Coercive treatments in forensic psychiatry: a study of patients' experiences and preferences

Abstract

The aim of this study was to report on forensic rehabilitation inpatients' experiences and preferences for physical restraint, seclusion and emergency intra-muscular medication using mixed qualitative and quantitative methods. Of 252 inpatients, 79 met the study inclusion criteria and 57 (72%) agreed to take part. Just over half thought they should have been subjected to coercive treatment. Although coercive treatments were generally perceived as negative experiences, 16% of participants reported the last episode of seclusion or restraint had been a positive experience for them. The figure for emergency intra-muscular medication was 36%. Eleven percent of participants said they had made an advance statement but none could be found in their records. Most participants preferred intra-muscular medication to seclusion. Participants made suggestions as to how to improve their experiences of coercive treatments. Patients' views on coercive treatments should be incorporated into their care plans and they should be encouraged to make advance statements.

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“…In addition to the timeline before coercion, some patients in the studies by Bonner, Lowe, Rawcliffe, and Wellman (), Wynn (), Chien, Chan, Lam, and Kam (), Haw, Stubbs, Bickle, and Stewart (), Katsakou et al. ( ) and Larsen and Terkelsen () reported having various types of symptoms that they perceived to constitute the initial reason for coercion.…”

The Experience of Seclusion and Restraint in Psychiatric Settings: Perspectives of Patients

“…These results contrast with recent studies in which SR was found to be a decidedly negative experience. In the study by Haw et al (2011), 84% of forensic psychiatry inpatients experienced their SR negatively, saying it reminded them of a "prison cell," and believed it was a consequence of disobedience to staff. Keski-Valkama et al (2010) found that 66.3% of patients perceived seclusion as a punitive measure; this proportion was significantly higher in the forensic group (73.1%) than in the general psychiatric group (54.1%).…”

“…The countries were Finland (Keski-Valkama, Koivisto, Eronen, & Kaltiala-Heino, 2010;Kontio & al., 2012), Norway (Iversen et al, 2011), the United Kingdom (Haw, Stubbs, Bickle, & Stewart, 2011), France (Cano, Boyer, Garnier, Michel, & Belzeaux, 2011), and South Africa (Mayers, Keet, Winkler, & Flisher, 2011). Patients' experiences in a psychiatric unit or general forensic psychiatry were documented through surveys or interviews.…”

Causes and management of aggression and violence in a forensic mental health service: Perspectives of nurses and patients

“…Previous research supports our findings, for example, that many similar patients felt that their most recent episode of seclusion or restraint was necessary though not, of course, desirable (Haw et al . ). However, this should not be taken to indicate that staff should simply apply active and coercive interventions in this setting; rather, it indicates the need for improved therapeutic relationships and relational security because patients have longer lengths of stay and are more reliant on staff to meet their needs for acceptance, and to model appropriate behaviours that reduce aggression.…”