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Background: Coercion can cause harm to both the patient and the patient's family. Few studies have examined how the coercive treatment of a close relative might affect young next-of-kin., Research Questions: We aimed to investigate the views and experiences of health professionals being responsible for supporting young next-of-kin to patients in mental health care (children-responsible staff) in relation to the needs of these young next-of-kin in coercive situations and to identify ethical challenges., Research Design: We conducted a qualitative study based on semistructured, focus group interviews and an individual interview., Participants and Research Context: We held three focus group interviews with six to seven children-responsible staff in each group (a total of 20 participants) and one individual interview with a family therapist. The participants were recruited from three hospital trusts in the eastern part of Norway., Ethical Considerations: The study was approved by the National Data Protection Official for Research and based on informed consent and confidentiality., Findings: Coercion was not a theme among the participants in relation to their work with young next-of-kin, and there was much uncertainty related to whether these young people need special support to deal with the coercive treatment of their close relative. Despite the uncertainty, the study indicated a need for more information and emotional support among the youth., Discussion: Few studies have addressed the potential impact of coercive treatment of a close family member on young next-of-kin. The findings were consistent with existing research but highlighted disagreement and uncertainty among the children-responsible staff about to what extent the young next-of-kin should visit and whether they should enter the ward unit or not. We identified ethical challenges for the children-responsible staff related to the principle of not inflicting harm ( nonmaleficence )., Conclusion: From the perspective of children-responsible staff, it appears that the coercive treatment of a close family member entails a need for extra support of young relatives both in relation to information and the facilitation of visits, but more systematic knowledge about these issues is needed.

Background:: Young next of kin to patients with mental health problems are faced with many challenges. It is important to focus on the special needs of children and adolescents as next of kin to ensure their welfare and prevent harm., Research Questions:: We aimed to investigate young next of kin's need for information and involvement, to examine the ways they cope with situations involving coercion related to the treatment of their relative, and to identify ethical challenges., Research Design:: We conducted a qualitative study based on semi-structured, individual interviews., Participants and Research Context:: Seven young next of kin aged 14-22 years participated in the study. The informants were recruited from a regional hospital trust in Norway., Ethical Considerations:: The study was approved by the National Data Protection Official for Research and based upon informed consent and confidentiality., Findings:: The adolescents wanted more information and described a need for increased interaction with their sick relative at the hospital. They struggled to keep their relationship with their relative intact, and they described communication problems in the family. Coercive treatment was perceived in a negative way., Discussion:: The study finds that there are ethical challenges at stake for young next of kin and their families other than those that are often emphasized by traditional healthcare, which often focuses on the individual patient's rights. These challenges are related to the young next of kin's needs for interconnectedness and for the preservation of relationships as well as challenges related to family communication and the need for information., Conclusion:: The study finds a need for more family-oriented perspectives in both mental healthcare practices and healthcare ethics.

Background: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients' moral evaluations of coercion., Aim: The purpose of this study is to increase understanding of patients' moral views and considerations regarding coercion., Research Design: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012-2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured., Findings: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice., Discussion: The participants' views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion., Conclusion: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded 'grey zone articles', in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients' and caregivers' views on ethical challenges, is presented., (© The Author(s) 2014.)