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BackgroundIn times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated. ObjectiveThis paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting. MethodsPSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups—patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)—compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test. ResultsThis pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020. ConclusionsStudy results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study. Trial RegistrationClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324 International Registered Report Identifier (IRRID)PRR1-10.2196/22500

Background/Objectives: Coercion in mental health is challenged, prompting reduction interventions. Among those, the Joint Crisis Plan (JCP), which aims to document individuals' treatment preferences in case of future de-compensation, regardless of the potential loss of discernment, has been identified as a key path to study. Identified challenges related to its implementation highlight the need to adapt this intervention to the local context. Considering that in Quebec (Canada), the JCP is not widely used, but the scientific literature supports its adoption and corroborates its potential impact on reducing coercion, this study evaluates the feasibility, acceptability, and preliminary outcomes of the JCP among psychiatric and forensic inpatient settings. Methods: A pilot mixed-methods study was conducted through 16 individual interviews with inpatients and healthcare providers, combined with a pre–post analysis of seclusion and restraint use and the violence prevention climate (VPC) based on healthcare providers' (n = 57) and inpatients' perspectives (n = 53). Results: Although the challenging implementation of the JCP complicated the evaluation of its effects on seclusion and restraint use, a moderate change (d = 0.40) in the VPC was identified based on healthcare providers' perspectives. Qualitative findings are also insightful to understand the acceptability and feasibility of the JCP use. A tension emerged between the perspectives of inpatients and healthcare providers: while inpatients valued the reflective process of completing the plan, providers focused more on its technical aspects. Conclusions: The results support the integration of the JCP into patient care pathways, as it provides a tool to amplify patients' voices, promote patient empowerment, facilitate open dialog on alternatives to coercion, and foster more collaborative and humane mental health care. [ABSTRACT FROM AUTHOR]

The term 'mental health crisis' is a widely used concept in clinical practice and research, appearing prominently in mental health literature across healthcare and social science disciplines. Within these contexts, the term is frequently either left undefined or defined rather narrowly, confined to clinical observations or guidelines targeted at healthcare providers and negating the multifaceted nature of crisis as described by those with lived experience. Therefore, the aim of this paper is to explore the characteristics of and provide a conceptual definition for the concept of 'mental health crisis'. Rodgers' method of evolutionary concept analysis was employed and 34 articles, ranging from 1994 to 2021 and a variety of disciplines, were analysed. The results highlighted the contrast between clinically oriented surrogate terms and related concepts and those used by individuals with lived crisis experience. Antecedents of crisis included underlying vulnerabilities, relational dysfunction, collapse of life structure and struggles with activities of daily living. The concept's attributes encompassed the temporality of crisis, signs and symptoms of crisis, functional decline and crisis in family and caregivers. Finally, the consequences comprised looking inward for help, looking outward for help, and opportunities and dangers. This concept analysis serves as a foundational step in understanding 'mental health crisis' and its various dimensions, facilitating more nuanced discussions and interventions in the realm of mental healthcare. [ABSTRACT FROM AUTHOR]

Purpose: COVID-19 pandemic-related restrictions have significantly changed the environment and the delivery of direct care in all health services, including psychiatric hospitals. The aim of the study is two-fold: 1) to retrospectively assess the incidence of seclusion and mechanical restraint in a Quebec mental health hospital over 4 years; and 2) to assess the impact of the COVID-19 pandemic on their incidence. Methods: We conducted a retrospective study based on medical records from a Quebec mental health hospital collected (a) from April 2016 to March 2019), (b) from April 2019 to March 2020 (pre-COVID onset), and (c) from April 2020 to March 2021 (post-COVID onset). Descriptive statistics, chi square tests, Mann-Kendall test and Welch's t-test were performed. Results: Following several years during which the use of restrictive measures remained stable, we have noted a significant increase within the first year following the COVID-19 pandemic. This increase can be seen in the use of both seclusion and restraints, which have risen 205% and 170% respectively. Conclusion: There are a multitude of factors associated with the incidence of seclusion and restraint that have the potential to be triggered during emergencies and global crisis situations, impacting in turn the rights of an already vulnerable population. [ABSTRACT FROM AUTHOR]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A cohort of 11 patients with an intellectual disability and a psychiatric diagnosis present severe behavioural disorders in psychiatric hospital of Quebec in 2009. Control-measure use for this clientele has now been reduced. How do management personnel, families and care teams explain the changes? What clinical interventions did management and care providers implement that contributed to the reduction? Method: A retrospective case study was conducted. Five focus groups were held with people involved in their care, and the patient files were examined. Results: The factors contributing to this change were the cohesion of the care providers, the involvement of the families and the efforts to determine the function of the behaviour. Implications: This study may inspire other care teams to try new approaches in dealing with patients with severe behavioural disorders. Also, the model of factors and interventions supporting a reduction in seclusion and restraint measures may inspire future studies.

