Use Of Coercion In Psychiatry Research Articles

Coercive Measures in Psychiatry Can Hardly Be Justified in Principle Any Longer-Ethico-Legal Requirements Versus Empirical Research Data and Conceptual Issues.

To review the scientific and empirical evidence that is usually accepted for the ethical and legal justification of coercion in psychiatry. Five key criteria are examined as follows: (1) the demonstrable existence of a mental disorder; (2) the effectiveness of psychiatric measures; (3) the use of coercion as last resort and as least possible restriction; (4) the benefit of the person affected by the coercive measure and (5) the restoration of the affected person's autonomy. (1) The existence of a demarcation between a mentally ill and a mentally healthy state cannot be confirmed; (2) Pharmacological and psychotherapeutic interventions in psychiatry are not even moderately effective; (3) Coercive measures are usually not used as last resort and as least restrictive measure; (4) Most people affected by psychiatric coercion do not benefit from the measures; (5) It is at least unclear whether autonomy is affected by a mental illness and whether it can be restored through a coercive psychiatric measure. None of the central ethical and legal criteria for the use of coercion in psychiatry are clearly and unambiguously fulfilled according to current research. Psychiatric coercion can hardly be justified any longer.

Le développement de pratiques de soutien à l’exercice des droits en soins psychiatriques à partir de l’expérience qu’en font les personnes vivant avec une problématique de santé mentale en contexte d’hospitalisation ou de traitement involontaire

Introduction: Worldwide, there is an increased use of coercion in psychiatry, particularly through involuntary hospitalization or treatment. Like many other Canadian provinces, Quebec is no exception. However, the therapeutic outcomes of these measures are questioned when compared to voluntary care. Given the infringement of human rights and freedoms, coercion in psychiatry has been contested by many organizations, including the World Health Organization (2021). Human rights-based practices have been recognized as an important nursing role in Quebec. However, these practices are often informal and poorly documented in scientific literature.
 
 Objective: This article presents the research protocol of an interpretative phenomenological study that aims to understand the lived experiences of coercion and human rights-based practices in psychiatry from the perspectives of people living with mental health problems.
 
 Methods: This qualitative study uses an interpretative phenomenological analysis design developed by Smith et al. (2009). In depth, one-on-one interviews along with socio-demographic questionnaire will be conducted with approximately 10 participants. Data analysis will follow an iterative and hermeneutic emergence coding process.
 
 Discussion and conclusion: By centering human rights-based practices to the lived experiences of people living with mental health problems who encountered coercion, this study will highlight contributing and limiting factors to the recognition of human rights in nursing practices. This study will also promote the development of nursing knowledge and practices that can significantly contribute to individuals’ recovery process.

Mental health professionals' feelings and attitudes towards coercion

BackgroundDespite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them. MethodMental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions. Results130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled “Internal pressure”, “Emotional impact”, “External pressure” and “Relational involvement”. The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion. ConclusionsAs voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.

Krizna stanja i primjena mjera prisile u psihijatriji

The article deals with phenomena of aggression and violence in humans with special attention to mental illnesses. Crisis and violent behaviour do not occur only in psychiatry. It can happen in any context or circumstance, and any person could either fall victim or be the perpetrator. Knowledge of multicausality and complexity as well as of individual environmental and situational factors that can lead to violent behaviour has little power of prediction. Statistical indicators can conceal false positive and false negative results, whereby the error of assessment can dramatically increase the risk of some behaviour or lead to an unjustified suspension of human rights of freedom. The use of coercion in psychiatry is necessary only in exceptional situations where dangerous behaviour directly threatens the life and health of the person or the environment or property. Positive legislation, in particular the Law on the Protection of Persons with Mental Disabilities (Narodne novine 76/2014) and the Ordinance on the Types and Methods of Enforcement of Coercion to a Person with Serious Mental Disorders (Narodne novine 16/2015) further protects the rights of the mentally ill and prescribes the type and mode of coercion as well as procedures for handling. Professional psychiatric societies have provided additional guidelines and treatment strategies. The paper emphasizes the need for better conditions, infrastructure and human resources, with continuous improvement and evaluation of the quality of work in psychiatry. In conclusion, the standards and ethical issues of society and a broad spectrum of activities are being discussed, from destigmatization, through better access to services to standards of living and social inclusion, which can indirectly lead to a significant reduction of violence in society.

