| 71. |
- Pértega, Elvira, et al.
(författare)
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A systematic mapping review identifying key features of restraint research in inpatient pediatric psychiatry: A human rights perspective.
- 2023
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Ingår i: International Journal of Law and Psychiatry. - 1873-6386. ; 88
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Forskningsöversikt (refereegranskat)abstract
- Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently.To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints.A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022.The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values.Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, the lack of references to parents suggests insufficient consideration of the CRC. The shortage of quantitative studies focusing on factors beyond patient-related aspects, and the general absence of qualitative studies exploring the perspectives of children and adolescents regarding restraints, suggest that the social model of disability proposed by the CRPD has not yet fully penetrated the scientific research on this topic.
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| 72. |
- Radovic, Susanna, 1969, et al.
(författare)
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Introducing a standard of legal insanity: The case of Sweden compared to The Netherlands
- 2015
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 40, s. 43-49
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Tidskriftsartikel (refereegranskat)abstract
- Abstract in UndeterminedA recent governmental report has suggested that the notion of insanity, which has not been a relevant concept in Swedish criminal law for the last 50years, should be reintroduced into the criminal justice system. This move has generated a debate over the most appropriate criteria to be included in a legal standard for insanity. We consider the fundamental question of whether a legal standard is required when introducing insanity, by looking at a legal system in which legal insanity is available but where no standard is used: The Netherlands. Overall, a review of advantages and disadvantages leads to the conclusion that such a standard is necessary. What exactly should that standard be? Is the development of different "grades" of insanity desirable? Legal considerations concerning what is essentially a legal notion should predominate in making these determinations-informed by psychiatric and other relevant scientific findings.
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| 73. |
- Sugiura, Kanna, et al.
(författare)
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Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals
- 2020
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 73
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Tidskriftsartikel (refereegranskat)abstract
- Background In involuntary psychiatric admission, used globally, professionals or caretakers decide upon hospitalization regardless of what the person with psychosocial disabilities decides. This raises clinical, ethical, legal, and human rights concerns, and it goes against Convention on the Rights of Persons with Disabilities (CRPD). CRPD mandates that member states respect the autonomy of people with disabilities. Through Article 12, it recognizes full enjoyment of legal capacity for persons with disabilities. Implementation of Article 12 is challenging in every country, and exploring all the stakeholders' experiences at admission decision-making will help us to understand the challenges that the current psychiatry system poses for service users to exercise their autonomy and identify the areas where service users need support to have their rights, will, and preferences respected. Aim To describe the experiences of service users, informal carers, and professionals in involuntary psychiatric admission decision-making and throughout the subsequent involuntary admission. We explored the support that the service users need to have their rights, will, and preferences respected. Method A search of twelve databases in medicine, sociology, and law in Danish, English, Japanese, Norwegian, Portuguese, Spanish, and Swedish was conducted in 2017 and 2018, limited to the past 10 years, using terms such as “involuntary,” “admission,” “mental illness,” and “experience”. The search identified 682 articles. Four researchers independently reviewed the articles to find those that completed original qualitative or mixed method studies exploring experiences of involuntary psychiatric admission among adults. We added seven publications from the articles' references, contacted experts in the field (no publications were added), and excluded two articles that were in German. Three researchers analyzed the articles' results using Thematic Analysis (PROSPERO registration number CRD42019072874). Results Overall, 37 articles were included from 11 countries; they involved 731 service users, 100 informal carers, and 291 mental health professionals. We identified a lack of communication and a power imbalance among the stakeholders, which was exacerbated by the professionals' attitudes. At admission decision-making, the service users wanted to be heard and wanted to understand the situation. The families felt responsibility for the service users, they were careful not to ruin relationships, and they struggled to obtain support from the mental health system. Professionals believed that threats or harming others should lead to admission regardless of what the service users or their families felt. Professionals sometimes felt that it was not necessary to explain the information to the service users because they would not understand. Professionals were concerned and frustrated with difficulties in coordinating among themselves. During admission, service users struggled with the ward environment and relationship with staff; they most objected to coercion, such as forced medication. Families were frustrated that they were not involved in the treatment planning, especially as the service users moved toward discharge. The professionals often rationalized that coercion was necessary, and they believed that they knew what was best for the service users. Conclusions A lack of communication and a power imbalance among the stakeholders hindered respect for the service users' rights, will, and preferences. This was exacerbated by professionals rationalizing coercion and assuming that service users were incapable of understanding information. Services that encourage communication and overcome power imbalances (e.g. Crisis Plans, Family Group Conferencing) combined with stronger community mental health support will respect service users' rights, will, and preferences and avoid substituted decision-making on issues such as involuntary admission and forced medication.