The theory of procedural justice, derived from social psychology, is employed in numerous fields of study concerned with the quality of interactions involving individuals in positions of authority. Although this theory is increasingly cited for its potential to promote approaches aimed at mitigating the effects of psychiatric coercion and better respecting individuals' rights, empirical literature provides limited insights into how procedural justice could be translated into practice. It is important, therefore, to examine the theoretical and practical implications of such an orientation. Based on a critical analysis of existing literature, this article will discuss the potential contributions and limitations of procedural justice applied in the field of mental health and psychiatric nursing. Procedural justice has limitations regarding solutions for human rights violations in psychiatry. It nonetheless allows a focus on the quality of interactions with individuals in coercive contexts, in addition to considering the social and identity-related implications of psychiatric coercion. [ABSTRACT FROM AUTHOR]

Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full‐text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice. [ABSTRACT FROM AUTHOR]

This study aimed to explore staff and patients' views on the violence prevention climate in civil and forensic mental health settings. We conducted a cross-sectional survey of 110 inpatients and 198 staff members from three civil mental health hospitals (including two forensic units) and one forensic mental health hospital in Canada. Staff and patients' perceptions of the violence prevention climate on civil and forensic mental health units were measured using the modified violence prevention climate scale, French version (VPC-M-FR). Multiple analyses of variance (ANOVAs) were performed to assess differences in the VPC-M-FR total and subscale scores (staff action, patient action, therapeutic environment) between patients and staff, settings (civil vs. forensic), restrictive practices (presence vs. absence of seclusion or restraints), incidents of violence during hospitalization (presence vs. absence), and victimization (presence vs. absence). In both settings, patients' views of the violence prevention climate were significantly more positive than those of the staff. Staff in forensic mental health settings had a more positive perception of the violence prevention climate than those in civil mental health units. The results contribute to a better understanding of the violence prevention climate among staff and patients and will guide future interventions within civil and forensic settings. [ABSTRACT FROM AUTHOR]

Given the increasing literature on forensic assertive community treatment (FACT), we conducted a systematic review and meta-analysis to explore the effectiveness of FACT among justice-involved individuals with severe mental illness. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Sixteen studies were included in the systematic review, six of which were included in the meta-analyses for a total of 1,246 participants. Mixed results regarding health-related outcomes were found. The pre-post FACT analysis and comparison with control groups did not yield significant results other than increased outpatient service use. Results on forensic outcomes were more compelling. Both the narrative review and the meta-analysis highlighted that FACT programs may improve justice outcomes such as the number of days spent in jail. More high quality and multisite randomized controlled trials are needed to consolidate findings. Further research is needed to examine other psychosocial factors related to FACT program success. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Involuntary treatment orders are increasingly being used around the world to allow the treatment of individuals living with a mental illness deemed incapable of giving consent and who are actively refusing treatment.The use of involuntary treatment orders can impact the nurse–patient therapeutic relationship, which is essential to offer quality care and promote recovery. What the paper adds to existing knowledge?: Nurses and patients do not agree on the possibility to develop a therapeutic relationship, with nurses believing they can build a bond with the patients despite the challenges imposed by the involuntary treatment order, and patients rejecting this possibility.Nurses caring for patients on involuntary treatment orders feel obligated to apply the conditions of this measure, even if it damages the relationship with their patients. This difficult aspect of their work leads them to question their role in relation to the management of involuntary treatment orders. What are the implications for practice?: Nurses need to be aware of the reasons why patients on involuntary treatment orders do not believe in the possibility of building a therapeutic relationship.Nurses need to reflect on and express their concerns about the damaging effects that managing involuntary treatment orders conditions can have on the nurse–patient therapeutic relationship. Introduction: Involuntary treatment orders (ITO) can impact the nurse–patient therapeutic relationship (TR) negatively. Despite the increasing use of ITOs around the world, few studies have explored their influence on the TR from the perspectives of nurses and patients. Aim: To describe the TR in the context of ITOs as reported by nurses and individuals living with a mental illness. Method: Secondary data analysis of qualitative interviews with nurses (n = 9) and patients (n = 6) was performed using content analysis. Results: Participants described the TR as fundamentally embedded in a power imbalance amplified by the ITO, which was discussed through the conflicting roles of nurses, the legal constraints imposed on patients and nurses, the complex relation between the ITO and the TR, and the influence of mental healthcare settings' context. Discussion: Nurses and patients' views were opposed, questioning the authenticity of the relationship. Implications for Practice: Nurses should be aware of the patients' lack of faith in the TR to ensure that they are sensitive to patients' behaviours that may falsely suggest that a relationship is established. Further studies should explore ways to alleviate the burden of the management of ITOs on nurses and allow for a trusting relationship to be build. [ABSTRACT FROM AUTHOR]

Recidivism among released inmates is associated with a substantial societal burden given the financial and medical consequences of victimization. Among incarcerated North Americans, approximately 7% are housed in solitary confinement (SC). Studies show SC can lead to psychological deterioration and dispute it can effectively reduce institutional misconduct or recidivism. This meta-analysis aims to clarify the impact of SC on postrelease recidivism, which we hypothesized would increase following SC. A meta-analysis was conducted using PubMed, PsycINFO, Web of Science, and Google Scholar databases from inception until December 2019. Studies on adult inmates in correctional settings were included if they met an operational definition of SC, measured recidivism, and included a comparison group in general inmate population. Random-effect models were used to assess the impact of SC on multiple types of recidivism. Of the 2,713 identified records, 12 met inclusion criteria (n = 194,078). A moderate association was found between SC and any recidivism (odds ratio [ OR ] = 1.67, 95% confidence interval [1.41, 1.97]), which persisted in controlled studies (OR = 1.41). This association was replicated across types of recidivism comprising violence (OR = 1.41), rearrests (OR = 1.37), and reincarceration (OR = 1.67). Moreover, a more recent exposure to SC increased recidivism risk (OR = 2.02), and a dose–response relationship was found between days in SC and recidivism. The overall database presented high heterogeneity but no publication bias. Findings show a small to moderate association between SC and future crime/violence. Considering the societal costs associated with antisocial behaviors following SC, mental health and psychosocial programming facilitating inmates' successful reentry into society should be implemented and rigorously evaluated in strong research design. [ABSTRACT FROM AUTHOR]