Good coercion: Patients' moral evaluation of coercion in mental health care

Abstract

The use of coercion in mental health care is not self-evident and requires moral justification. A joint understanding is difficult to achieve, because patients and health professionals often evaluate coercion differently. The present study aims to discuss patients' 'moral' evaluation of coercion. We believe that such a focus can form the basis for a better and more differentiated understanding of how we evaluate coercion. This is a qualitative study based on participant observation and interviews with patients. In order to focus specifically on the moral evaluation of coercion, we looked within patients' narratives to examine whether we could differentiate between how they experienced coercion and how they morally evaluated its use, and how they envision/describe good coercion. We found that patients differentiated implicitly between experiences and moral evaluation. The findings have been ordered into three types of reactions: agreeing and accepting, fighting or resisting, and resignation. Further reflection upon patients' positive and negative moral evaluations of coercion resulted in the formulation of different concrete elements at three levels: threshold elements, process elements, and empathic elements. These elements helped us to understand what these patients considered 'good coercion'. The implications are that good clinical practice cannot be separated from the formal, moral evaluation of coercion. A differentiated moral understanding of coercion can form the basis for better and more sensitive communication about coercion among all those involved. A more respectful dialogue on the moral evaluation of coercion might also raise awareness during both the decision-making process and the actual practising of coercion.

Two approaches, one goal: How mental health registered nurses' perceive their role and the role of peer support workers in facilitating consumer decision‐making

“…; Lorem et al . ; Muskett ). Involuntary admission often means opportunities to contribute to decision‐making either do not exist or are heavily restricted, and even voluntary admissions can be met with restricted capacity to participate in decision‐making (Norvoll & Pedersen ).…”

Staff’s normative attitudes towards coercion: the role of moral doubt and professional context—a cross-sectional survey study

“…Reluctance to use coercion may even deny the patient the help and care that he/she sometimes desperately needs [7]. Others suggest that pro and contra arguments should be weighed: the use of coercive measures can be morally acceptable as long as “ the ‘benefits’ with regard to protection or treatment outweigh the ‘negative effects’ on patients’ autonomy, integrity and comfort ” [8] (p. 231). In a Dutch empirical-ethics study, eight normative guidelines with respect to when and how to use coercive measures in a right way have been developed [9, 10].…”

“…At the same time, many studies point to the harm caused by the use of coercive measures for both patients, their family members, as well as their care providers [16–24]. Other studies show that some patients in retrospect report that coercion was a ‘correct’ or even ‘necessary’ approach in a given situation [8, 25], and that patients and relatives even may blame professional caregivers for using coercive measures too little, too late or too short [26, 27]. Hence, despite the increasing empirical studies pointing towards the negative aspects of the use of coercion, it remains difficult to determine the moral justification of the use of coercion in particular situations.…”

Traversing the Services: A Constructivist Grounded Theory of Admission in Two Adult Acute Mental Health Inpatient Wards

“…This may be unsurprising; nevertheless increased patient satisfaction scores were observed when coercive measures were perceived by patients to restore autonomy [21]. Research further highlights that service-users who are subjected to the Mental Health Act (1983;amended 1995 and [23,24] may resist efforts to engage in therapeutic discussion and in some cases perceive coercive treatment as unnecessary [10, [25][26][27].…”

“…Carers also encounter difficulties accessing information from mental health professionals who routinely identify the issue of patient confidentiality as validation for carer exclusion [31]. Research further suggests that patient satisfaction levels are positively influenced by the sincere and open communication of staff, and the validation of the patient's perspective by staff members [27,32]. However, the Adult Inpatient Survey (2015) highlighted that 17% of mental health service-users didn't feel actively involved with shared decision-making (SDM) in comparison with 8% of service-users without mental health conditions [33].…”