Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland

Elmer, Timon; Rabenschlag, Franziska; Schori, Dominik; Zuaboni, Gianfranco; Kozel, Bernd; Jaeger, Susanne; Mahlke, Candelaria; Heumann, Kolja; Theodoridou, Anastasia; Jaeger, M.

doi:10.1016/j.psychres.2017.09.014

Cited by 42 publications

(52 citation statements)

References 25 publications

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“…Consequently, the use of compulsory medication is preventable in advance. Solutions may include greater sensitivity to the use of informal coercion, which may represent a precursor of coercive measures and lead to disruptions in the therapeutic relationship ( 56 ). Reducing the consequences of coercive measures could include debriefing of events, which in Switzerland is considered standard ( 40 ) (SAMW guideline).…”

Section: Discussionmentioning

confidence: 99%

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

et al. 2018

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Background: In clinical psychiatric practice, health care professionals (HCP) must decide in exceptional circumstances after the weighing of interests, which, if any, containment measures including coercion are to be used. Here, the risk for patients, staff, and third parties, in addition to therapeutic considerations, factor into the decision. Patients' preference and the inclusion of relatives in these decisions are important; therefore, an understanding of how patients and next of kin (NOK) experience different coercive measures is crucial for clinical decision making. The aim of this study is to compare how patients, HCP, and NOK assess commonly used coercive measures.Methods: A sample of 435 patients, 372 HCP, and 230 NOK completed the Attitudes to Containment Measures Questionnaire (ACMQ). This standardized self-rating questionnaire assessed the degree of acceptance or rejection of 11 coercive measures.Results: In general, HCPs rated the coercive measures as more acceptable than did NOK and patients. The largest discrepancy in the ratings was found in regard to the application of coercive intramuscular injection of medication (effect size: 1.0 HCP vs. patients). However, the ratings by NOK were significantly closer to the patients' ratings compared to patients and HCP. The only exception was the acceptance of treatment in a closed acute psychiatric ward, which was deemed significantly more acceptable by NOK than by patients. Also, patients who had experienced coercive measures themselves more strongly refused other measures.Conclusion: Patients most firmly rejected intramuscular injections, and the authors agree that these should only be used with reservation considering a high threshold. This knowledge about the discrepancy of the ratings should therefore be incorporated into professional training of HCP.

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Section: Discussionmentioning

confidence: 99%

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

et al. 2018

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“…Thirty-two studies focused on coercion; one study examined prevalence of coercive measures141 and one study explored how the experience of staff might contribute to the use of restrictive practices 210. The attitudes of staff,142 144 211–222 patients145 223–226 and mixed groups143 168 227–230 towards coercion were explored in 25 studies, and 5 studies examined the process of coercive interventions139 140 231 232 and rules of engagement in caring for aggressive patients 233…”

Section: Resultsmentioning

confidence: 99%

Patient safety in inpatient mental health settings: a systematic review

et al. 2019

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ObjectivesPatients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.DesignSystematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.ResultsOf the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.ConclusionsPatient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.PROSPERO registration numberCRD42016034057.

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“…Use of coercion implies ethical challenges and may cause moral distress and uncomfortable feelings among mental health care professionals [5,9]. It is usually regarded as exercised on different levels on a continuum of coercion [16] or a hierarchy [8]. Our study indicates that in practice informal coercion may be used in a variety of ways, including but not exclusively limited to the treatment pressures in the commonly-used hierarchy, and not always starting with the least coercive step and if necessary moving on to the next.…”

Section: Discussionmentioning

confidence: 99%

Different forms of informal coercion in psychiatry – a qualitative study

Pelto‐Piri¹,

Kjellin

Hylén

et al. 2019

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Objectives The objective of the study was to investigate how mental health professionals describe and reflect upon different forms of informal coercion. Results In a deductive qualitative content analysis of focus group interviews, several examples of persuasion, interpersonal leverage, inducements, and threats were found. Persuasion was sometimes described as being more like a negotiation. Some participants worried about that the use of interpersonal leverage and inducements risked to pass into blackmail in some situations. In a following inductive analysis, three more categories of informal coercion was found: cheating, using a disciplinary style and referring to rules and routines. Participants also described situations of coercion from other stakeholders: relatives and other authorities than psychiatry. The results indicate that informal coercion includes forms that are not obviously arranged in a hierarchy, and that its use is complex with a variety of pathways between different forms before treatment is accepted by the patient or compulsion is imposed.

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Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland

Cited by 42 publications

References 25 publications

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

Patient safety in inpatient mental health settings: a systematic review

Different forms of informal coercion in psychiatry – a qualitative study

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