1
PATERNALISM AND AUTONOMY
A NORDIC STUDY ON COERCION
IN THE MENTAL HEALTH CARE SYSTEM
NORAI
The NORdic Admission Interview
VERSION 14.11.96
1
FILE INFORMATION (LEVEL 3, CORE STUDY):
1. COUNTRY NUMBER:_____ 2. RUNNING NUMBER:______
(D=1,F=2,I=3,N=4,S=5)
3. ADMISSION DATE:___/___/___ 4 A. INTERVIEW DATE:___/___/___
D M Y D M Y
4 B. AGE:_____YEARS 5. SEX: 1. FEMALE 2. MALE
6. HOSPITAL:______7. WARD (name):______
8. WARD SIZE (no of beds):______
9. TYPE OF WARD 1:
1. ACUTE
2. LONG-STAY
3. MIXED ______
4. SECURITY
5. OTHER(Specify):______
10. TYPE OF WARD 2:
1. OPEN ______
2. LOCKED
3. MIXED ______
PRESENT MEDICATION:
11. NEUROLEPTICS 1. YES 2. NO
12. ANTI-DEPRESSANTS 1. YES 2. NO
13. MINOR TRANQUILIZERS 1. YES 2. NO
14. HYPNOTICS1. YES 2. NO
15. OTHER 1. YES 2. NO
16. WAS AUDIOTAPE USED 1. YES 2. NO
------
ID-PART
NAME:
ID-NUMBER (NATIONNUMBER+RUNNING NUMBER):
PERSONNUMBER:
PERCEIVED COERCION. CORE INTERVIEW
GH1 17. WHEN DID YOU ARRIVE AT THE HOSPITAL FOR THIS
HOSPITALIZATION?
Days ago:____ or Date:___/___/___
Don't know:999999 D M Y
No answer:000000
GH3 18. DID YOU COME ALONE OR DID ANYBODY ACCOMPANY
YOU?
1. Came alone
2. Was accompanied
9. Don't know
0. No answer
IF "CAME ALONE" IS ANSWERED, JUMP TO Q. 20
GH4 19. WHO ACCOMPANIED YOU?
1. Came alone
2. Family
3. Police
4. Friend(s), Neighbor(s), Fellowworker(s)
5. Therapist(s), Health care worker(s), Socialworker
6. Somebody else
8. Irrelevant
9. Don't know
0. No answer
In case of combinations, code the actual numbers of those
involved starting with the lowes number. Up till three
persons/agencies are allowed.
GH6 20. WAS IT YOURSELF OR OTHERS WHO MEANT YOU SHOULD
GO TO THE HOSPITAL THIS TIME?
1. It was completely my own idea
2. others
3. both myself and others
8. Irrelevant
9. Don't know
0. No answer
Note:
IF "COMPLETELY MY OWN IDEA" IS ANSWERED, JUMP
TO Q. 23, AND SKIP Q. 21 and 22.
GH7 21. WHO EXACTLY WERE THOSE OTHERS?
ME5
ILC2 1. Close family (spouse/children/parents)
2. Other family
3. Police
4. Friend(s), Neighbor(s), Fellowworker(s)
5. Therapist(s), Health care worker(s), Socialworker
6. Somebody else
8. Irrelevant
9. Don't know
0. No answer
In case of combinations, code the actual numbers of those
involved starting with the lowest number. Up till three
persons/agencies are allowed.
GH8 22. EVEN IF THERE WERE OTHERS WHO MEANT YOU SHOULD
COME HERE NOW, DID YOU YOURSELF AGREE THAT YOU
SHOULD GO?
1. Yes
2. No
8. irrelevant
9. Don't know
0. No answer
GH9 23. SO, THIS TIME YOU CAME HERE TO THE HOSPITAL:
ILC4 AGAINST YOUR OWN WILL/INVOLUNTARILY/ON YOUR OWN
ME3 REQUEST/VOLUNTARILY? (Choose the proper
RKH2 alternative according to what the patient has
answered so far)
1. against own will/involuntarily committed
2. at own request/voluntarily admitted
3. Neither (indifferent)
9. Don't know
0. No answer
Notes:
GH10 24 A. THE OTHERS (GIVE NAMES IF POSSIBLE) WHO SAID
YOU HAD TO GO TO THE HOSPITAL, DID THEY SAY
WHY YOU HAD TO GO?
