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Post-incident treatment following coercive measures: a Delphi study

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Background

Coercive measures may traumatize patients and may disturb their relationship to carers. To maintain a good therapeutic relationship and to help avoid future coercion carers should address the aftermath of coercion with the patients involved. Much variation exists regarding post-incident treatment and Swiss data show that only about 30% of patients receive such treatment. Thus, the study objective was to ascertain the possible content of post-incident treatment.

Methods

A Delphi study including 28 psychiatric professionals (nurses, psychologists, psychiatrists) was conducted. The major themes presented in the first round were: terminology, objectives, timing, content, necessity, contra-indications and exemption, carer responsibility, atmospheric aspects, recording, and general remarks.

Results

22 (79%) of the surveyed institutions have no guidelines regarding post-incident treatment and in the hospitals with guidelines only 3 (50%) use them systematically. After three Delphi rounds a positive consensus was established on the following themes: Professionals view post-incident treatment as supportive and helpful in helping to cope with trauma, to promote the patient-carer relationship, and to help prevent future coercion. Trying to convince patients of the justification of the coercive measures or using the post-incident treatment to debrief personnel were consensually rejected. No consensus was established e.g. on the "right" time or the frequency for the post-incident treatment or on regarding possible re-traumatisation of patients as a contraindication for post-incident treatment.

Conclusion

Post-incident treatment is generally viewed as helpful although some details are difficult to regulate (timing, possible re-traumatisation). Minimal standards/guidelines could possibly motivate carers to increase the number of post-incident treatment. However, the expert opinion established on post-incident treatment must be subjected to empirical testing.

Author information

Correspondence to Diana Grywa.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Grywa, D., Needham, I. Post-incident treatment following coercive measures: a Delphi study. BMC Psychiatry 7, S113 (2007) doi:10.1186/1471-244X-7-S1-S113

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Keywords

  • Public Health
  • Expert Opinion
  • Empirical Testing
  • Major Theme
  • Study Objective