General and Case-Specific Approval of Coercion in Psychiatry in the Public Opinion

Abstract

Background: Psychiatric patients are subjected to considerable stigmatization, in particular, because they are considered aggressive, uncontrollable, and dangerous. This stigmatization might influence the approval of coercive measures in psychiatry by the public and healthcare professionals and might have an influence on the clinical practice of coercive measures. We examined whether the general approval of coercive measures for psychiatric patients with dangerous behaviors differs from case-specific approval. Method: We conducted a representative survey of the general population (n = 2207) in the canton of Basel-Stadt, Switzerland. In total, 1107 participants assessed a case vignette depicting a fictitious character with a mental illness and indicated whether they would accept coercive measures (involuntary hospitalization, involuntary medication, and seclusion) for the person in the vignette. It was explicitly stated that within the last month, the fictitious character displayed no dangerous behavior (Vignette ND) or dangerous behavior (Vignette D). Another 1100 participants were asked whether they would approve coercive measures (involuntary hospitalization, involuntary medication, and seclusion) for psychiatric patients with dangerous behavior in general (General D), i.e., without having received or referring to a specific case vignette. Findings: The logistic regression model containing all variables explained 45% of the variance in approval of any type of coercive measures. Assessment of case vignettes without dangerous behavior (Vignette ND) was associated with significantly reduced approval of coercive measures compared to assessment of a case vignette with dangerousness (Vignette D), while approval for coercive measures in a person with mental health disorder with dangerous behavior in general (General D) was significantly higher than for the case vignette with dangerousness. Conclusions: The general approval of coercive measures for people with mental disorders seems to differ depending on if the respondents are asked to give a general assessment or to examine a specific and detailed clinical case vignette, indicating an increased role of stigmatization when asking about generalized assessments. This may contribute to diverging findings on the acceptance of coercive measures in the literature and should be considered when designing future studies.

Die Haltung der Öffentlichkeit zu Zwangsmassnahmen bei psychiatrischen PatientInnen

“…Aus den erhobenen Daten wurden bereits Auswertungen zum Bedürfnis nach sozialer Distanz 18 , zur empfundenen Gefährlichkeit 19 , zur Prädiktion der Befürwortung von Zwangsmassnahmen 20 , zum Verhältnis zwischen der Persönlichkeit der Befragten, Stigmatisierung und empfundener Gefährlichkeit 21 und zur fallbezogenen und pauschalen Zustimmung der Bevölkerung zu Zwangsmassnahmen 24 veröffentlicht. Die in der vorliegenden Arbeit berichteten detaillierten Zahlen zur Zustimmung der Bevölkerung zu Zwangsmassnahmen in der Psychiatrie stellen wichtige Informationen für die wissenschaftliche Diskussion dar und sind als Referenzwerte für zukünftige Arbeiten von Relevanz, wurden aber bislang nicht veröffentlicht.…”

“…Aus den erhobenen Daten wurden bereits Auswertungen zum Bedürfnis nach sozialer Distanz [18], zur empfundenen Gefährlichkeit [19], zur Prädiktion der Befürwortung von Zwangsmassnahmen [20], zum Verhältnis zwischen der Persönlichkeit der Befragten, Stigmatisierung und empfundener Gefährlichkeit [21] und zur fallbezogenen und pauschalen Zustimmung der Bevölkerung zu Zwangsmassnahmen [24]…”

Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem

“…To this day, suffering from a mental illness means a double burden for those affected due to the illness itself and the stigmatization of mentally ill people (1,2). Despite the availability of effective treatments, a substantial number of individuals with mental illness continue to experience barriers in seeking and receiving appropriate care (3)(4)(5). Only about one third of individuals with mental illnesses actually seek mental health treatment (6).…”

Patient-reported experience measures (PREMs) in outpatient psychiatry – is there an association to perceived discrimination and devaluation?

“…Previous research suggests that patient satisfaction ratings are influenced by stigmatization ( 18 ). Mental health stigma leads to impaired self-esteem and creates significant barriers to seeking help and accessing appropriate treatment, exacerbating the already challenging experiences faced by those with mental health conditions ( 19 – 26 ). It has been shown to increase co-morbid depression and to influence the course of treatment and dropout rates in psychiatric settings ( 27 – 34 ).…”