Frederik Alkier Gildberg

• Ph.D., Professor in Forensic Mental Health
• Professor at University of Southern Denmark

Question Evidence on the likelihood of receiving rapid tranquillisation (RT) across ethnic groups is mixed, with some studies suggesting that ethnic minorities are more likely to receive RT than others. We aimed to investigate the association between ethnicity and RT use in adult mental health inpatient settings and to explore explanations for RT u...

Background: Although hotly disputed, coercive measures are widely used in mental health services globally. In Denmark, to ensure the rights of patients, special psychiatric legislation that emphasizes the imperative to always use the least intrusive intervention has been implemented. This raises the question of which coercive measures are perceive...

Introduction: Even if coercive measures are widely applied in psychiatry and have numerous well-known drawbacks, there is limited known on the agreement among mental healthcare professionals' opinions on their use. In a questionnaire study using standardized scenarios, we investigated variation in staff opinions on coercion. Methods: In a web-ba...

Purpose: To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. Methods: We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use...

In forensic mental health care (FMHC), family caregivers perceive themselves as burdened in their relationships with the service user (the family member with mental illness) and by difficult collaboration with healthcare professionals (HCPs). There is a political objective to involve this group in the care and treatment of the service user in menta...

Mechanical restraint is a commonly used restrictive practice worldwide, although reducing its use is an international priority. Interventions to reduce mechanical restraint are needed if reducing mechanical restraint is to succeed. Therefore, this systematic review aimed to examine evaluated evidence‐based interventions that seek to reduce the inci...

Background: Models are central to the acquisition and organisation of scientific knowledge. They can be viewed as tools for interpretive description as well as cognitive representations of an empirical phenomenon. However, discussions about how to develop models in qualitative research - particularly in the literature on thematic analysis - are sp...

Rapid tranquillization is a restrictive practice that remains widely used in mental health inpatient settings worldwide. Nurses are the professionals most likely to administer rapid tranquillization in mental health settings. To improve mental health practices, an enhanced understanding of their clinical decision-making when using rapid tranquilliz...

Background: Models are central to the acquisition and organisation of scientific knowledge. However, there are few explanations of how to develop models in qualitative research, particularly in terms of thematic analysis. Aim: To describe a new technique for scientific qualitative modelling: the Empirical Testing Thematic Analysis (ETTA). Part 2...

Introduction: There is a lack of research about experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. Research shows that caregivers are burdened. Further knowledge is required, to provide a foundation for improving clinical practice. Aim: To review research literatur...

There has been an international surge towards online, digital, and telehealth mental health services, further amplified during COVID‐19. Implementation and integration of technological innovations, including artificial intelligence (AI), have increased with the intention to improve clinical, governance, and administrative decision‐making. Mental he...

Purpose To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. Methods A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and S...

Objective Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. Methods For coercive ep...

Grey literature complementing evidence from common scientific sources, such as journals, may serve to provide a broader range of evidence, fill in commercial literature gaps and reduce publication bias in research. However, grey literature from legal sources has been used only to a limited extent in forensic mental health research. In this paper, w...

Introduction Previous studies have found substantial weight gains in forensic mental health patients (FMHP) during hospitalisation. However, previous studies have not compared in- and outpatients, thus the weight change could be a general change over time. Research on the association between proportional hospitalization time (PHT) and weight change...

The purpose of this study was to explore the experiences and perceptions of parents in forensic mental health services with regard to their cooperation with healthcare professionals and their role as parent carers. 15 participants were interviewed using qualitative, in-depth interviews and transcripts were analysed thematically. The identified them...

Introduction: People with mental disorders have higher mortality from lifestyle diseases than the general population. Forensic mental health patients (FMHPs) are often hospitalised for longer periods of time than non-FMHPs. Thus, hospitalisation may have a greater effect on the risk of lifestyle diseases in FMHPs. Objective: Investigate associat...

Despite the fact that eating disorders (EDs) are conditions that are potentially life-threatening, many people decline treatment. The aim of this study was to investigate why women decline specialized ED treatment, including their viewpoints on treatment services. Eighteen semi-structured qualitative interviews were conducted with women who had dec...

The aim is to investigate how psychiatric patients and psychiatric staff experience the application of different types of coercive measures in order to examine and identify the coercive measures which in general and in relation to specific patient and staff characteristics are least intrusive (cf. the Danish law Psychiatry Act and the 'least-intrus...

