Sources of coercive behaviours in psychiatric admissions

Lidz, Charles W.; Mulvey, Edward P.; Hoge, Steven K.; Kirsch, Brenda L.; Monahan, Jennifer L.; Bennett, Nancy S.; Eisenberg, Mara; Gardner, William; Roth, Loren H.

doi:10.1034/j.1600-0447.2000.101001073.x

Cited by 31 publications

(24 citation statements)

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“…These insights enabled the treatment team to develop plans that could address and substantially improve Mr. B's deficits in voluntarism and hence in the adequacy of his capacity for informed consent. Here, the assessment of voluntarism was pivotal to the resolution of the case and permitted the patient to assert the self-determination he had always in essence possessed (20). In more difficult and less plastic cases, recognition of deficits in voluntarism may not automatically restore this capacity (21).…”

Section: Discussionmentioning

confidence: 98%

Voluntarism in Consultation Psychiatry: The Forgotten Capacity

Geppert¹,

Abbott²

2007

AJP

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Case PresentationConsultation Request "Mr. B, a 36-year-old man with a history of Graves' disease and mood disorder is admitted to the inpatient psychiatric service on an emergency hold. The endocrinology service has recommended radioactive iodine (RAI) ablation of his thyroid gland to control severe Graves' disease, but the patient is refusing this procedure. Please assess for informed consent." InformantsInformation was obtained from Mr. B, the inpatient psychiatric service, the endocrinology service, and a review of most of Mr. B's outpatient psychiatric and medical records. History of Present IllnessPolice brought Mr. B to the emergency department after he was caught trespassing in a restricted area. He told the police officers that he had to go to this restricted area to punish those responsible for implanting satellite chips in his head, neck, and abdomen when he was 1 year old. On interview, Mr. B provided the same account. He denied any auditory or visual hallucinations or suicidal ideation. His mood was irritable, and he would not cooperate with an assessment of neurovegetative symptoms. Mr. B reported that he had not been taking his psychotropic medications or his methimazole for his Graves' disease. Because of evidence of psychiatric disorder, imminent harm to others, and perc e i v e d b e n e f i t o f i n p a t i e n t psychiatric treatment, Mr. B was placed on a 7-day hold. Hospital CourseMr. B was quickly titrated to his former outpatient dose of ziprasidone (80 mg b.i.d.). Despite this treatment, he continued to have an irritable mood, impulsive and aggressive behavior, decreased need for sleep, and somatic and paranoid delusions. On multiple occasions, his disruptive and "dangerous" behavior resulted in the use of chemical and physical restraints. His cooperation with the treatment team was minimal. Mr. B's inpatient psychiatric hospitalization was further complicated by his medical problems. The psychiatric service consulted the internal medicine service to investigate malignant hypertension and the endocrinology service regarding Graves' disease. The endocrinology service was impressed with the severe stigmata of Mr. B's Graves' disease, which included visible goiter, bilateral tremor, and Graves' dermopathy. Mr. B's thyroid laboratory test results on admission were equally impressive, with his thyrotropin level undetectable and his T 4 level at 23.4 µg/dl. Given the failure of outpatient management with methimazole, the low likelihood of cure with methimazole with such a large gland, and the severity of the psychiatric and medical manifestations of Mr. B's hyperthyroidism, the endocrinologists recommended a definitive cure with RAI ablation. The endocrinologists explained their reasoning to Mr. B, but he refused the procedure. According to the endocrinology notes, his rationale for refusal was that he was "being held against [his] will." Efforts to contact Mr. B's family to obtain a surrogate decision maker were unsuccessful. The psychiatric intern subsequently told the patient and the endocr...

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Section: Discussionmentioning

confidence: 98%

Voluntarism in Consultation Psychiatry: The Forgotten Capacity

Geppert¹,

Abbott²

2007

AJP

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“…Lidz et al [25] interviewed patients who identified health professionals as the most coercive group at the time of admission to hospital, stating that both verbal and physical coercion were used to pressurize patients into accepting hospitalisation. This is certainly the group exerting most pressure on patients, at least in terms of the therapeutic measures deemed necessary.…”

Section: Discussionmentioning

confidence: 99%

Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers

Girela

López²,

Ortega³

et al. 2014

BioMed Research International

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We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.

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“…Although mental health professionals have worked hard to minimise the negative attitudes towards mental health in the community, 39,40 these negative attitudes remain present even within services, 41 suggesting a need to remain focused on the interactions of all clinicians. The importance of this approach is supported by the work of the MacArthur Foundation who coined the phrase 'procedural justice' 42 to express a similar view. For inpatients, the fact that one in four voluntary patients experience coercion suggests consideration of the consent process for intervention in hospital needs to be reviewed, and implied consent in this patient group may not be sufficient.…”

Section: Implications and Limitationsmentioning

confidence: 96%

Coercion in psychiatric care: where are we now, what do we know, where do we go?

Newton‐Howes

2010

Psychiatrist

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SummaryCoercion is a subjective response to a particular intervention and has been considered an unfortunate but necessary part of the care of people with psychiatric illness. Its ethical underpinnings, evidence base and clinical implications are not commonly considered in day-to-day care; however, this requires reconsideration as the potential for an increase in coercion stretches beyond the boundaries of the hospital into the community. Much of the research that has been undertaken highlights the prevalence of coercion, the ‘grey zone’ between compulsory interventions and the experience of patients and patient outcomes in the light of coercion. Policy makers need to consider the evidence for interventions that increase the experience of coercion in order to reduce its impact. Clinicians need to understand the principles of procedural justice, minimise the use of legal detention and be mindful that implied consent for one intervention may lead to experiences of coercion involving linked management strategies.

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Sources of coercive behaviours in psychiatric admissions

Abstract: Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental-health professionals, including especially those who are not legally mandated to participate in the admission process.

Cited by 31 publications

References 0 publications

Voluntarism in Consultation Psychiatry: The Forgotten Capacity

Voluntarism in Consultation Psychiatry: The Forgotten Capacity

Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers

Coercion in psychiatric care: where are we now, what do we know, where do we go?

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