ABSTRACT

Background and aims. Improving care for people in crisis remains high on the UK government agenda. Trauma-informed approaches (TIAs) have been advocated to address concerns raised about psychiatric hospital services by service-users, particularly around the use of coercion in risk management. This study explores service-users’ experiences of risk management in both hospital services and a trauma-informed crisis house.

Methods. Eight women were interviewed using a semi-structured interview schedule. Interviews were transcribed and analysed using thematic analysis within a critical realist framework.

Results and discussion. Four themes were developed. In the first two (‘The Medical-Custodial Approach: They Only Think About Physical Safety‘ and ‘Coercion is Counterproductive‘) participants described hospital as being dominated by a medical-custodial approach, which they said was ineffective in managing long term safety and could exacerbate distress. In the next two themes (’Talking Heals’ and ’Relationships as Risk Management’) the crisis house was described as using a relational approach to risk management that enabled women to maintain some freedom, privacy and control and was felt to be more effective long term. This research was carried out with a small sample and both recruitment and context likely privileged positive accounts of TIAs. Clinical implications and areas for further research are discussed.

摘要

背景和目标。改善对处于危机中的人的护理仍然是英国政府议程上的重中之重。已经提倡使用创伤知情方法 (TIA) 来解决服务使用者对精神病院服务提出的担忧，特别是在风险管理中使用强制措施。本研究探讨了服务用户在医院服务和创伤知情危机中心的风险管理经验。

方法。八名女性使用半结构化的访谈时间表进行了访谈。在批判现实主义框架内使用主题分析对访谈进行转录和分析。

结果和讨论。开发了四个主题。在前两个（“医疗监护方法：他们只考虑人身安全”和“强制措施适得其反”）中，参与者将医院描述为以医疗监护方法为主，他们说这种方法在管理长期安全方面无效，并且可能会加剧痛苦。在接下来的两个主题（“谈话治愈”和“关系作为风险管理”）中，危机之家被描述为使用关系方法进行风险管理，使女性能够保持一定的自由、隐私和控制权，并被认为更有效学期。这项研究是在小样本的情况下进行的，招募和背景都可能对 TIA 的正面描述有利。讨论了临床意义和进一步研究的领域。