Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study

Barts and the London School of Medicine, Queen Mary University of London, London, UK.
Psychiatry Research (Impact Factor: 2.47). 05/2011; 187(1-2):275-82. DOI: 10.1016/j.psychres.2011.01.001
Source: PubMed

ABSTRACT This study aimed to investigate factors linked to perceived coercion at admission and during treatment among voluntary inpatients. Quantitative and qualitative methods were used. Two hundred seventy patients were screened for perceived coercion at admission. Those who felt coerced into admission rated their perceived coercion during treatment a month after admission. Patient characteristics and experiences were tested as predictors of coercion. In-depth interviews on experiences leading to perceived coercion were conducted with 36 participants and analysed thematically. Thirty-four percent of patients felt coerced into admission and half of those still felt coerced a month later. No patient characteristics were associated with perceived coercion. Those whose satisfaction with treatment increased more markedly between baseline and a month later were less likely to feel coerced a month after admission. In the qualitative interviews three themes leading to perceived coercion were identified: viewing the hospital as ineffective and other treatments as more appropriate, not participating in the admission and treatment and not feeling respected. Involving patients in the decision-making and treating them with respect may reduce perceived coercion.

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Available from: Stefan Priebe, Sep 09, 2014
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    • "The concept of perceived coercion is not restricted to involuntarily admitted service users, with previous studies reporting up to 48% of voluntarily admitted service users describing levels of perceived coercion comparable to that of involuntarily admitted service users (Prebble et al., 2014). Voluntary patients who are treated on locked wards and those with more severe symptoms are more likely to have higher levels of perceived coercion (O'Donoghue et al., 2014), while those who are more satisfied with their treatment feel less coerced (Katsakou et al., 2011). Overall, levels of perceived coercion tend to reduce over time and improvements in functioning and psychotic symptoms are associated with reduced perceived coercion (Fiorillo et al., 2012). "
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    ABSTRACT: Voluntarily admitted service users can report levels of perceived coercion comparable to those admitted involuntarily, yet little is known of this groups longer term outcome. The 'coerced voluntary' had a score of 4 or above on the MacArthur perceived coercion scale and one year after discharge, they had a better therapeutic relationship compared to involuntarily admitted service users. There was no difference between the coerced voluntary, uncoerced voluntary and involuntary groups in engagement, satisfaction and functioning. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 07/2015; DOI:10.1016/j.psychres.2015.07.013 · 2.47 Impact Factor
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    • "The opportunity to participate makes the patient feel like a valued and normal human being, while lack of participation makes her/him feel of less value than other people. Studies have found [28,29] that patients who appreciated the commitment on the part of staff rarely perceived that they were subject to coercion in comparison with those who did not consider staff members to be committed. Thus the sense of being subject to coercion was not directly related to whether or not the care was voluntary. "
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    ABSTRACT: Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity. All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives. The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients. Paternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients' right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.
    BMC Medical Ethics 12/2013; 14(1):49. DOI:10.1186/1472-6939-14-49 · 1.50 Impact Factor
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    • "In addition, voluntary service users who perceive high levels of coercion often think that if they do not agree to a voluntary admission they will be admitted involuntarily anyway (Katsakou et al., 2011a). Worryingly, it is possible that this action by clinicians could actually have the opposite effect to that intended, as more recent evidence suggests that individuals who experience coerced voluntary treatment have worse outcomes compared to involuntarily admitted service users (Kallert et al., 2011). "
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    ABSTRACT: The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. Individuals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixtyone individuals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. Individuals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that individual's rights are respected.
    Psychiatry Research 10/2013; 215(1). DOI:10.1016/j.psychres.2013.10.016 · 2.47 Impact Factor
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