Psychiatry and Individual Liberties: a Study of Institutions Characterized by a Reduced Use of Coercion

Study Overview
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Brief Summary
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Psychiatric establishments show significant disparities in terms of coercion: while some use it frequently, others use it only exceptionally. This project aims at a better understanding of the less coercive establishments, which are currently little investigated and whose study may allow to identify the levers of a psychiatry more respectful of individual liberties.

Detailed Description
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This study aims precisely at understanding the history of less coercive establishments, and at identifying the knowledge as well as the forms of organization, coordination and cooperation that are developed there. To do so, it will consist of an inventory of establishments and practices based on the analysis of scientific literature, and an intensive study of seven less coercive establishments (four establishments on the French national territory, three establishments in the Auvergne-Rhône-Alpes region). The study of these institutions and their environment, which mobilizes nursing research and sociology, is based on a methodological approach combining interviews with professionals and users, observations in the institutions and services, a documentary method, and analysis of data from the RIM-P, the SAE, and the institutions' databases.

Official Title
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Psychiatry and Individual Liberties: a Study of Institutions Characterized by a Reduced Use of Coercion

Conditions
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Psychiatric Hospitalization

Intervention / Treatment
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* Behavioral: Individual and collective semi-structured interviews
* Behavioral: Individual semi-structured interviews with ex-patients
* Behavioral: Observations out in the services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Professionals who worked in one of the seven establishments identified Ex-patients who were hospitalized in these establishments in the two years preceding the survey and whose condition is stabilized Exclusion Criteria: People who refused to participate to the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Professionals from the seven least coercive facilities<br>Volunteer professionals selected on the basis of their experience in reducing the use of coercion. | Behavioral: Individual and collective semi-structured interviews<br>* Individual and collective semi-structured interviews will be performed with professionals to identify levers (practices, knowledge, tools, regulations) which, at the level of services and establishments, enable the development of a policy of less recourse to coercion<br>Behavioral: Observations out in the services<br>* Observations will be carried out in the services in order to measure the gap between rhetoric and practice, and to observe the effective implementation of lesser use practices<br>|
| Voluntary ex-patients<br>Voluntary ex-patients who were hospitalized in these establishments in the two years preceding the survey and whose condition is stabilized | Behavioral: Individual semi-structured interviews with ex-patients<br>* Individual semi-structured interviews will be performed with ex-patients in order to gather their experiences in the seven institutions concerned and to better understand the impact of their hospitalization in these institutions on their lives<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| understand the history of less coercive institutions | identify and characterize the presence of tools, knowledge, rules, organizational specificities and collaborations in the territories allowing for less recourse to coercion. | Baseline from 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analysis of professionals' satisfaction | Analysis interview responses | Baseline from 24 months | 
| Analysis of ex-patients' satisfaction | Analysis interview responses. | Baseline from 24 months | 
| Analysis of the impact on care pathway | Analysis interview responses. | Baseline from 24 months | 
| Analysis of the impact on career paths | Analysis interview responses. | Baseline from 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Psychiatry, Reduction of coercion, Interviews, Observations, Sociology, Nursing