1. Yes
2. No
8. Irrelevant, (completely patients own idea)
9. Don't know
0. No answer
24 B. IF "OTHERS" GAVE A REASON, WHAT WAS
MENTIONED?
State reasons here:
8. Irrelevant
9. Don't know
0. No answer
RKH1 25. IN YOUR OPINION, WHY WERE YOU ADMITTED TO THE
HOSPITAL?
State reason(s) here:
8. Irrelevant
9. Don't know
0. No answer
RKH5 26. DO YOU THINK IT WAS NECESSARY THAT YOU WERE
ADMITTED AT THE TIME IT HAPPENED?
1. Yes
2. No
9. Don't know
0. No answer
RKH8 27 A. WOULD YOU HAVE PREFERRED ANY OTHER KIND OF
ILC8 HELP OR TREATMENTTHAN BEING ADMITTED TO THIS
ILC18 WARD/HOSPITAL?
1. Yes (GO TO 27.B)
2. No (GO TO 27 C)
9. Don't know
0. No answer
27 B. IF YES, COULD YOU EVENTUALLY SPECIFY WHAT
KIND OF HELP OR TREATMENT?
1. Out-patient treatment (psychotherapy)
2. Medication (as an out-patient)
3. Sickness certification
4. Support from family
5. Support from public agencies
6. Other (please specify):
8. Irrelevant
9. Do not know
0. No answer
In case of combinations, code the actual numbers of those
involved starting with the lowes number. Up till three
persons/agencies are allowed.
27 C. IF NO, DOES THAT MEAN THAT YOU MEAN THAT YOU
DID NOT NEED ANY TREATMENT AT ALL OR THAT IT
WAS OK TO GO TO THIS WARD/HOSPITAL?
1. I did not need any treatment
2. I think it was ok to go here
8. Irrelevant
9. Don't know
0. No answer
NEW 28. DID YOU EVER FEEL OFFENDED DURING THE ADMISSION
PROCEDURES?
1. Yes
2. No
9. Don't know
0. No answer
GH22 29. IS IT THE FIRST TIME YOU HAVE BEEN ADMITTED OR
HAVE YOU BEEN ADMITTED TO A MENTAL HOSPITAL
(WARD) BEFORE?
1. First time this or other hospitals
2. First time this hospital, but has been
admitted to another hospital before
3. I have been admitted to this hospital before
9. Don't know
0. No answer
ME4 30. IF YOU WERE ADMITTED BEFORE, WAS IT ONCE OR MORE
INVOLUNTARY (AGAINST YOUR OWN WILL/A CIVIL
COMMITMENT)?
1. Against own will/involuntarily committed
2. At own request/voluntarily admitted
3. Neither (indifferent)
8. Irrelevant
9. Don't know
0. No answer
GH23 31. DO YOU WANT TO BE DISCHARGED FROM THE HOSPITAL
NOW?
1. Yes
2. No
9. Don't know
0. No answer
GH24 32 A. EVEN THOUGH YOU SAID YOU WANTED TO STAY/YOU
ME19 SAID YOU WANTED TO BE DISCHARGED (Choose the
proper alternative depending on what is
answered above), (BUT) ARE YOU ABLE TO LEAVE
WHENEVER YOU WANT, OR DO YOU FIRSTHAVE TO ASK
SOMEBODY'S PERMISSION?
