‘It's unbelievably humiliating’—Patients' expressions of negative effects of coercion in mental health care

Abstract

Involuntary medication and dismissal of patient perspective, combined with the accumulated effects of minor negative incidents, can explain the feelings of humiliation, oppression and the use of metaphors such as imprisonment by totalitarian systems. Our model can help explain such patient reactions seen in clinical practice and the literature.

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

“…“Being subjected to professionals’ control” was characterized by patients’ reported perceptions of being physically and mentally abused (Wynn, ; Haw et al., ; Sibitz et al., ; Knowles et al., ), punished and treated like criminals by the professionals while being coerced (Meehan et al., ; Haglund et al., ; Wynn, ; Chien et al., ; Mayers et al., ; Kontio et al., ; Faschingbauer et al., ; Ling et al., ). Patients felt that their autonomy and rights had been violated (Haglund et al., ; Hoekstra, Lendemeijer, & Jansen, ; Wynn, ; Larue et al., ; Ezeobele et al., ; Larsen & Terkelsen, ; Riley et al., ), and strong feelings of humiliation were reported (Holmes et al., ; Wynn, ; Mayers et al., ; Haw et al., ; Faschingbauer et al., ; Larue et al., ; Van Wijk et al., ; Ling et al., ; Nyttingnes, Ruud, & Rugkasa, ). These experiences were exacerbated by the position of power held by professionals (Meehan et al., ; Haglund et al., ; Hoekstra et al., ; Katsakou et al., ; Kontio et al., ; Faschingbauer et al., ; Ezeobele et al., ; Knowles et al., ).…”

“…Inj. (Meehan et al., ; Hoekstra et al., ; Holmes et al., ; Chien et al., ; Haw et al., ; Kontio et al., ; Ezeobele et al., ; Ling et al., ; Nyttingnes et al., ), which was associated with “negative patient‐perceived impacts” of loneliness, shame, frustration and humiliation.…”

“…Furthermore, “communication” was characterized by patients’ reported perceptions of how professionals would not respond to questions (Chien et al., ) or listen to their requests (Haglund et al., ; Hoekstra et al., ; Chien et al., ; Ezeobele et al., ; Wyder et al., ; Nyttingnes et al., ) while being in MR, seclusion or being subjected to medication (N/D) or IM inj. and this was associated with “negative perceived impacts” of being abandoned, loneliness, fear and powerlessness.…”

“…and this was associated with “negative perceived impacts” of being abandoned, loneliness, fear and powerlessness. Finally, patients also perceived that the professionals communicated with them in a degrading way, for example, by degrading remarks made during seclusion, MR and holding (Haw et al., ; Kontio et al., ; Faschingbauer et al., ; Lanthén et al., ), speaking loudly and rudely (Chien et al., ; Kontio et al., ), using threats (Nyttingnes et al., ), talking about the patients instead of with them or by making fun of patients while coerced (Faschingbauer et al., ; Ezeobele et al., ; Lanthén et al., ). Degrading communication was especially associated with “negative patient‐perceived impacts” of being punished, and feelings of guilt, and embarrassment.…”

Engagement, Empowerment and Patient Generated Health Data

“…Sense-making was expressed as coming to terms with the abstract concept of a illness by Pat08_MF54_R evidence has not been detailed in any patient generated health data literature to date, and has been superficially discussed in association with the medical record, suggesting once clinicians document in the medical record they become a form of 'objective truth' that asserts clinician power and can be used to coerce (Nyttingnes, Ruud, & Rugkåsa, 2016).…”