Mechanische Bewegungseinschränkungen: Die klinische Praxis an einer psychiatrischen Universitätsklinik

Public opinion on psychiatric medicine is still dominated by images of repression; in particular, the aspects of involuntary admissions, restraint, isolation, or involuntary administration of medication contribute significantly to public prejudice. Furthermore, violations of individual privacy rights and the use of coercion in psychiatry is an ethical challenge. The aim of this study was to describe the "practice of mechanical restraint" at a university hospital in Austria. In this study, all admissions to the closed ward at the Department of Psychiatry of the University Clinic of Innsbruck between July and December 2009 were assessed through retrospective data analysis. 529 admissions were identified during the study period. In 148 admitted patients mechanical restraint was arranged at least once. Mechanical restraint was used most frequently and over the longest period of time in patients of the ICD diagnosis group F0. In most cases, "self- harm" had been the reason for restraint. Fourteen percent of the restraints were due to a "danger to others". In patients with "danger to others", a 5 point fixation was used significantly more often than in patients without danger to others, where a restriction by bedrail and/or abdominal belt was most common. A comparison of these data with those of other centers is limited due to diverse documentation systems. A unified approach in terms of an effective quality management would be desirable in this regard.

Moral margins concerning the use of coercion in psychiatry

In the closed wards of mental health institutions, moral decisions are made concerning the use of forced seclusion. In this article we focus on how these moral decisions are made and can be improved. We present a case study concerning moral deliberations on the use of seclusion and its prevention among nurses of a closed mental health ward. Moral psychology provides an explanation of how moral judgments are developed through processes of interaction. We will make use of the Social Intuitionist Model of Jonathan Haidt that emphasizes the role of emotions, intuitions and the social context in moral judgments and reasoning. We argue that this model can help to explain social dynamics in the context of enforced seclusion. In the discussion we explore how moral psychology can be complemented with the normative perspective of dialogical ethics to develop strategies for improving psychiatric practices. We conclude that social processes play an important role in moral deliberations and that moral development can be fostered by bringing in new perspectives in the dialogue. Moral case deliberation provides a practical tool to systematically organize moral reflections among nurses on the work floor.

Consensual vs. coercive treatment: new manifestations of an old dilemma

The 1960s and 1970s were a time of substantial changes in approaches to involuntary hospitalization and treatment in the United States, a process that was also reflected elsewhere in the world. Objections to the use of coercion in psychiatry became widespread, rooted in concerns about the reality of mental illnesses, the effects of institutional treatment, financial considerations, and growing attention to patients' rights. This movement led to narrowed criteria for civil commitment (from criteria based on need for treatment to dangerousness-based criteria), along with increased procedural protections. Committed patients were given unprecedented rights to refuse treatment in many jurisdictions. Advocates envisioned steady progress towards a community-based, essentially consensual system of care. In the early 21st century, however, it has become apparent that, even as coercive treatment in institutions has diminished, new forms of coercion have developed to enforce treatment in the community. These include mental health courts, probation and parole requirements, outpatient commitment, and use of informal leverage over patients' money, housing, parenting rights, and the like. Coercive treatment in psychiatry has not disappeared, and may not even have diminished. Rather it has moved from the institution to the community. This presentation will describe this evolution and consider the lessons that may be drawn regarding the future of psychiatric treatment and systems of care.

Using nursing skills instead of restraints

Despite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them.Mental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions.130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled “Internal pressure”, “Emotional impact”, “External pressure” and “Relational involvement”. The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion.As voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.