Change in policy and practice in psychiatric hospitals in Finland
Submitting Institution
Kingston UniversityUnit of Assessment
Allied Health Professions, Dentistry, Nursing and PharmacySummary Impact Type
HealthResearch Subject Area(s)
Medical and Health Sciences: Nursing, Public Health and Health Services
Summary of the impact
Research into service user involvement in mental health care resulted in
the development of an
educational intervention for registered mental health nurses to deliver
effective, ethically
appropriate therapeutic interventions for highly distressed and disturbed
patients.
The research outputs were taken up and implemented by Halikko hospital in
Finland, leading to a
significant change in policy and practice, including a substantial
reduction in the use of coercive
techniques. Following the success of this change, other psychiatric
hospitals in Finland have
adopted the system.
Underpinning research
In 2006, Professor Mary Chambers began a 26 month project entitled
`Understanding the Lived
Experience of Detained Patients''. This three-phase action research study
was undertaken in a
London Mental Health NHS Trust, and explored patients' experiences of
their hospital stay whilst
detained under the 1983 Mental Health Act. Mental health patients/service
users were employed
as researchers on the project. The project established that
patients/service users wanted to be:-
treated with higher levels of dignity and respect by staff members; more
involved in the decision-making
process regarding their care; given more information about their
treatment plans
(particularly medication); offered access to more talking therapies and
therapeutic engagement;
given access to more daily activities (to alleviate boredom); `heard' by
staff members. These
findings were integrated into an education intervention consisting of
communication and clinical
skills training, which was subsequently evaluated. Funding was obtained
from the Mental Health
Trust Executive Board (peer reviewed internally).
This work formed the foundation for ePsychNurse.Net, a project funded by
the European
Commission Leonardo da Vinci Lifelong Learning Programme (competitive
funding source, with
funds awarded on the basis of expert assessment) and carried out in
2006-2008. This project
developed an educational intervention for registered mental health nurses
to deliver effective,
ethically appropriate therapeutic interventions for highly distressed and
disturbed patients. The
research included a survey across 6 EU countries (n=806) and focus groups
with 130 nurses in the
same countries. The outputs included an e-learning course that was pilot
tested in Finland and in
England and has been running several times per year in Finland since. The
key results were a
decrease in the number of critical incidents on the wards, decreased use
of coercive interventions
(used as last resort), increased confidence in working with distressed
patients/service users,
increased uptake of nurses doing further training and a change of policy
about the use of coercive
interventions.
A second study in 2010-2012, funded separately by the same funding body,
developed a quality
assurance system for the e-learning course to enable its application
across Europe. This phase
enabled the course to be further developed and tested in 10 EU countries.
The research methods
used included a Delphi study and a postal survey. The key outcomes were an
updated and quality
assured course that was taught and evaluated in 10 EU countries together
with an eQuality
Assurance system for use across a range of e-learning professional
development courses for
registered nurses across Europe.
Mary Chambers is Professor of Mental Health Nursing at Kingston
University / St George's,
University of London Joint Faculty of Health, Social Care and Education,
and has been employed
on a Kingston University contract from 2004 to present.
References to the research
[1] Gillard S, Borschmann R, Turner K, Goodrich-Purnell N, Lovell K and
Chambers M (2010) The
impact of mental health service user researchers on research into the
experiences of detained
psychiatric patients. Health Expectations, 13, pp185-194 (Cited 10 times;
Impact Factor 2.315).
[2] Chambers M, Guise V, Valimaki M, Antonia Rebelo Botelho M, Scott A,
Staniuliene V, Zanotti
R (2010) Nurses' attitudes to mental illness: A comparison of a sample of
nurses from five
European countries. International Journal of Nursing Studies 47, 3,
350-362 (Cited 21 times
including India, China and Sweden; Impact Factor 2.178)
[3] Camuccio, C A, Chambers, M, Välimäki, M, Farro, D and Zanotti, R
(2012) Managing distressed
and disturbed patients: the thoughts and feelings experienced by Italian
nurses. Journal of
Psychiatric and Mental Health Nursing, 6, 19 807-815 (Cited once in
unpublished thesis; available
on line; Impact Factor 0.799)
Details of the impact
The success of the ePsychNurse project has led to a catalysing effect in
Finland, with substantial
reform in psychiatric nursing practice and facilities being rolled out
nationwide.
Prior to the ePsychNurse project, psychiatric hospitals made routine use
of mechanical restraints
and seclusion. The seclusion conditions were extremely basic, having
remained essentially
unchanged for a century: the seclusion room was a bare cell with no
furniture and primitive toilet
facilities, and the secluded person had no opportunity for activity or
conversation during seclusion
periods that lasted from several hours up to a week. There was no
involvement of service users in
issues relating to clinical care, policy development, research or
education.
In 2008, following the successful pilot study in Finland, and other
nurses completing the course,
Halikko hospital changed its policy on the use of coercive interventions.
The use of mechanical
restraints was entirely stopped, and the seclusion rate was reduced by
approximately 50-60%. In
addition, the physical environment of seclusion rooms was entirely
redesigned, with the
introduction of furniture, a radio, a clock, proper toilet facilities and
a buzzer to press to
communicate with nurses. These changes were made with the involvement of
service users, and
drew substantially on their wishes for reform of seclusion.
The benefits of these changes are that patients are more satisfied with
their treatment, and trauma
to patients has been reduced. The new treatment regimes are not only less
harsh, as detailed
above, but also more individualised. Where restrictions are employed, they
are based on the
specific needs of individuals, rather than being generalised restrictions
as in the past.
These changes have proved to be successful, and have been disseminated to
over 18 other
hospitals and hospital districts in Finland. Over 1000 registered nurses
in Finland have now
completed the ePsychNurse.net course. The use of mechanical restraints and
seclusion in
psychiatric care has decreased throughout Finland, as a consequence of
this project.
These changes in nursing practice have been driven by a significant
change in mindset within the
Finnish psychiatric care system. Before the ePsychNurse project, this was
a strongly professional-led
system, with little or no room for service user involvement. This has
now changed, as a result
of ePsychNurse, and service users now have a strong voice within the
system. Furthermore,
doctors and nurses would not previously have shared a public platform with
patients/service users
addressing multi-professional audiences: this is now commonplace.
The Finnish Social Affairs and Health Ministry issued a new national
guidance document on mental
health and substance abuse work in 2009. This set the core national
principles for mental health
care in Finland from 2009 to 2015. As a result of the work described
above, this guidance states
that service users must be included in the development of mental hospital
services.
Sources to corroborate the impact
[1] Mental Health Service Manager, City of Vantaa, Finland (Corroborating
Contact Identifier: 1)
[2] Testimonial from Service User, Halikko Hospital, Finland
(Corroborating Contact Identifier: 2)
[3] MIELI — National plan for mental health and substance abuse work,
National Institute for Health
and Welfare (Finland): http://www.thl.fi/en_US/web/en/research/programmes/mieliplan