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| 74. |
- Svennerlind, Christer, 1963, et al.
(författare)
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Mentally disordered criminal offenders in the Swedish criminal system
- 2010
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 33:4, s. 220-226
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Tidskriftsartikel (refereegranskat)abstract
- Historically, the Swedish criminal justice system conformed to other Western penal law systems, exempting severely mentally disordered offenders considered to be unaccountable. However, in 1965 Sweden enforced a radical penal law abolishing exceptions based on unaccountability. Mentally disordered offenders have since then been subjected to various forms of sanctions motivated by the offender's need for care and aimed at general prevention. Until 2008, a prison sentence was not allowed for offenders found to have committed a crime under the influence of a severe mental disorder, leaving forensic psychiatric care the most common sanction in this group. Such offenders are nevertheless held criminally responsible, liable for damages, and encumbered with a criminal record. In most cases, such offenders must not be discharged without the approval of an administrative court. Two essentially modern principles may be discerned behind the “Swedish model”: first, an attempted abolishment of moral responsibility, omitting concepts such as guilt, accountability, atonement, and retribution, and, second, the integration of psychiatric care into the societal reaction and control systems. The model has been much criticized, and several governmental committees have suggested a re-introduction of a system involving the concept of accountability. This review describes the Swedish special criminal justice provisions on mentally disordered offenders including the legislative changes in 1965 along with current proposals to return to a pre-1965 system, presents current Swedish forensic psychiatric practice and research, and discusses some of the ethical, political, and metaphysical presumptions that underlie the current system.
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| 75. |
- Svensson, Olof, et al.
(författare)
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Experts' decision-making processes in Swedish forensic psychiatric investigations: A case vignette study.
- 2024
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Ingår i: International journal of law and psychiatry. - 1873-6386. ; 92
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Tidskriftsartikel (refereegranskat)abstract
- It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations.
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| 76. |
- Svensson, Olof, et al.
(författare)
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Experts' decision-making processes in Swedish forensic psychiatric investigations: A case vignette study.
- 2024
-
Ingår i: International journal of law and psychiatry. - 1873-6386. ; 92
-
Tidskriftsartikel (refereegranskat)abstract
- It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations.
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| 77. |
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| 78. |
- Moradian, Farzad, 1981-, et al.
(författare)
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Thermodynamic equilibrium prediction of bed agglomeration tendency in dual fluidized-bed gasification of forest residues
- 2016
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Ingår i: Fuel processing technology. - : Elsevier BV. - 0378-3820 .- 1873-7188. ; 154, s. 82-90
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Tidskriftsartikel (refereegranskat)abstract
- Dual fluidized-bed (DFB) gasification is one of the recently developed technologies for production of heat, power, transportation fuels and synthetic chemicals through steam gasification of biomass. Bed agglomeration is a serious ash-related problem that should be taken into account when biomass-based fuels are selected for fluidized-bed gasification and combustion. This study developed a thermodynamic equilibrium model to assess the risk of bed agglomeration in gasification and combustion reactors of a DFB gasifier using biomass (forest residues) as feedstock. The modelling approach combined thermodynamic equilibrium calculations with chemical fractionation technique to predict the composition and melting behaviour of the fuel-derived ash as well as bed particles coating layer in the gasification and combustion reactors. FactSage was employed for the thermodynamic equilibrium calculations. The modelling results were then compared with experimental data obtained from a full-scale DFB gasifier to estimate the reliability and validity of the predictive model. In general, a good agreement was found between the modelling results and experimental observations. For the forest residues as feedstock and olivine as bed material, the modelling results indicate a low risk of bed agglomeration in the DFB gasifier, as long as the dominant temperature in the combustion zone is below 1020 °C. In contrast, quartz as bed material in the DFB gasifier was shown to significantly increase the risk of bed agglomeration through coating-induced agglomeration mechanism.
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