Dignity, coercion and involuntary psychiatric care: a study of involuntary and voluntary psychiatry inpatients in Dublin

Plunkett, Róisín; O’Callaghan, Aoife K; Kelly, Brendan D.

doi:10.1080/13651501.2021.2022162

Cited by 5 publications

(3 citation statements)

References 46 publications

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“…It is possible that patients showing greater negative symptoms, probably linked to more prominent, disease-related cognitive impairments, are more vulnerable to the psychological impact of coercive measures and have difficulties to understand and interpret the context of the interventions. This is line with a recent research that showed that negative symptoms were associated with a lower feeling of dignity in inpatient care [ 29 ]. Another work by Horvath et al (2018), also showed that lower levels of insight and higher levels of negative symptoms were both correlated with a higher perceived coercion regarding treatment in forensic setting [ 30 ].…”

Section: Discussionsupporting

confidence: 93%

Relationship between perceived coercion and perceived justification of coercive measures – secondary analysis of a randomized-controlled trial

Wullschleger,

Vandamme,

Mielau

et al. 2023

BMC Psychiatry

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Background Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients’ appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients’ appraisal of the justification of coercive measures and their level of perceived coercion. Methods This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants’ appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. Results 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). Conclusions Patients’ perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.

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Section: Discussionsupporting

confidence: 93%

Relationship between perceived coercion and perceived justification of coercive measures – secondary analysis of a randomized-controlled trial

Wullschleger,

Vandamme,

Mielau

et al. 2023

BMC Psychiatry

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“…Nevertheless, certain house rules that are common in psychiatric inpatient settings and not strictly necessary for safety (for example, restricting access to mobile phones or designating bedrooms as off limits during the day) risk increasing patients' experience of coercion and contravening their dignity without proportionate benefit. 13,15 It is therefore vital that restrictions on patients' freedom are limited to those that are essential, proportionate, and justifiable.…”

Section: Discussionmentioning

confidence: 99%

“…Patients' subjective experience of coercion is negatively correlated with their perception of dignity. 13 In addition, environmental restrictions are associated with increased risk of self-harm. 5,14 More generally, factors such as feeling controlled by staff, having requests denied by staff, and experiencing restrictive practices are antecedents to self-harm in psychiatric inpatient units.…”

Section: Safe Healing Spacesmentioning

confidence: 99%

Should Dignity Preservation Be a Precondition for Safety and a Design Priority for Healing in Inpatient Psychiatry Spaces?

2024

AMA Journal of Ethics

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Therapeutic security in inpatient psychiatric settings requires careful planning and implementation if it is to support patients' safety and dignity. This commentary on a case considers patients' dignity experiences when restrictions on their freedom are used to keep them safe.Case BL is a 48-year-old woman suffering an initial episode of severe depression. She has been contemplating ending her life and, at her sister's urging, agrees to voluntary inpatient admission to be treated for depression. To her horror, she is asked to remove and relinquish her bra, her drawstring sweatpants, and her shoelaces, since straps and strings are viewed as a ligature risk. She is admitted, alone, and feels stripped and ashamed. Wearing no bra and ill-fitting hospital-issued clothing and footwear, she meets Dr Psych for the first time.

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How do decision making and fairness mediate the relationship between involuntary hospitalisation and perceived coercion among psychiatric inpatients?

Morandi,

Silva,

Pauli

et al. 2024

Journal of Psychiatric Research

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Dignity, coercion and involuntary psychiatric care: a study of involuntary and voluntary psychiatry inpatients in Dublin

Cited by 5 publications

References 46 publications

Relationship between perceived coercion and perceived justification of coercive measures – secondary analysis of a randomized-controlled trial

Relationship between perceived coercion and perceived justification of coercive measures – secondary analysis of a randomized-controlled trial

Should Dignity Preservation Be a Precondition for Safety and a Design Priority for Healing in Inpatient Psychiatry Spaces?

How do decision making and fairness mediate the relationship between involuntary hospitalisation and perceived coercion among psychiatric inpatients?

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