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Norvoll R, Hem MH, Pedersen R. The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care. HEC Forum. 2017;29(1):59-74doi: 10.1007/s10730-016-9312-1.
Norvoll, R., Hem, M. H., & Pedersen, R. (2017). The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care. HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 29(1), 59-74. https://doi.org/10.1007/s10730-016-9312-1
Norvoll, Reidun, et al. "The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care." HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues vol. 29,1 (2017): 59-74. doi: https://doi.org/10.1007/s10730-016-9312-1
Norvoll R, Hem MH, Pedersen R. The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care. HEC Forum. 2017 Mar;29(1):59-74. doi: 10.1007/s10730-016-9312-1. PMID: 27743277.
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HEC Forum. 2017 Mar;29(1):59-74. doi: 10.1007/s10730-016-9312-1.

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.

HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues

Reidun Norvoll, Marit Helene Hem, Reidar Pedersen

Affiliations

  1. Section for Medical Ethics, Faculty of Medicine, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, 0318, Oslo, Norway. [email protected].
  2. Work Research Institute, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. [email protected].
  3. Section for Medical Ethics, Faculty of Medicine, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, 0318, Oslo, Norway.

PMID: 27743277 DOI: 10.1007/s10730-016-9312-1

Abstract

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals' descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.

Keywords: Clinical ethics support; Coercion; Ethics; Mental health policy; Quality improvement and research

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