Ten Years of High and Intensive Care Within Psychiatry: Professionals' Reflections Upon Developments and Future Implications

Over the past decade, psychiatric wards across the Netherlands have worked in accordance with the High and Intensive Care model to reduce coercion and improve the quality of care. Securing implementation of the model within a challenging mental health care context has proven to be effective but complex in practice. Consequently, this study aimed to both gain insight into the process of implementing the High and Intensive Care model by drawing upon professionals' own reflections and provide recommendations for improving practice and the model. This is a national multicentre study that utilised qualitative methods. Data was collected by a total of 26 institutional and national group interviews on which thematic analysis was conducted. Staff turnover, coercion, collaboration with outpatient care, working methodically and the move from control to contact were found to be the key developments since the model's implementation. Future efforts should focus upon staff retention and acquisition to ensure continuity of care and safety. Ongoing evaluation of coercion is essential to further reduce coercion. Collaborations with outpatient care and other stakeholders should be intensified to promote effective care. Management support, reflexivity and a clear vision are required to strengthen methodical working and collaboration between wards to create uniformity of practice. Working in contact with patients ensures safety but requires time and behavioural change. Applying implementation science can support improvements in acute mental health care by systematically addressing barriers to change, promoting sustainable evidence-based practices, and guiding the reduction of coercion. Further research into these barriers, including the exploration of non-coercive strategies and stakeholder involvement, is needed to enhance High and Intensive Care implementation and similar practices.