Internationally, clinical services are under pressure to reduce their use of restrictive practices. The aim was to explore how mental health nurses and nursing assistants perceive conflict and their use of restrictive practices with mental health inpatients in forensic mental health care. A total of 24 semi-structured interviews with forensic menta...

Studies show that oral health of persons with severe mental illnesses (SMI), including schizophrenia, is poor compared to the oral health of the general population. The aim of the study is to explore how adults with schizophrenia experience being met by healthcare professionals in relation to oral health challenges. 23 adults with schizophrenia wer...

Studies show that oral health of persons with severe mental illnesses (SMI), including schizophrenia, is poor compared to the oral health of the general population. The aim of the study is to explore how adults with schizophrenia experience being met by healthcare profes�sionals in relation to oral health challenges. 23 adults with schizophrenia we...

Dette kapitel vil introducere læseren til begrebet personcentreret omsorg og sætte begrebet i forhold til en klinisk psykiatrisk sygeplejepraksis. Til dette formål vil vi udforske en række tilgange og praksisser. Læseren vil blive opmuntret til at overveje de tilgængelige teoretiske referencerammer til at underbygge det, at patienten sættes i centr...

The aim of this study was to investigate the experiences of patients and providers regarding the use of videoconferences in older patients with depression. The qualitative study consisted of semi-structured interviews with patients and providers and focus group interviews with providers. Themes were identified through using thematic analysis. Three...

Introduction: People with mental disorders have increased risk of dying from diabetes and cardiovascular diseases, both of which can be prevented by lifestyle. Aim: To review existing research, in order to investigate the characteristics of, and factors that influence forensic mental health service users' (FMU) health behaviours. Method: We se...

This paper compares legislation on clinical research conducted on patients subject to coercion in the Scandinavian countries and the UK, examines it from a human rights perspective, and problematizes the Danish legal model as the only one employing a total ban on this kind of research. Reference is made to the consequences to evidence-based psychia...

Introduction: Depression is the leading cause of mental illness among an aging population and fewer than half of those who are affected receive treatment. There is an increased need for alternative ways of treating patients; the use of video consultations has been shown to be a viable option for delivering mental health care. However, none of the...

Results from the construct validation of MR-CRAS within 13 forensic psychiatric inpatient units in Denmark

This poster represents the results of the face validation, the content validation and the pilot testing of MR-CRAS

Aim: To investigate whether there is a correlation between age and satisfaction with the use of videoconferences (VCs) and whether the number of video sessions had an impact on satisfaction. Methods: This study was a subanalysis of the joint European project, MasterMind, and participants were recruited from15 pilot studies in 11 different countrie...

The specific objective were to construct validate whether scores in the three MR-CRAS subscales; confounder, risk and paramenters of alliance, were an adequate reflection of its content domains and determine the final domains of MR-CRAS, and evaluate the use of MR-CRAS and determine the need for revisions of the checklist and its user manual

Aim: To evaluate whether there was a difference in satisfaction scores between providers and patients in the use of videoconferences (VCs) by depressed adults. Method: This study was a subanalysis of the joint European project, MasterMind, and participants were recruited from 15 pilot studies in 11 different countries. The Client Satisfaction Quest...

Ethnic minority patients are overrepresented in Danish forensic psychiatry and knowledge is needed on how these patients are approached in relation to religious and cultural issues. The aim of this study was to investigate how psychiatrists in Danish forensic psychiatry approach religious ethnic minority patients. The study revealed positive approa...

This article presents the findings of an empirical research project on how psychiatrists in a secular country (Denmark) approach the religious patients, and how the individual worldview of the psychiatrist influences this approach. The study is based on 22 interviews with certified psychiatrists or physicians in psychiatric residency. The article p...

Background: A new short-term risk assessment instrument, the Mechanical Restraint – Confounders, Risk, Alliance Score (MR – CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists’ etc., and shows evidence of being comprehensible, relevant, comp...

Introduction: Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits th...

Objective: Retrieving the qualitative literature can be challenging, but the number and specific choice of databases are key factors. The aim of the present study is to provide guidance for the choice of databases for retrieving qualitative health research. Study design and setting: Seventy-one qualitative systematic reviews, from the Cochrane D...

The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance, constituted separate subscales and needed further revisions. Materials and methods: MR – CRAS was field-study tested among nurses, nurse assistants and social and healthcare assistants in 13 Danish closed forensic mental health inpatient u...

