Evaluation of behavioral changes and subjective distress after exposure to coercive inpatient interventions

Irina Georgieva,Cornelis L Mulder,Richard Whittington

doi:10.1186/1471-244x-12-54

Irina Georgieva, Cornelis L Mulder + Show 1 more

Open Access

https://doi.org/10.1186/1471-244x-12-54

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Abstract

BackgroundThere is a lack of evidence to underpin decisions on what constitutes the most effective and least restrictive form of coercive intervention when responding to violent behavior. Therefore we compared ratings of effectiveness and subjective distress by 125 inpatients across four types of coercive interventions.MethodsEffectiveness was assessed through ratings of patient behavior immediately after exposure to a coercive measure and 24 h later. Subjective distress was examined using the Coercion Experience Scale at debriefing. Regression analyses were performed to compare these outcome variables across the four types of coercive interventions.ResultsUsing univariate statistics, no significant differences in effectiveness and subjective distress were found between the groups, except that patients who were involuntarily medicated experienced significant less isolation during the measure than patients who underwent combined measures. However, when controlling for the effect of demographic and clinical characteristics, significant differences on subjective distress between the groups emerged: involuntary medication was experienced as the least distressing overall and least humiliating, caused less physical adverse effects and less sense of isolation. Combined coercive interventions, regardless of the type, caused significantly more physical adverse effects and feelings of isolation than individual interventions.ConclusionsIn the absence of information on individual patient preferences, involuntary medication may be more justified than seclusion and mechanical restraint as a coercive intervention. Use of multiple interventions requires significant justification given their association with significant distress.

Highlights

There is a lack of evidence to underpin decisions on what constitutes the most effective and least restrictive form of coercive intervention when responding to violent behavior
The research was approved by the local Medical Ethical Committee, which waived the requirements for informed consent because the research involved no risks to the patients, and because data were being collected as part of a policy-control procedure
It was shown by comparison of group 1, group 2 and group 3 with group 4 that type of coercive intervention did not predict any aspects of effectiveness (Table 2)

Summary

Introduction

There is a lack of evidence to underpin decisions on what constitutes the most effective and least restrictive form of coercive intervention when responding to violent behavior. We compared ratings of effectiveness and subjective distress by 125 inpatients across four types of coercive interventions Coercive interventions such as seclusion, involuntary medication and mechanical restraint are common methods for managing violent behavior during psychiatric hospitalization. Even though they are intended to protect patients and those around them, they are highly controversial, because they restrict freedom and are used against a patient’s will. It is widely accepted in mental health services around the world that coercion is a last resort and should be proportionate to the degree of threat being faced [3,4,5] For this reason, it should always be decided whether its possible dangers are considerably outweighed by the likely benefits to the patient and others. An individualized approach is required in which the most effective and least damaging intervention for the particular person is established

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