Legal Aspects of the Use of Coercive Measures in Psychiatry

Albrecht, Hans-Jörg

doi:10.1007/978-3-319-26748-7_3

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…The nature of these restrictions can have significant impacts upon patient recovery. Such restrictions can be counter to human rights ideals (55), best practices, and contemporary models of rehabilitation such as the recovery approach (17) and the Good Lives Model (56). Accordingly, a measure of patient experiences of these restrictions is warranted.…”

Section: Discussionmentioning

confidence: 99%

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

et al. 2019

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Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = −0.72) and ward climate (Spearman's ρ = −0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.

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Section: Discussionmentioning

confidence: 99%

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

et al. 2019

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“…The common reasons for utilizing such measures on patients are reported to be violent/aggressive behaviour, agitation and/or verbal threats directed at staff (Duxbury & Whittington, ; Stewart, Bowers, Simpson, Ryan, & Tziggili, ; Laiho et al., ; Hallett, Huber, & Dickens, ). The mental health laws in most countries consider coercion to be acceptable in emergency situations to prevent harm to the patients themselves, other patients or staff (Albrecht, ). However, use is controversial, as the most recent Cochrane review shows no strong evidence of the value of seclusion and restraint (i.e., Sailas & Fenton, ), and serious physical and mental consequences from the use of coercive measures have been consistently reported (e.g., Tinetti, Liu, & Ginter, ; Evans, Wood, & Lambert, ; Mohr, Petti, & Mohr, ; Hui, Middleton, & Vollm, ; Steinert, Birk, Flammer, & Bergk, ).…”

Section: Introductionmentioning

confidence: 99%

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

Tingleff

Bradley²,

Gildberg

et al. 2017

Psychiatric Ment Health Nurs

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Introduction There is a lack of research into psychiatric patients' perceptions of coercion that discriminates between different types of coercive measures, while also investigating patients' perceptions of undergoing coercion as a process. This knowledge is required to improve our understanding and provide a foundation for improving clinical practice. Aims To review existing research literature in order to investigate adult psychiatric patients' reported perceptions of situations before, during and after specific and defined types of coercive measures, and to investigate what patients perceive as moderating factors, in regard to the use of these coercive measures. Method A systematic review and thematic analysis of 26 peer-reviewed studies was undertaken. Results The analysis identified six themes and additional subthemes, where "interactions with professionals" and "communication" were predominant themes across the timeline of coercion. Altogether, themes were associated with either "positive or negative patient-perceived impact." Implications for practice Increased sensitivity to patients' views of the situation at each point in the process is desirable in order to respond to the patients' individual needs. Professionals also need to articulate concern and empathy towards the patient and to improve communication skills before, during and after a coercive incident. Use of de-escalation and noncoercive strategies is required. Relevance statement Coercion within psychiatric/mental health care remains controversial, and repeated international calls have recommended a reduction of their use. This review indicates that greater attention to how patients perceive the use of coercive measures (before, during, and after incidents) needs to be considered in order to improve the evidence-based and clinical practice.

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“…In mental health inpatient settings, restrictive practices remain common and are largely classified into four main types: manual restraint, mechanical restraint, rapid tranquillisation and seclusion [ 3 , 27 ]. Although, most mental health acts consider their use to be acceptable as a last resort to prevent people from harming themselves and/or others [ 28 , 29 ], the practices remain a topic of considerable debate [ 30 , 31 ]. Their use is considered necessary by some mental health professionals to ‘ maintain safety for all ’ [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review

Pedersen

Gildberg

Baker

et al. 2022

Soc Psychiatry Psychiatr Epidemiol

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Purpose To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. Methods A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. Results Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe ( n = 26), Western Pacific ( n = 8), Americas ( n = 3) and South-East Asia ( n = 1). In primary studies, ethnicity was reported according to migrant/national status ( n = 16), mixed categories ( n = 12), indigenous vs. non-indigenous ( n = 5), region of origin ( n = 1), sub-categories of indigenous people ( n = 1) and religion ( n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies ( n = 20), multiple restrictive practices studied concurrently ( n = 17), mechanical restraint ( n = 8), rapid tranquillisation ( n = 7) and manual restraint ( n = 1). Conclusions Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers’ and clinicians’ understanding of the issue. Further research in this field may improve mental health practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-022-02387-8.

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Legal Aspects of the Use of Coercive Measures in Psychiatry

Cited by 8 publications

References 15 publications

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review

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