Implementing clinical ethics support services in psychiatry: A qualitative study

BackgroundDespite the ubiquity of ethical challenges in psychiatric practice, many psychiatric hospitals in Germany have not yet successfully established clinical ethics support services (CESS).AimOffering and evaluating a program that supports professionals in implementing CESS in psychiatric hospitals in Germany, and identifying which barriers and facilitators they encounter in the process.Research design, participants and research contextWe offered online implementation support to four psychiatric hospitals over a period of 14 months, which included regular support meetings with members of the hospitals' ethics committees. We conducted three focus groups with a total of 12 members of the respective clinical ethics committees at the beginning of the project, after 6 and after 12 months. Focus group transcripts and protocols of the support meetings were analyzed using qualitative content analysis.Ethical considerationsThe study was approved by the University's Research Ethics Committee.ResultsBarriers for implementation included structural factors, such as a lack of financial and time resources, a lack of knowledge about ethics consultation and its benefits in psychiatry, and difficulties distinguishing ethical questions from medical and legal questions or team conflicts. Participants assumed that specific psychiatric expertise was necessary to offer ethics consultation for psychiatric cases but generally found interdisciplinary and multiprofessional ethics committees helpful. Further helpful factors included the support of hospital management and strategies to increase awareness for ethics support services among different professional groups. Participants found the online support program helpful to discuss specific problems and identify next steps for implementation, and reported improvements in the implementation of CESS in the respective hospitals.ConclusionsThe provision of adequate personnel and time resources is essential to address structural implementation barriers. Our study demonstrates that establishing support programs on a broader scale is promising to improve the implementation of CESS in psychiatry.