Service users’ perspective of their admission: a report of study findings

Abstract

Objectives. The 'Service Users' Perspective of their Admission' study examined voluntarily and involuntarily admitted services users' perception of coercion during the admission process and whether this was associated with factors such as the therapeutic alliance, satisfaction with services, functioning and quality of life. This report aims to collate the findings of the study.Methods. The study was undertaken across three community mental health services in Ireland. Participants were interviewed before discharge and at 1 year using the MacArthur Admission Experience. Caregivers of participants were interviewed about their perception of coercion during the admission.Results. A total of 161 service users were interviewed and of those admitted involuntarily, 42% experienced at least one form of physical coercion. Service users admitted involuntarily reported higher levels of perceived coercion and less procedural justice than those admitted voluntarily. A total of 22% of voluntarily admitted service users reported levels of perceived coercion comparable with involuntarily admitted service users and this was associated with treatment in a secure ward or being brought to hospital initially under mental health legislation. In comparison with the service user, caregivers tended to underestimate the level of perceived coercion. The level of procedural justice was moderately associated with the therapeutic relationship and satisfaction with services. After 1 year, 70% experienced an improvement in functioning and this was not associated with the accumulated level of coercive events, when controlled for confounders.Conclusions. This study has provided valuable insights into the perceptions of coercion and can help inform future interventional studies aimed at reducing coercion in mental health services.

Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study

“…Not surprisingly, several studies (18, 19, 20) have shown that involuntarily admitted patients perceive higher levels of coercion compared to those voluntarily admitted. However, perceived coercion is only partially related to the formal status of admission, and it is confounded by several socio-demographic and clinical variables, including age, ethnicity (perceived coercion is higher in non-white populations), diagnosis, insight of the illness and severity of symptoms (10, 21, 22).…”

Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies

“…Hospitalisation could be perceived as a form of protection or as a violation by both voluntarily and involuntarily hospitalized patients, confirming the limitations of using formal compulsion as a measure of perceived coercion [ [1] , [2] , [3] , [4] , 16 , 76 , 77 ]. Patients who described the hospital experience more positively, often perceived their situation before admission as critical and dangerous for themselves or for others.…”

Refusing Medication Therapy in Involuntary Inpatient Treatment—A Multiperspective Qualitative Study

“…The real concerns of the patients were related to the involuntary hospitalization, the associated restrictions, and how to regain control of their own lives. It is known that the perception of coercion is higher in involuntarily than in most voluntarily hospitalized patients (18), and that it is of particular importance in involuntarily hospitalized inpatients to stay in control and maintain a sense of autonomy (19, 20). As expressed by our respondents, too, perceived loss of autonomy went hand in hand with a more negative relationship between the patients and the clinicians (21).…”