Special section on seclusion and restraint: Consumers' perceptions of negative experiences and "sanctuary harm" in psychiatric settings
Special section on seclusion and restraint: Consumers' perceptions of negative experiences and "sanctuary harm" in psychiatric settings
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DOI：
10.1176/appi.ps.56.9.1134
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发表时间：
2005-09-01
影响因子：
3.8
通讯作者：
Frueh, BC
中科院分区：
文献类型：
--
作者：
Robins, CS;Sauvageot, JA;Frueh, BC
目的：最近的研究表明，在公共部门精神卫生系统接受治疗的严重精神疾病患者中，创伤症状的患病率很高。不幸的是，越来越多的证据表明，许多消费者在各种精神病院接受治疗时都有过创伤或有害的经历。这项研究探讨了消费者对这种有害的住院经历的看法，作者将这些事件归为“庇护伤害”。方法：作者对随机抽取的27名心理健康消费者进行半结构化定性访谈，听取他们对接受精神科治疗期间所经历的不良事件的描述。我们对访谈记录的分析侧重于理解消费者对有害经历的叙述——这些事件不符合DSM-IV的创伤标准，但却导致了严重的痛苦。结果：27位受访者中有18位描述了他们亲眼目睹或直接经历的有害事件，其中许多事件在他们的叙述中引起了消费者强烈的情绪反应。所描述的几乎所有事件都发生在医院，并围绕两组主题聚集在一起。第一组与医院环境有关，包括对身体暴力的恐惧和规则的专断性。第二组与叙述者与临床工作人员的互动有关，包括人格解体、缺乏公平和不尊重。结论：研究结果表明，许多心理健康消费者都有过他们认为有害的终身庇护经历。他们还就心理健康服务提供系统如何减少庇护所伤害经历的可能性提出了建议。
Objective: Recent studies show a high prevalence of trauma symptoms among people with serious mental illness who are treated in public-sector mental health systems. Unfortunately, growing evidence suggests that many consumers have had traumatic or harmful experiences while being treated in various psychiatric settings. This study explores consumers' perceptions of such harmful inpatient experiences, events that the authors place under the rubric of "sanctuary harm." Methods: The authors conducted semistructured qualitative interviews with 27 randomly selected mental health consumers to hear their descriptions of adverse events that they experienced while receiving psychiatric care. Our analysis of interview transcriptions focused on understanding consumers' narratives of harmful experiences-events that would not meet DSM-IV criteria for trauma but that nevertheless resulted in significant distress. Results: Eighteen of 27 interviewees described harmful incidents that they had witnessed or experienced directly, many of which evoked strong emotional responses by consumers during their narration. Nearly all incidents described were hospital based and were clustered around two sets of themes. The first set related to the hospital setting, including the fear of physical violence and the arbitrary nature of the rules. The second set related to the narrators' interactions with clinical staff, including depersonalization, lack of fairness, and disrespect. Conclusions: The findings suggest that many mental health consumers have had a lifetime sanctuary experience that they perceived as harmful. They also offered suggestions for how the mental health service delivery system might reduce the potential for sanctuary harm experiences.