An eight country European study has found that
caregivers are generally happy with the treatment given to their
loved ones who have been admitted to hospital against their
The findings contrast with smaller studies,
which have found high levels of dissatisfaction, with carers and
patients unhappy with the information and guidance they were given,
and particularly critical of their lack of involvement in treatment
decisions and discharge planning.
was carried out as part of the European Evaluation of Coercion in
Psychiatry and Harmonisation of Best Clinical Practice (EUNOMIA) in
Bulgaria, Czech Republic, Germany, Greece, Italy, Poland, Slovakia
It consisted of 336 patients and 336
caregivers; just over 56% of the patients were male and the average
age was just under 39; two thirds of the patients involved had been
admitted to psychiatric hospital before.
Of the caregivers, 62% were women with an
average age of 51; 46.4% were parents; 30.4% were spouses; 10.7%
siblings and 7.1% sons or daughters. The remainder were another
relation, such as a grandparent, aunt or uncle, or a friend.
Patients were recruited from between one and
five hospitals per country and the interviews were carried out at
the time of the admission and four weeks after by a team
independent of those giving treatment.
Participants rated their views of the
treatment using a seven item Clinical Assessment of Treatment
scale, with the caregiver questionnaire modified slightly to
capture their views more effectively. The average approval score
for caregivers was 8.5 (out of 10), with an average score of
7.7 for patients.
Out of seven questions, the highest ranking
score for caregivers was for the question: ‘Do you believe your
relative is receiving the right medication?’ and the lowest score
was for the question ‘Do you believe his/her relations with other
staff members are pleasant or unpleasant for him/her?’
For patients, the highest score was in
response to the question: ‘Are relations with staff members
pleasant/unpleasant for you?’; the lowest score was for ‘Do you
believe you are receiving the right medication?’
The research found that when patients showed a
favourable symptom change after four weeks, caregivers tended to
have a more positive view of their treatment.
The researchers conclude that higher
caregivers’ satisfaction is related to the success of the
treatment. Improving information and support for caregivers should
help clinicians to better engage with caregivers.
They say: “The findings suggest that
caregivers actually have a ‘point’ when appraising the patients’
hospital treatment. Taking into consideration the views of
caregivers about the quality of treatment that involuntary patients
receive in hospital – and taking those views seriously – might
therefore be not only an ethical requirement and a move to involve
caregivers as requested by mental health policies, but also reveal
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Caregivers’ appraisals of patients’ involuntary hospital treatment: European multicentre study. Giacco D, Fiorillo A, Del Vecchio V, Kallert K, Onchev G, Raboch J, Mastrogianni A, Nawka A, Hadrys T, Kjellin L, Luciano M, De Rosa C, Maj M and Priebe S. The British Journal of Psychiatry, 2012, epub ahead of print, 25 October 2012