Despite a general consensus against coercive practices in mental healthcare, the results and the sustainability of interventions designed to stop or reduce coercion are still variable. This thesis presents a study that aims to identify potential drivers and barriers to the implementation process of these interventions to better understand the dynamics of the observed variability.
The study applies Extended Normalisation Process Theory (ENPT) across two phases. Firstly, a theory-informed integrative review of primary research on the implementation of coercion reduction interventions in adult inpatient mental health facilities. The data from the included studies were extracted qualitatively and analysed using (ENPT).
The second study Semi-structured interviews informed by ENPT with experts involved in the implementation of coercion reduction intervention (experts by experience and academic and clinical implementation experts). Transcripts were analysed using qualitative content analysis.
Analysis of the 28 implementation studies showed staff resistance, a lack of trust and resources to be barriers and a sense of ownership, and reflexive monitoring acted as drivers to the process. The analysis of the transcript data from 23 participants showed commitment as a driver and adverse problematic embedded cultures as a cause of resistance. Experts by experience played a central role in establishing reflexive practice, which was shown to facilitate positive shifts in culture, and through continuous reflexive monitoring, help achieve sustainability.
The study demonstrates the dynamics of the implementation process and presents how specific factors impact that process. There is a need to consider the implementation process holistically; adequate attention must be given to all stages, in particular to understanding the existing context prior to implementation; and implementation must be supported at all organisational levels.
The adverse context created by problematic cultures and the potential of reflective practice to address these problematic cultures is potentially of general relevance to implementing health care interventions.