1. I can leave whenever I want (GO TO 33)
2. I must ask for permission (GO TO 32 B)
9. Don't know
0. No answer
32 B. YOU SAID THAT YOU MUST ASK FOR PERMISSION IF
YOU WANT TO GO HOME/BE DISCHARGED, DOES THAT
MEAN THAT YOU CAN NOT DECIDE YOURSELF IN THIS
MATTER, OR CAN YOU MAKE THIS DECISION ON YOUR
OWN, EVEN IF YOU THINK IT IS RIGHT TO ASK
SOMEBODY FIRST?
1. I can decide myself
2. I can not decide myself
8. Irrelevant
9. Don't know
0. No answer
ME19 33. SO THIS MEANS THAT YOUR STAY HERE AT THE
HOSPITAL NOW IS VOLUNTARY/INVOLUNTARY (Choose
the proper alternative according to what the
patient answered in question 32 A OR B)
1. Against own will/involuntarily committed
2. At own request/voluntarily admitted
3. Neither (indifferent)
9. Don't know
0. No answer
Notes:
ILC105 34. HAS IT HAPPENED THAT YOU HAVE BEEN DENIED TO
ME63,64 GO OUTSIDE THE WARD OR BEEN SUBJECTED TO
OTHER RESTRICTIONS REGARDING YOUR PERSONAL
LIBERTY TO GO WHEREVER YOU WANT? (PRESENT STAY).
1. Yes
2. No
9. Don't know
0. No answer
ME7 35. AS YOU REGARD THE SITUATION RIGHT NOW, DO YOU
THINK IT WAS GOOD FOR YOU THAT YOU WERE ADMITTED
TO THIS WARD/HOSPITAL?
1. Yes
2. No
9. Don't know
0. No answer
36. ADMISSIONS TO MENTAL HEALTH CARE INSTITUTIONS
When a person gets admitted to a mental hospital or ward, different things will be of importance in each case. In some cases a lot of pressure and even physical force is used when a person is admitted, while in other cases patients come to the ward totally at their own will.
If you think of your own admission to this hospital this time, try to consider if you were subjected to any kind of coercion, threats, pressure, persuasion or inducements. Then try to figure what step on the ladder below that best corresponds to the amount of pressure from others that you experienced when you were admitted, and mark this step with an X. For instance, if you came entirely on your own initiative, you put an X on step 1, but if you were subjected to the maximum use of coercion, then you put the X on step 10.
10 MAXIMUM USE OF COERCION
9
8
7
6
5
4
3
2
1 MINIMUM USE OF COERCION
(I CAME TOTALLY AT MY OWN WILL AND INITIATIVE)
FINALLY I WOULD LIKE TO HEAR YOUR OPINION ABOUT FOUR STATEMENTS I AM GOING TO READ TO YOU. IF YOU THINK OF WHAT HAPPENED TO YOU WHEN YOU WERE ADMITTED TO THE HOSPITAL, PLEASE TELL IF THE FOLLOWING STATEMENTS ARE TRUE OR FALSE IN YOUR CASE.
(PUT A CIRCLE AROUND WHAT IS ANSWERED BY THE RESPONDENT)
37. I HAD ENOUGH OF A CHANCE TO SAY WHETHER I
WANTED TO COME INTO THE HOSPITAL TRUE FALSE
(DID YOU HAVE ENOUGH OF A CHANCE TO SAY
WHETHER YOU WANTED TO COME INTO THE HOSPITAL? YES NO)
38. I GOT TO SAY WHAT I WANTED ABOUT COMING
TO THE HOSPITAL TRUE FALSE
(DID YOU GET TO SAY WHAT YOU WANTED ABOUT
COMING TO THE HOSPITAL? YES NO)
39. NO ONE SEEMED TO WANT TO KNOW WHETHER I
WANTED TO COME INTO THE HOSPITAL TRUE FALSE
(DID ANYBODY SEEM TO WANT TO KNOW WHETHER
YOU WANTED TO COME INTO THE HOSPITAL? YES NO)
40. MY OPINION ABOUT COMING INTO THE
HOSPITAL DIDN'T MATTER TRUE FALSE
(DID YOUR OPINION ABOUT COMING INTO THE
HOSPITAL MATTER? YES NO)
41. BPRS SCORE: 42. GAF SCORE:
PATERNALISM AND AUTONOMY
A NORDIC STUDY ON COERCION
IN THE MENTAL HEALTH CARE SYSTEM
CORE INTERVIEW
ON PERCEIVED COERCION:
MANUAL
VERSION 14.11.96
The following guidelines and instructions should be applied to as strict as possible. In cases where you are in doubt how to score the actual answer, please make a short note explaining the problem and how it has been solved. Only questions representing potential coding problems are included in the manual.
