Use of physical restraint is a common practice in mental healthcare, but is controversial due to risk of physical and psychological harm to patients and creating ethical dilemmas for care providers. Post-incident review (PIR), that involve patient and care providers after restraints, have been deployed to prevent harm and to reduce restraint use. However, this intervention has an unclear scientific knowledge base. Thus, the aim of this scoping review was to explore the current knowledge of PIR and to assess to what extent PIR can minimize restraint-related use and harm, support care providers in handling professional and ethical dilemmas, and improve the quality of care in mental healthcare. Systematic searches in the MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Science databases were carried out. The search terms were derived from the population, intervention and settings. Twelve studies were included, six quantitative, four qualitative and two mixed methods. The studies were from Sweden, United Kingdom, Canada and United States. The studies’ design and quality varied, and PIR s’ were conducted differently. Five studies explored PIR s’ as a separate intervention after restraint use, in the other studies, PIR s’ were described as one of several components in restraint reduction programs. Outcomes seemed promising, but no significant outcome were related to using PIR alone. Patients and care providers reported PIR to: 1) be an opportunity to review restraint events, they would not have had otherwise, and 2) promote patients’ personal recovery processes, and 3) stimulate professional reflection on organizational development and care. Scientific literature directly addressing PIR s’ after restraint use is lacking. However, results indicate that PIR may contribute to more professional and ethical practice regarding restraint promotion and the way restraint is executed. The practice of PIR varied, so a specific manual cannot be recommended. More research on PIR use and consequences is needed, especially PIR’s potential to contribute to restraint prevention in mental healthcare.

Stuck in limbo: illicit drug users’ experiences with opioid maintenance treatment and the relation to recovery

Background: Alcohol consumption is deeply integrated in people’s social- and work lives and, thus, constitutes a serious public health challenge. Attitudes toward drinking stand out as important predictors of drinking, but have to date been sparsely studied in employee populations. This study explores the association of employees’ attitudes toward drinking with their alcohol-related problems, and whether this association is moderated by gender and employment sector. Methods: Cross-sectional data were collected from a heterogeneous sample of employees (N = 4094) at 19 Norwegian companies. Drinking attitudes were assessed using the Drinking Norms Scale. The AUDIT (Alcohol Use Disorders Identification Test) scale was then used to assess any alcohol-related problems. Data were analyzed using chi-square tests, analysis of covariance (ANCOVA), and multiple logistic regression. Results: Employees with predominantly positive drinking attitudes were almost three times as likely to report alcohol-related problems compared to employees with more negative drinking attitudes (OR = 2.75; 95% CI: 2.00–3.76). Gender moderated the association between positive drinking attitudes and alcohol-related problems (OR = 3.30; 95% CI: 2.10–5.21). The association was stronger in women (OR = 5.21; 95% CI: 3.34–8.15) than in men (OR = 3.10; 95% CI: 2.11–4.55). Employment sector did not moderate the association between drinking attitudes and alcohol-related problems. Conclusions: Employee attitudes toward alcohol should be monitored to better enable early workplace health promotion interventions targeting alcohol problems. These interventions might need to be gender-specific.

Objectives: The aim of this study was to explore drinking culture and drinking situations that employers and employees encounter in the grey zone between work and leisure, and identify what might affect employees’ risky drinking behaviour. Methods: We used eight focus groups to interview 61 core company informants from eight Norwegian companies (private and public sector) participating in the WIRUS – Workplace-based interventions preventing risky alcohol use and sick leave – project. The informants represented employers and employees with a diversity of roles at multiple organisational levels. The transcribed interviews were analysed by applying a phenomenological hermeneutical approach. Results: The analysis revealed six dimensions of drinking culture representing potentially risky drinking behaviour in situations that fall in the grey zone between work and leisure: (1) “Who invited me?” (Degree of obligation towards inviter), (2) “Do I have to participate?” (Degree of participation volunteerism), (3) “To drink or not to drink?” (Degree of drinking volunteerism), (4) “Work talk or small talk?” (Degree of work-related conversation), (5) “Are there any drinking rules to follow?” (Degree of regulation), and (6) “The influence of being away from home” (degree of distance to home). Conclusions: The findings reveal that employers and employees’ experience of drinking culture can be categorised as six different “shades of grey”. The grey zone is shaded from light to dark grey, indicating how risky the informants perceive the grey zone to be. The findings may be useful when designing workplace health promotion programmes and alcohol regulations in the workplace.

Aims: There are many grey zones between work and leisure time, where colleagues drink together. Managers are more often involved in grey-zone situations than other employees, and the managerial arena is dominated by men. What is the significance of female managers’ visibility in their understanding of their own consumption of alcohol? What leads female managersto moderate their work-related alcohol consumption? Data and Methods: To capture the female managers’ perspectives, we conducted 13 in-depth interviews. The female managers represented various kinds of work within care or nursing, media or publishing, public administration and commodity trading. Results: The female managers’ reflections and experiences of consuming alcohol in grey zones explain how their heightened visibility as women leads them to moderate their alcohol consumption. Three themes were especially salient: (1) need to be in control, (2) concern about stigmatisation, and (3) life stages marked with caring tasks. Conclusions: The results show the importance of external factors in work-related drinking. Women's visibility is significant in relation to cultural dimensions, moderating work-related drinking even when women are managers. The women place demands upon themselves based on their own conceptions of others’ expectations of female managers.

Background: Persons with co-occurring disorders, both substance use and mental health problems (COP) may be encountered within various disciplinary systems and organisational levels of treatment. In western countries, the most common evidence-based housing programme for persons with complex, long-term needs due to severe mental illness and substance use is Housing First. The context of this study were the Nordic countries, granting universal access to treatment and free public services. The aim was to examine how multidisciplinary and integrated housing services are organised and coordinated for persons with COP. Methods: We conducted a systematic search for literature in six databases (i.e. CINAHL, Ovid, SocINDEX, Web of Science, Scopus, and Social Services Abstracts), along with manual searches. After blinded review by two authors in Rayyan, the full texts of 75 articles were reviewed for inclusion, the quality of the selected research articles was completed according to checklists from the Joanna Briggs Institute. A thematic analysis of nine articles was completed according to a coding scheme. Results: From the Nordic perspective, introduced as a model in this article, regions need to develop the organisation and the workforce skills of health and social services as an integrated whole, with special focus on defining responsibilities at different levels, maintaining and improving relationships within a multidisciplinary, integrated, comprehensive, and community-based system of care inclusive of housing services. Supporting the recovery of persons with COP means giving them a voice and having professionals skilled in COP aid them. Conclusions: The approach of emphasizing primary care and multidisciplinary mental health is yet today a challenge even in high-income areas. The integration of services was not on an ideal level, even though the housing policies were rights-based. We identified societal responsibilities stemming from national policies. It is possible that functional integration does not take place in all regions. As the working methods were based on active relationship building to be able to help persons with COP, we interpreted this as a sign of clinical integration. The recommendations for the organisation and coordination of services for persons with COP include ensuring the right to a home, ensuring social integration and community involvement, combatting stigma, and systemising user involvement. There are research gaps in all Nordic countries and the research within housing for persons with COP is scarce. We call for using multi-dimensional research approaches. Clinical trial number: Not applicable.