Measures of perceived coercion at psychiatric hospital admission have been developed. We aimed to investigate predictors of perceived coercion in subjects admitted to psychiatric hospital in the UK, and to test the hypothesis that high perceived coercion at admission predicts poor engagement with community follow-up.
A cohort of consecutively admitted subjects were interviewed at admission and before discharge, and were followed prospectively for 10 months. Service use and compliance with care were rated from case notes and by clinicians.
One hundred interviews were obtained from 118 consecutive admissions (85%). Compulsory admission was strongly associated with perceived coercion, but one-third of voluntary patients felt highly coerced, and two-thirds were not certain they were free to leave hospital. Greater age, less insight, and non-white ethnicity were associated with high perceived coercion. Perceived coercion did not predict engagement with follow-up.
Services recognise provision of care in the least restrictive setting as a key objective. Perceived coercion should be regarded as an important outcome measure in service evaluation.
"In this vein, prior investigators have suggested strategies to mitigate the impact of coercive practices. For example, Bindman et al. (2005) suggest engaging patients in frank discussion about the circumstances under which coercive practices may be applied and the limits of such practices, preferably before hospitalization is necessary. Likewise, more structured treatment planning tools, including psychiatric advance directives, have been developed to allow patients to proactively create crisis plans and voice specific treatment preferences in advance of a mental health crisis. "
[Show abstract][Hide abstract] ABSTRACT: Consumers' satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers' perceptions of coercion and its effects on satisfaction, including potential "downstream" effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients' satisfaction with care in a psychiatric inpatient sample (N = 240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients' satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations.
Community Mental Health Journal 09/2012; 49(4). DOI:10.1007/s10597-012-9539-5 · 1.03 Impact Factor
"The use of threats and force are classed as negative pressures and are associated with higher levels of perceived coercion . It has been found that the level of perceived coercion at the time of admission is not associated with treatment adherence following discharge, nor does it predict engagement with follow-up services  . It has not yet been investigated whether procedural justice is associated with engagement upon discharge. "
[Show abstract][Hide abstract] ABSTRACT: We sought to determine the level of procedural justice experienced by individuals at the time of involuntary admission and whether this influenced future engagement with the mental health services.
Over a 15-month period, individuals admitted involuntarily were interviewed prior to discharge and at one-year follow-up.
Eighty-one people participated in the study and 81% were interviewed at one-year follow-up. At the time of involuntary admission, over half of individuals experienced at least one form of physical coercion and it was found that the level of procedural justice experienced was unrelated to the use of physical coercive measures. A total of 20% of participants intended not to voluntarily engage with the mental health services upon discharge and they were more likely to have experienced lower levels of procedural justice at the time of admission. At one year following discharge, 65% of participants were adherent with outpatient appointments and 18% had been readmitted involuntarily. Insight was associated with future engagement with the mental health services; however, the level of procedural justice experienced at admission did not influence engagement.
This study demonstrates that the use of physical coercive measures is a separate entity from procedural justice and perceived pressures.
European Psychiatry 05/2011; 26(4):208-14. DOI:10.1016/j.eurpsy.2010.01.014 · 3.44 Impact Factor
"Admissions formally defined as voluntary are often the outcome of a complex process involving advice, persuasion, pressure and threats from patients' families or professionals (Kjellin et al., 2004). Hence, the legal status of admission is only a crude proxy for experienced coercion and many 'voluntary' patients feel excluded from treatment decisions and psychologically forced into hospitalisation (Sorgaard, 2007; Bindman et al., 2005). 'Procedural justice' (i.e. the perception of being respectfully involved in a fair decision-making process regarding admission) has been identified as predicting lower perceived coercion at admission among involuntary patients or mixed groups of involuntary and voluntary patients (Bennett et al., 1993; Lidz et al., 1995; Hiday et al., 1997; Lidz et al., 1998; McKenna et al., 2001). "
[Show abstract][Hide abstract] 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.
Psychiatry Research 05/2011; 187(1-2):275-82. DOI:10.1016/j.psychres.2011.01.001 · 2.47 Impact Factor
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