Patients’ Preference and Experiences of Forced Medication and Seclusion

Abstract

This study examined patients’ preferences for coercive methods and the extent to which patients’ choices were determined by previous experience, demographic, clinical and intervention-setting variables. Before discharge from closed psychiatric units, 161 adult patients completed a questionnaire. The association between patients’ preferences and the underlying variables was analyzed using logistic regression. We found that patients’ preferences were mainly defined by earlier experiences: patients without coercive experiences or who had had experienced seclusion and forced medication, favoured forced medication. Those who had been secluded preferred seclusion in future emergencies, but only if they approved its duration. This suggests that seclusion, if it does not last too long, does not have to be abandoned from psychiatric practices. In an emergency, however, most patients prefer to be medicated. Our findings show that patients’ preferences cannot guide the establishment of international uniform methods for managing violent behaviour. Therefore patients’ individual choices should be considered.

Understanding Mental Health Service User Experiences of Restraint through Debriefing: A Qualitative Analysis

“…Literature suggests that inpatients have varying perceptions of different types of restraint. 38,39 Therefore, it is possible that the findings of our study would be different if the contents of the forms were analyzed according to which form of restraint the inpatient experienced. However, it is clear that, generally, inpatients experience any type of restraint as negative.…”

Use of Coercive Measures during Involuntary Psychiatric Admission and Treatment Outcomes: Data from a Prospective Study across 10 European Countries

“…A German study that interviewed 90 patients, however, found that mechanical restraint was perceived as ‘more profound’ in its impact on patient satisfaction than involuntary medication [17]. Although some have suggested that there may be cultural and national preferences in attitudes towards coercive measures [18], forced medication was found to be significantly associated with patient disapproval across all 10 countries in the EUNOMIA study, which would suggest that the impact of national and cultural differences may be limited.…”

Patient Experience of Coercive Measures

“…These are not results the psychiatric services can be proud of. It should be obvious that patients' opinions need to be taken into account when making treatment decisions, even those concerning restriction (Bergk et al 2011;Georgieva et al 2012). We need to listen to patients in a similar way we listen to others.…”

“…Adaptation to the illness and treatment system as well as experiences of earlier coercive measures have been shown to influence patients' perception of coercive measures (Hoekstra et al 2004;Georgieva et al 2012). Patients hospitalised more than once might be more familiar with the treatment system, adapted to their symptoms to some extent and had lowered their expectations of their living conditions and well-being (Kahneman et al 2004).…”