Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A cross-sectional design was adopted. The Attitudes to Containment Measures Questionnaire (ACMQ) was completed by 1,361 service users and 1,226 staff in acute care mental health services from three regions of England. This provided evaluation of eleven coercive measures (e.g. seclusion) on six dimensions of approval (e.g. indignity, safety) in a large national sample. Comparisons between groups were tested using independent samples t-tests, χ 2 or Spearman correlations. Permanent repository linkResults: Both service users and staff disapproved strongly of mechanical restraint and expressed a relative preference for compulsory intramuscular medication and seclusion. Male staff, older service users and staff who had been involved in implementing coercion expressed greater approval of coercive measures.Conclusion: Mechanical restraint remains highly objectionable to staff and service users in English mental health services despite its widespread acceptance elsewhere in the world.

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

“…Those that have considered ratings of acceptability have shown that staff rate seclusion as less acceptable than nearly every other form of containment and PICU care as one of the most acceptable forms of containment. 4 In our results, transfer to a PICU was rated as the most acceptable form of containment. However, seclusion was rated as less acceptable than transfer to a PICU, intermittent observations, constraint observation, PRN, time out and manual restraint.…”

“…53 Previous studies evaluating the acceptability and/or use of different containment methods in mental health services 4,45,54 have not considered the association between access to seclusion and/or PICUs and acceptability/use of different containment methods. Those that have considered ratings of acceptability have shown that staff rate seclusion as less acceptable than nearly every other form of containment and PICU care as one of the most acceptable forms of containment.…”

“…Previous research has shown that patients rate seclusion as less acceptable than nearly every other form of containment. 4 In line with this finding, a recent report by MIND on acute inpatient care 5 calls for the elimination of seclusion and manual restraint as soon as possible, and their replacement with a system based on co-operation, negotiation and mutual respect.…”

“…45 Surveys have shown variation in the acceptability of different containment methods, with patients and staff having rated seclusion as one of the least acceptable interventions and PICU care is rated as more acceptable than seclusion, but is still not the most acceptable of interventions. 4 Despite the negative connotations of seclusion, one study suggested that staff with access to seclusion rated this method of containment as more effective in resolving an emergency than alternative methods of containment used in resolving the same emergency rated by staff from the same hospital (but without access to seclusion). 46 The study suggests that seclusion is regarded as more effective in aiding with emergency situations than other methods of containment; however, these other methods were not described and it is not yet clear what seclusion may be substituted with, when a seclusion unit is not directly available to the ward.…”

Involuntary Hospitalization of Patients With the Diagnostic: Delirium, Dementia and Other Cognitive Impairments.

“…The coercion, traumatizing procedure for the patient, has also a negative impact on the doctor-patient relation (Bonsack, Borgeat, 2007). Some studies followed the patient attitude towards coercion (Whittington et al, 2009), and its correct application in psychiatric care, using monitoring scales of the coercion measures throughout hospitalization (Swartz, Swanson, 2004). Isolation, coercion measure in psychiatry, is a managing the aggressive impulses measure of the patients with psychiatric impairments, as well as their psychomotor agitation.…”