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Abstract. Background: Persons who have attempted suicide are often admitted to a hospital's emergency department (ED). The risk of them repeating their attempt is lower if they have had access to a psychiatrist in hospital and had been referred to mental health care services. However, the literature suggests this is often lacking. Aims: To describe perceived barriers to and supportive factors for psychiatric consultation and appropriate referral of suicide attempters in the ED. Method: The perspective of the heads of emergency and psychiatry departments in all hospitals with an ED in Brussels-Capital Region was investigated with a qualitative study. Data were obtained with semistructured personal interviews and analyzed in the tradition of content analysis. Results: Eight emergency physicians and 11 psychiatrists participated. Perceived barriers can be summarized as a lack of resources in the ED in terms of psychiatrists, psychiatric beds, and a room for counseling. Intense collaboration between physicians and psychiatrists and integration in a network of mental health services were perceived as being supportive factors. Conclusion: According to the heads of department, psychiatric consultation and referral of suicide attempters could be improved by an increase and more even distribution of beds for temporary psychiatric hospitalization in the ED and a more appropriate financing of the psychiatry function in the ED.

Les médecins sont de plus en plus conduits à prendre des décisions médicales susceptibles d'abréger la vie de leurs patients très âgés. D'après l'enquête Eureld menée dans six pays européens, un quart à la moitié des décès font l'objet d'une décision médicale de ce type. Il s'agit principalement de la mise en œuvre de traitements de la douleur susceptibles d'abréger la vie (19 % de l'ensemble des décès en Italie, 26 % au Danemark). Les décisions médicales avec intention explicite de hâter la mort du patient concernent de 2 % (Italie) à 21 % (Suisse) des décès. Elles consistent soit à ne pas mettre en œuvre ou à arrêter un traitement, soit à administrer ou prescrire des substances létales. Patients ou familles sont généralement associés à cette décision : dans 68 % des cas en Italie et dans 95 % aux Pays-Bas. L'euthanasie active par administration d'une substance létale reste rare.

Although palliative care nurses are identified as key players in supporting couples during advanced illness, there is a lack of evidence about their knowledge and experiences with this particular role. The aim of the study was to explore palliative care nurses' attitudes, roles, and experiences in addressing relationship functioning of couples in daily practice. A qualitative study was conducted using in-depth interviews, observational research, and peer debriefing groups with palliative care nurses in Flanders, Belgium. Nurses support relationship functioning by creating a couple-positive care environment, by being present/acknowledging feelings, and by rectifying imbalances between couples. They do so in a proactive way, backed up by team support. Nurses hesitate toward explicitly unraveling and intervening in relationship problems, in favor of providing comfort or offering a strengths-based approach. The findings offer an urgent call to enhance the educational programs for palliative care nurses by integrating the theories and practice frameworks that guide relational assessment and intervention, which are being used in family nursing.

SummaryStigma and discrimination within health care settings remain a public health challenge across diverse cultural environments and may have deleterious effects on mental and physical health. This study explores the causes, forms and consequences of HIV-related stigma and discrimination among migrant sub-Saharan African women living with HIV in Belgium. A qualitative study was conducted with 44 HIV-positive sub-Saharan African migrant women between April 2013 and December 2014 in health care settings in Belgium. Data were analysed using thematic content analysis. Twenty-five of the women reported overt stigma and discrimination and fifteen reported witnessing behaviours that they perceived to be stigmatizing and discriminatory in health care settings. The themes that emerged as to the causes of stigma and discrimination were: public perceptions of migrants and HIV, fear of contamination and institutional policies on HIV management. Reported forms of stigma and discrimination included: delayed or denied care, excessive precautions, blame and humiliation. The consequences of stigma and discrimination were: emotional stress, inconsistent health-care-seeking behaviour and non-disclosure to non-HIV treating personnel. Stigma and discrimination in health care settings towards people with HIV, and more specifically towards HIV-positive sub-Saharan African migrant women, impedes sustainable preventive measures. Specialized education and training programmes for non-HIV health care providers require in-depth investigation.

Tijdens een doctoraatsopleiding worden onderzoekers voornamelijk onderwezen in de verschillende methodieken, theorieën en technieken in kwalitatief onderzoek. Dit creëert de indruk dat kwalitatief onderzoek een instrumenteel en dus neutraal proces is. Wanneer onderzoekers het veld betreden, worden ze echter geconfronteerd met verschillende onverwachte uitdagingen en valkuilen. Deze kunnen van emotionele, ethische of praktische aard zijn. Door de publish or perish-cultuur komen deze zaken weinig of zelfs helemaal niet aan bod. Wie geeft de onderzoeker bijvoorbeeld meer informatie over hoe met de eigen emoties om te gaan bij sensitieve interviews? Wie onderricht de onderzoeker over hoe een grens gesteld kan worden tussen het 'onderzoeker-zijn' en het 'zorgverlener-zijn'?Deze en andere vragen brachten vier PhD-onderzoekers (de auteurs van dit artikel) van de Vrije Universiteit Brussel ertoe een training te organiseren om deze onderbelichte kwesties te bespreken. De tweedaagse training werd bijgewoond door een dertigtal PhD-onderzoekers van verschillende universiteiten in Vlaanderen met verschillende disciplinaire achtergronden, maar allen direct betrokken bij kwalitatief onderzoek.

It is important that therapists manage adequately their romantic and sexual feelings toward clients as it can negatively affect the psychotherapeutic relationship and may even pose a risk of sexual abuse. This study explores how psychotherapists in Flanders (Belgium) manage such feelings, by conducting both a survey (using 105 of 786 respondents for analyses, as they reported romantic feelings) and focus groups (with a total of 36 participants). Results show that most therapists never consider starting a romantic relationship with a client. They reflect profoundly on their feelings, dwell on possible consequences, while maintaining strict boundaries. Although therapists themselves highly recommend referring the client to a colleague if feelings become too intense, this rarely happens in practice. Most therapists consider talking about their romantic and sexual feelings towards clients as something very important, but only a third have disclosed their feelings in supervision, peer-supervision, or in personal therapy. Therapists indicate there is still hesitance about this due to fear of condemnation.

Abstract Background The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN) and Life End Information Forum (LEIF) in Belgium. The aim of this study is to describe and compare these initiatives. Methods We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols). Results In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions. Conclusion In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a consultation provision could also be considered in order to safeguard the practice of euthanasia (as it can provide safeguards to adequate performance of euthanasia and assisted suicide).

BACKGROUND: To prevent sexual boundary violations (SBV) in mental health care institutions overall governments require these institutions to report SBV incidents to a central registry and to develop institutional guidelines how to react. In Europe SBV policies are only recently developed or implemented, as is also the case in Flanders (Belgium). The implementation of a new institutional policy is always a challenge and can encounter resistance, especially when it concerns SBV, because they remain delicate and complex. METHOD: This study evaluated the extent to which mandatory policies on SBV have been implemented in mental health care institutions in Flanders, and possible factors for (non-)implementation of these policies. An online survey was sent to the executives of all mental health care institutions in Flanders (N = 162). RESULTS: In total 56 executives of mental health care institutions filled out the survey (response rate 35%). Results showed that the implementation of an SBV policy in mental health care institutions is unfortunately inadequate and not all SBV incidents were reported to the central registry. Type of institution and opinions on the SBV policy were related to the (non-)implementation of the requirements. CONCLUSIONS: It is recommended that governments regularly communicate with mental health care institutions to better understand the concerns and difficulties concerning implementation of the required SBV policy and to support/stimulate an organisational culture of more openness and safety on this topic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12910-022-00778-9.