In the March edition of Magnify – the Journal Club blog from BJPsych – Dr Angharad de Cates and Dr Mariana Pinto da Costa chair a journal club in collaboration with the WPA, discussing ‘Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence’. They are joined by a group of early career psychiatrists who presented an appraisal of the paper, and who have written a blog post discussing their reflections on the process. An expert panel, including the senior author of the paper, also joined the discussions.

It was exciting to be invited to present at a recent journal club jointly organised by the British Journal of Psychiatry (BJPsych) and the World Psychiatry Association (WPA). A fabulous opportunity and learning event to take part in alongside reputed psychiatrists from other parts of the globe.

Initially tasked to find an article to present, we sought out something suitably international and relevant to many different parts of the world. Out of many interesting articles, we decided on one based around coercion: “Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence”. This included primary studies based in several European countries and the USA. We collectively agreed that this was an important and prevalent topic in psychiatry. We were interested to explore this further and to understand this on an international level as well as share our own experiences.

As we came from three different continents, we used Microsoft Teams and WhatsApp to meet and chat to prepare. It was a challenge to choose timings to suit four busy people in different parts of the globe. This fell harder on Chonnakarn who works in Thailand (7 hours ahead of the UK) and had to deal with late evening meetings, often after a busy day shift at work. However, she would always join the meetings with a smile and with lots of discussion points prepared.

Initially we all talked through the article together and discussed areas that interested us or areas that we were confused about; as it was an umbrella review there were many factors to consider. We then each worked on a different section of the presentation, splitting this into four parts. We met a few more times to practice presenting together and giving each other feedback. This sparked very interesting conversations at times where we would discuss the difference in our experiences and the cultures where we were based. We also learnt about each of our different backgrounds in training and life. We were all at different stages of our training and had been exposed to different amounts of psychiatry and journal clubs. Therefore, we  worked as a team to ensure everyone felt supported and had an open platform to ask questions and learn more. Throughout this preparation time we had the support of Angharad de Cates and Mariana Pinto da Costa, who were both always available to offer assistance and encouragement, and provided helpful feedback in the rehearsals. Unfortunately, one member of the presenting team had to drop out last minute due to unforeseen circumstances. As we had all been working together there was a smooth transition allowing the other three presenters to ensure all parts of the article and discussion topics were covered.

At the time of the journal club, it was nerve-wracking having to present in front of an expert panel, filled with world renowned senior experts in psychiatry, like Professor Sir Graham Thornicroft and Professor Afzal Javed, amongst others. However due to all our practice, preparation and support as a team, we felt prepared to talk about this article. It was reassuring to be able to present as a team and all be able to support each other on the day.

One really important part of the journal club was the chance to have an expert patient, Founder of Global Mental Health Peer Network, Charlene Sunkel, as part of the panel. Hearing their view and personal experiences with coercion really brought to light the issues of coercion in a poignant way.

The journal club itself sparked really interesting debates, such as whether sectioning patients or involuntary admissions are part of coercion itself. There was also a topical discussion about the impact of COVID and whether this has changed any coercive measures used in psychiatry.

Reflecting on this experience, I think we all learnt a lot about different areas of psychiatry that may not learnt in exam revision or thought about as a priority in a busy day shift. Having the opportunity to work with colleagues from all over the world is a privilege that can’t be underestimated. We all plan to stay in touch and keep helping each other!

Looking towards the future, I hope focus on reducing coercion continues to increase globally. Different areas of the world continuing to work towards this goal will lead to innumerable positive outcomes.

Author: Harriet Battle, Core Trainee, South London and Maudsley NHS Foundation Trust