Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries

Valenti, Emanuele; Banks, Ciara; Calcedo‐Barba, Alfredo; Bensimon, Cécile M.; Hoffmann, Karin-Maria; Pelto‐Piri, Veikko; Jurin, Tanja; Mendoza, Octavio Márquez; Mundt, Adrian P.; Rugkåsa, Jorun; Tubini, Jacopo; Priebe, Stefan

doi:10.1007/s00127-015-1032-3

Cited by 65 publications

(96 citation statements)

References 30 publications

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“…They can feel uncomfortable with their role in exerting formal coercion and also with use of so-called informal coercion, in the form of persuasion and other behaviour to influence patients to accept treatment suggestions. 132 The arising tension and uneasiness are part of the practice of many psychiatrists and should be explicitly addressed in public, professional debates, and clinical training and supervision.…”

Section: The Role Of Psychiatrists In Societymentioning

confidence: 99%

The WPA- Lancet Psychiatry Commission on the Future of Psychiatry

Bhugra

Tasman

Pathare

et al. 2017

The Lancet Psychiatry

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344

187

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Executive Summary BackgroundThis Commission addresses several priority areas for psychiatry over the next decade, and into the 21st century. These represent challenges and opportunities for the profession to sustain and develop itself to secure the best possible future for the millions of people worldwide who will face life with mental illness. Part 1: The patient and treatmentWho will psychiatrists help? The patient population of the future will reflect general demographic shifts towards older, more urban, and migrant populations. While technical advances such as the development of biomarkers will potentially alter diagnosis and treatment, and digital tech-nology will facilitate assessment of remote populations, the human elements of practice such as cultural sensitivity and the ability to form a strong therapeutic alliance with the patient will remain central. Part 2: Psychiatry and health-care systemsDelivering mental health services to those who need them will require reform of the traditional structure of services. Few existing models have evidence of clinical effectiveness and acceptability to service users. Services of the future should consider stepped care, increased use of multidisciplinary teamwork, more of a public health approach, and the integration of mental and physical health care. These services will need to fit into the cultural and economic framework of a diverse range of settings in high-income, low-income, and middle-income countries. Part 3: Psychiatry and societyIncreased emphasis on social interventions and engagement with societal expectations might be an important a ea fo ps hiat s de elop e t. This ould e o pass ad o a fo the ights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and, on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences. Part 4: The future of mental health lawMental health law worldwide tends to be based on concerns about risk rather than the protection of the rights of individuals experiencing mental illness. The United Nations Convention on the Rights of Persons with Disabilities, which states that compulsion based in whole or in part on mental disability is discriminatory, is a landmark document that should inform the future formulation and reform of mental health laws. An evidence-based approach needs to be taken: mental health legislation should mandate mental health training for all health professionals; ensure access to good-quality care; and cover wider societal issues, particularly access to housing, resources, and employment. All governments should include a mental health impact assessment when drafting relevant legislation. Part 5: Digital psychiatry-enhancing the future of mental healthDigital technology might offer psychiatry the potential for radical change in terms of service delivery and the development of new treatm...

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Section: The Role Of Psychiatrists In Societymentioning

confidence: 99%

The WPA- Lancet Psychiatry Commission on the Future of Psychiatry

Bhugra

Tasman

Pathare

et al. 2017

The Lancet Psychiatry

Self Cite

344

187

View full text Add to dashboard Cite

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“…Of these, 21 met the inclusion criteria (Figure 1). The 21 publications referred to 15 studies [1 study resulted in 2 (13, 14), another study in 6 publications (15–20), and 13 studies in 1 publication (21–33)].…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, one study revealed that interventions with stronger informal coercion were less accepted by mental health professionals (22), and mental health professionals tended to avoid informal coercion and to respect the patients’ decisions if possible although some stated to feel being pressured to use it. Some participants used informal coercion more often than they were aware to use it (21), and one study revealed that the degree of coercion was underestimated in the whole study population. Detailed analysis showed differences in the underestimation of professions with physicians showing the least underestimation of the degree of coercion followed by nurses and other professions (22).…”

Section: Resultsmentioning

confidence: 99%

Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review

Hotzy

Jaeger

2016

Front. Psychiatry

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IntroductionAlthough informal coercion is frequently applied in psychiatry, its use is discussed controversially. This systematic review aimed to summarize literature on attitudes toward informal coercion, its prevalence, and clinical effects.MethodsA systematic search of PubMed, Embase, PsycINF, and Google Scholar was conducted. Publications were included if they reported original data describing patients’ and clinicians’ attitudes toward and prevalence rates or clinical effects of informal coercion.ResultsTwenty-one publications out of a total of 162 articles met the inclusion criteria. Most publications focused on leverage and inducements rather than persuasion and threat. Prevalence rates of informal coercion were 29–59%, comparable on different study sites and in different settings. The majority of mental health professionals as well as one-third to two-third of the psychiatric patients had positive attitudes, even if there was personal experience of informal coercion. We found no study evaluating the clinical effect of informal coercion in an experimental study design.DiscussionCultural and ethical aspects are associated with the attitudes and prevalence rates. The clinical effect of informal coercion remains unclear and further studies are needed to evaluate these interventions and the effect on therapeutic relationship and clinical outcome. It can be hypothesized that informal coercion may lead to better adherence and clinical outcome but also to strains in the therapeutic relationship. It is recommendable to establish structured education about informal coercion and sensitize mental health professionals for its potential for adverse effects in clinical routine practice.

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“…Coercion into treatment for substance use disorder (SUD) is practised throughout the world, and it has been the subject of a long-standing ethical debate [1]. According to Klag (2006), critics of legal coercion argue that compulsory treatment may violate basic civil rights [2].…”

Section: Introductionmentioning

confidence: 99%

Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders

Opsal

Kristensen

Vederhus

et al. 2016

BMC Health Serv Res

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BackgroundPerceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient’s internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily.MethodsThis study included patients admitted to combined substance use disorder and psychiatry wards in three publicly funded treatment centres in Norway in the period 2009–2011. Participants included 63 patients that were admitted involuntarily, pursuant to the Norwegian Public Health Act, and 129 patients that were admitted voluntarily. All participants completed the Perceived Coercion Questionnaire. Sociodemographic variables were determined with the European Addiction Severity Index. The range of psychopathological symptoms was evaluated with the Symptom Checklist-90-R. Independent sample t-tests, the chi-squared test, and Fisher’s exact test were used to detect statistically significant differences between groups.ResultsScores on the Perceived Coercion Questionnaire showed that patients admitted voluntarily and those admitted involuntarily experienced similar levels of perceived coercion. Those admitted voluntarily reported higher levels of perceived coercion from internal sources, and those admitted involuntarily perceived significantly higher coercion from legal sources. No differences between groups were found with the other tests.ConclusionsOur results suggested that assumptions about involuntary admissions should be evaluated carefully to determine how best to alleviate counterproductive feelings of coercion when a coerced admission is planned. Informing and collaborating with the patient will most likely facilitate a better experience during admission and treatment. Moreover, the patient is more likely to experience a better recovery process.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1906-4) contains supplementary material, which is available to authorized users.

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Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries

Abstract: A disapproval of informal coercion in theory is often overridden in practice. This dissonance occurs across different sociocultural contexts, tends to make professionals feel uneasy, and requires more debate and guidance.

Cited by 65 publications

References 30 publications

The WPA- Lancet Psychiatry Commission on the Future of Psychiatry

The WPA- Lancet Psychiatry Commission on the Future of Psychiatry

Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review

Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders

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