Use of Coercive Measures during Involuntary Psychiatric Admission and Treatment Outcomes: Data from a Prospective Study across 10 European Countries.

Paul Mclaughlin,Stefan Priebe,Domenico Giacco,Peter John Mckenna

doi:10.1371/journal.pone.0168720

Paul Mclaughlin, Stefan Priebe + Show 2 more

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https://doi.org/10.1371/journal.pone.0168720

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Abstract

To assess the association between different types of coercive measures (forced medication, seclusion, and restraint) used during involuntary psychiatric admission and two treatment outcomes: retrospective views of patients towards their admission and length of inpatient stay. A secondary analysis was conducted of data previously gathered by the EUNOMIA study (n = 2030 involuntarily detained inpatients across 10 European countries, of whom 770 were subject to one or more coercive measures). Associations between coercive measures and outcomes were tested through multivariable regression models adjusted for patients' socio-demographic and clinical characteristics. Use of forced medication was associated with patients being significantly less likely to justify their admission when interviewed after three months. All coercive measures were associated with patients staying longer in hospital. When the influence of other variables was considered in a multi-variate analysis, seclusion remained as a significant predictor of longer inpatient stay, adding about 25 days to the average admission. Of the three coercive measures, forced medication appears to be unique in its significant impact on patient disapproval of treatment. While all coercive measures are associated with patients staying longer in hospital, only use of seclusion is associated with longer inpatient stays independently of coerced patients’ having higher symptom scores at the time of admission.

Highlights

The use of coercion in mental health care remains common practice in jurisdictions across the world
There were no significant differences between patients who experienced coercive measures and those who did not for gender, age, employment, and living situation
There were, significant differences between the two groups for diagnosis of schizophrenia and Brief Psychiatric Rating Scale (BPRS) score at baseline, with patients who experienced coercive measures being significantly more likely to have a diagnosis of schizophrenia (68% versus 60%, p = .004) and significantly more likely to have a higher BPRS score at baseline (58 versus 52, p = < .001)

Summary

Introduction

The use of coercion in mental health care remains common practice in jurisdictions across the world. As well as involuntary admission to hospital under statutory powers of detention, the most obvious forms of coercive practice are those referred to as ‘coercive measures’–forced administration of psychotropic medication against the patient’s will, involuntary confinement of the patient in isolation or seclusion, and manual or mechanical restraint of the patient’s limbs or body to prevent free movement. Despite the widespread use of coercive measures, PLOS ONE | DOI:10.1371/journal.pone.0168720. Use of Coercive Measures and Treatment Outcomes Despite the widespread use of coercive measures, PLOS ONE | DOI:10.1371/journal.pone.0168720 December 29, 2016

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