General rules:
Code 8 is used whenever the question is irrelevant
Code 9 is used whenever the patients answers "Don't know"
Code 0 is used when the patient do not answer at all.
When the instruction tells to jump (a) question(s), code 8 (irrelevant) for the question(s) jumped.
Always record exactly what the patient answers. (Even if you know it is not true)
Note that some instructions are included in the questionnaire.
The individual questions:
2. Running number It is recommended to choose different series
applying to different institutions within
each country
3. Admission date The official date recorded by the institution
4 B. Age The age of the patient at the time of the
interview
6. Hospital Apply a unique code for each institution in
each country
7. Ward Make sure that the ward "name"
(symbol/figure) is unique to every ward
8. Ward size The officially approved number of beds
should be recorded. If no official number
exists, record the actual number
9. Type of ward 1 Problems may arise because different
countries have different ward categories.
The proposed categories are partially self- explaining. "Mixed" means sub-acute,
relatively short-stay wards (patients
needing more care than acute short-stay
patients). "Security" means ward designed
for specially dangerous patients (can be
both forensic and civil patients).
If none of the suggested categories fit,
code "Others" and specify.
10. Type of ward 2 "Mixed" means a ward which is sometimes
locked and sometimes open. Some wards are
separated into a locked section and an open
sections; if the patient is staying in the
locked section, code "Locked", and if
staying in the open section, code "Open"
11-15 Present medication Only psychopharmaca (and drugs given as a
consequence of the psychopharmaca applied,
like drugs aiming at relieving side
effects) should be recorded. "Minor
tranquilizers" include Buspiron,
Difenylmetans and all Benzodiazepins
excluding those applied as hypnotics
(Nitrazepam, Flunitrazepam and
Midazolam). "Others" may include drugs like
Lithium and psychostimulants.
17. When did you arrive To alternatives are given (Days ago or
date). The patient's answer determines what
alternative to use. If the patient answer x
days ago record x. If a date is answered
record that date.
28. Did you feel offended "Offended" should be understood as
violation of integrity
29. Is this the first.. If necessary, make it clear that the
question concerns all institutions ever,
not only admissions to the actual
ward/institution
31. Do you want.... "Discharged" means to leave the
ward/institution permanently.
32 A. Even though... The scope of the question is to learn the
patient's perception of the right he or
she has to decide for themselves to leave
(permanently) the institution.
34. Has it happened.. Make it clear that the question concerns
the present stay only.
35. As you regard... The patient's global assessment of
personal cost/benefit regarding the
present admission
36. The Cantril ladder The ladder shall be shown to the patient.
Preferably the patients shall mark the
actual step themselves, but it is OK that
the interviewer makes the mark after the
patient has stated a step. If the patient
wants to answer, but is unable to decide,
score 99 (Don't know). If the patient
refuses to score or is passive/indifferent
then score 00 apply (No answer).
It is important that the ladder is kept in
it's original shape, that is: upright and
with open ends. The scale and positioning
of numbers should also be kept as in
the original.
The introductory text should be read to
the patient word by word.
37-40 Read the introductory lines to the patient
word by word. The read every statement,
and ask the patient after each statement
if he or she thinks that this is true
or false in his or hers case.
If the patient finds it difficult to
relate to the statements then the
statements can be reformulated into
questions and be answered by yes/no as
indicated in the parenthesis below each
statement.
IMPORTANT: If the questions are used
instead of the statements, note that in
questions 38 and 39, "Yes" equals "False"
and "No" equals "True".