when children need immediate and long-term out-of-home care due to homicidal violence. In Sweden, children may be placed in out-of-home care without legal proceedings as a voluntary support measure even in serious cases of maltreatment, if the child’s custodians give their consent to such care. However, a formally given consent might be questioned if it is not regarded as adequate or enough to provide the child with the appropriate care. This article explores how Swedish social workers reason about their discretion to suggest a voluntary placement or compulsory care for children in these cases of serious violence, and some legal dilemmas in practice. The study is based on six qualitative group interviews with fourteen Swedish social workers from four municipalities. Two constructed vignettes were used in the interviews. The article highlights what arguments social workers use to justify compulsory care or a voluntary placement and how different legal arguments might be put forward. The article illustrates how social workers find it difficult to legally justify an immediate compulsory-care decision in these cases, yet most of them claim that they would, in time, initiate a legal proceeding and suggest compulsory care.

With a national restructuring of physician training to include critical care, what is the educational value of intensive care for physician trainees?

Radical restructuring of physician training has been proposed from 2019 that will see core medical training replaced with the internal medicine (IM) stage 1 training programme, which will include a compulsory critical care component. Few posts currently exist for core medical trainees (CMTs) in

Supported accommodation for people with schizophrenia

Background: As a result of deinstitutionalization of psychiatric treatment and care, many people with severe mental illness have been offered supported accommodation. However, research on this costly intervention in Norway has been scarce.Aims: The aim of this study was to prospectively investigate the clinical and demographic factors associated with allocation to supported accommodation for people with schizophrenia.Methods: The study was a prospective cohort study of 334 people with schizophrenia acutely admitted to Haukeland University Hospital between 2005 and 2010. Information concerning allocation to supported accommodation in their residential municipalities was collected retrospectively. Univariate and multivariate statistical methods were used to assess the association of clinical and demographical variables with allocation to supported accommodation.Results: Supported accommodation was allocated to 29.6% of the participants during the study period. Age, gender, implementation of compulsory mental health care, substance abuse, symptom burden and suicidality were not associated with allocation to supported accommodation. Functional impairment, especially difficulties with activities of daily living, experiencing exacerbation in the course of chronic disease, being medicated and of Norwegian origin, favoured supported accommodation.Conclusions: Our results supported the hypothesis that people with severe mental illness presenting the greatest need for supported accommodation, based on functional difficulties and exacerbation of chronic disease were allocated supported accommodation. Symptom burden was not associated with allocation.Clinical implications: Further research is needed to examine the impact of supported accommodation on the outcomes for people with schizophrenia.