Journal of Psychiatric and Mental Health Nursing, 2010, 17, 846–848





Submission address:

Liam Clarke

School of Nursing and Midwifery, University of
Brighton, Robert Dodd Building, 49 Darley Road,
Eastbourne, BN20 7UR, UK

Prevention of coercion in public
mental health care with family
group conferencing
Roskes (2009) states that the most important area
for future study is if coercive interventions are effective in changing a person’s life course. Given the
steadily rising rates of compulsory treatment and
involuntary admission (De Stefano & Ducci 2008)
and the damage this may do in terms of negative
experiences for patients and the reduction of their
autonomy (O’Brien & Golding 2003, Katsakou
et al. 2010), we point out that the most important
area for future study is the prevention of coercion.
The study of Van der Post et al. (2009) sheds
light on factors associated with the decision to
admit patients compulsorily to psychiatric services.
Remarkable findings were that ‘physicians were
more inclined to decide on compulsory admission
for patients with a history of compulsory admission
than for those without’ (p. 1545), and that ‘patients
who received more intensive outpatient treatment
in the year before the consultation were less likely
to have an emergency compulsory admission’ (p.
1545). The authors conclude their report with following statement: ‘to test the hypothesis that outpatient treatment indeed has a preventive effect on
compulsory admission, intervention studies are a
necessary next step’ (p. 1546).

Family group conferencing in public mental
health care
Since September 2009 we are researching the applicability of the concept of family group conferencing
(FGC) in the public mental health care (PMHC),
as a tool to mobilize resources, reduce stigma and
prevent coercion.
Conflict of interest
There or no conflicts of interests to be reported.


The PMHC serves as a safety net and deals with
activities in mental health that are not guided by a
voluntary, individual demand for aid. Core of the
PMHC is to help in spite of a lack of active cooperation of the person (or persons). PMHC clients
often lack the supports of a vital social network.
The target group of the PMHC is a group that does
not benefit from mutual commitment. Clients in
PMHC (Schout et al. 2010):
1 are not or not sufficiently able to provide in their
own living conditions: shelter, food, income,
social contacts, personal care, etc.;
2 have several problems simultaneously, including
lack of personal care, social isolation, unhygienic
living circumstances, lack of a permanent stable
home environment, debts, mental problems and
addiction problems;
3 do not – from the perspective of the care system
– receive the care they need in order to remain
independent in society;
4 do not have a demand for help – family, neighbours and bystanders often ask for help – so there
is unwanted interference or assistance.
Since the nineties, FGC is implemented in the youth
care system of divergent countries (Burford &
Hudson 2000). FGC was developed in New Zealand
as an attempt to give voice to Maori families in order
to prevent outplacements of their children. FGC is an
approach that tries to combine the formal system of
the government and care agencies with the informal
system of the family and their social network, so that
both systems have access to each other’s information
and the best decision can be made (Dalrymple 2002).
Here, ‘decision making is the responsibility of the
family, while the state provides appropriate services
and facilitates the decision-making process’ (Dalrymple 2002, p. 288). FGCs enable families to cope
with problems in a manner that is more consistent
with their own culture, lifestyle and history (Jackson
& Morris 1999). Unlike traditional approaches that
are often ‘family-centred’, a FGC is ‘family-driven’
(Merkel-Holguin 2004, p. 164). In other words, the
© 2010 Blackwell Publishing

but achieves results through the contributions of the family. and (3) the coordinator joins the group again so the group can agree about the definite plan.). Interim findings from our research brought to surface that there are good reasons to start experimenting with FGC in the PMHC (see: De Jong & Schout.. (2009) emphasized necessity of intervention programmes to prevent coercion.d. In other cases. the conference will be planned.. Aldine de Gruyter. Often a further deterioration of a problematic situation within the family. friends and neighbours requests for different forms and stages of coercion like conditional assistance. Crampton 2007.. In here. The coordinator ensures that the right people are invited (divergent significant others can be invited too. this programme has a practical emphasis on increasing support from the network and combating isolation. Wright 2008). Hayes & Houston 2007). we did not find any reports about the use of FGC in a public mental health setting. an independent coordinator will be asked to organize a conference (Macgowan & Pennell 2002. friends and lecturers). A FGC provides © 2010 Blackwell Publishing them structure they cannot develop themselves – it creates thresholds to chaotic behaviour. his family. the UK. & Hudson J. New Directions in Community-Centered Child & Family Practice.) Family Group Conferences in public mental health care: an exploration of oppor- 847 . any care provider(s) being present]. a community mental healthcare practice introduced FGC at the beginning of this century (Mirsky 2003. as described in the literature about FGC. Child Welfare 87. n. G. such as neighbours. a bipolar disorder or a personality disorder. let alone studies in a more specific field like the PMHC. 2009). (2008) Does Family Group Decision Making affect child welfare outcomes? Findings from a randomized control study.C. In an ideal scenario. After the conference. the care provider could be designated as the actor who will monitor and evaluate the plan (Berzin et al. De Jong D. Crampton D. (2002) Family Group Conferences and youth advocacy: the participation of children and young people in family decision making. 202–209. et al. (2) the second phase starts when the coordinator and care provider(s) withdraw from the group so the family has the opportunity to discuss and come to a plan in private time. especially in the prevention of coercion. Burford G. can be averted with the help of FGC (O’Shaughnessy et al. 995): (1) sharing and discussing the essential information with all actors [including the client. In addition. With the help of family members. the plan and its goals need to be established. Besides the practice in Essex. it is normally a care provider who informs the client about FGC and its possibilities (Crampton 2007).. 2008). Future research needs to verify if this is tenable. The conference consists of three phases (Hayes & Houston 2007. 287–299. DE JONG MSc Researcher Registered Nurse Department of Lifelong Learning University of Groningen Groningen The Netherlands G. it is the family who is responsible for the implementation of the plan. It is offered especially to adults who suffer from schizophrenia. New York. FGCs are especially valuable for clients who suffer from personality disorders and therefore often live in chaotic circumstances. (2007) Research review: Family Group Decision-Making: a promising practice in need of more programme theory and research. Dalrymple J. Thomas K. Child and Family Social Work 12. eds (2000) Family Group Conferencing. p. Because of lack of knowledge about its existence. community treatment order. Once an agreement between the client. Cohen E. or an outplacement. discrimination and stigma (Mirsky 2003). his family and the care provider is reached. European Journal of Social Work 5. The tapping and mobilizing of resources. Preventing coercion through FGC? An extended literature search revealed that studies on the applicability of FGC in mental health are scarce. and involuntary admission can be averted or postponed. & Schout G. According to the developers. he tries to find the right balance between supporting the agenda and paying notice to the wishes of their clients. 35–54. could be seen as an elaboration of outpatient treatment and could therefore play a key role in the by Van der Post et al. (n.Commentary approach is not aimed at the family. SCHOUT PhD Professor Registered Nurse School of Nursing Hanze University of Applied Sciences Groningen The Netherlands References Berzin S. In the county of Essex.d.

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