This thesis addresses the development and validation of the short-term risk assessment instrument – Mechanical Restraint – Confounder, Risk, Alliance Score (MR – CRAS), for use during MR to observe and assess the forensic mental health (FMH) inpatients’ readiness to be released from MR. This instrument development study spans from conceptual devel...

To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence‐based patient care, we need more knowledge about patients’ subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients’ perceptions of situations associated with the use of mechanical restraint and what they perceive...

Background: The use of physical coercive measures, e.g. mechanical restraint (MR), in mental health care, is a major infringement on the psychiatric patient’s autonomy. MR can cause physical and mental harm but may be necessary to avoid putting an individual’s health at risk. The nursing staff is tasked with protecting the life and health of, not o...

Forensic mental health care is faced with serious problems in the recruitment and retention of newly graduated nurses (NGNs). Research into NGNs' experiences of their transition to and evaluations of transition programs in forensic care is sparse, and more studies are called for. This study aimed to investigate the characteristics of NGNs' experien...

Postsecular theory is developing in academic circles, including the psychiatric field. By asking what the postsecular perspective might imply for the secular discipline of psychiatry, the aim of this study was to examine the postsecular perspective in relation to the secular nature of psychiatry, by way of a narrative review. In a systematic search...

This project focusses on the development of a clinically and psychometrically validation of a new short-term risk assessment instrument: Mechanical Restraint - Confounder, Risk, Alliance Score (MR-CRAS) among forensic psychiatric clinicians

Introduction: There is a lack of research into psychiatric patients' perceptions of coercion that discriminates between different types of coercive measures, while also investigating patients' perceptions of undergoing coercion as a process. This knowledge is required to improve our understanding and provide a foundation for improving clinical pra...

Background: Unstructured risk assessment, as well as confounders (underlying reasons for the patient's risk behaviour and alliance), risk behaviour, and parameters of alliance, have been identified as factors that prolong the duration of mechanical restraint among forensic mental health inpatients. Aim: To clinically validate a new, structured s...

One of the main reasons for prolonged duration of mechanical restraint is patient behaviour in relation to the clinician-patient alliance. This article reports on the forensic mental health clinicians experiences of the clinician-patient alliance during mechanical restraint, and their assessment of parameters of alliance regarding the patient's rea...

Results of the face validation, content validation and pilot testing of MR-CRAS

The development and clinical validation of MR-CRAS among forensic psychiatric clinicians

According to research literature, humor inside the staff-patient interaction seems to be significant in the area of forensic mental healthcare. However, existing literature on the subject is limited. Therefore, the aim of this study was to explore the characteristics of the use humor by forensic mental health staff members in interactions with fore...

Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular...

Text analysis is not a question of a right or wrong way to go about it, but a question of different traditions. These tend to not only give answers to how to conduct an analysis, but also to provide the answer as to why it is conducted in the way that it is. The problem however may be that the link between tradition and tool is unclear. The main ob...

Evidence suggests the prevalence and duration of mechanical restraint are particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of, prolonged use of mechanical restraint in forensic psychiatry. This study therefore aimed to investigate prolonged episodes of mech...

Background: Newly qualified nurses experience a stressful transition into mental health nursing, but research shows that transition programs meet many of the challenges. Research on transition into mental health nursing that includes experienced nurses and health care assistants seems sparse. Aim: To investigate how newly employed nursing staff ex...

Research on experiences of transition into mental health-care roles seems sparse, but it is vital in order to produce a comprehensive understanding of the transition into mental health-care roles and to serve as a foundation for future research and development. The aim of the present study was to review existing research literature, and in doing so...

Humor utilized in the practice of forensic mental health nursing might seem somehow inappropriate, given the serious circumstances surrounding most forensic mental health patients. However, some recent research has pointed to the use of humor as an important component in staff interactions with forensic mental health patients. This study reviews th...

This article reports on and compares two separate studies of the interactional characteristics of forensic mental health staff and acute mental health staff as they interact with inpatients, respectively. Both studies were conducted using participant observation, along with informal and formal interviews. Findings show that both acute and forensic...

Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic...

Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic...

In Denmark the increasing number of forensic mental health patients has led to prioritized services, including the area of nursing; however, this field is subject to sparse research. The aim of this study was to review existing research literature and in doing so investigate what characterizes forensic mental health staff interaction with forensic...

Reflecting only on the use of method involves the risk of reducing science to the use of tools, such as interviews, questionnaires or participant observations. In doing this there is a risk of overlooking the underlying epistemologies and methodological considerations, which are pivotal in understanding and assessing qualitative research. The aim o...