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

Abstract

To assess the association between different types of coercive measures (forced medication, seclusion, and restraint) used during involuntary psychiatric admission and two treatment outcomes: retrospective views of patients towards their admission and length of inpatient stay. A secondary analysis was conducted of data previously gathered by the EUNOMIA study (n = 2030 involuntarily detained inpatients across 10 European countries, of whom 770 were subject to one or more coercive measures). Associations between coercive measures and outcomes were tested through multivariable regression models adjusted for patients' socio-demographic and clinical characteristics. Use of forced medication was associated with patients being significantly less likely to justify their admission when interviewed after three months. All coercive measures were associated with patients staying longer in hospital. When the influence of other variables was considered in a multi-variate analysis, seclusion remained as a significant predictor of longer inpatient stay, adding about 25 days to the average admission. Of the three coercive measures, forced medication appears to be unique in its significant impact on patient disapproval of treatment. While all coercive measures are associated with patients staying longer in hospital, only use of seclusion is associated with longer inpatient stays independently of coerced patients’ having higher symptom scores at the time of admission.

Experience coercion, post‐traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization

“…In terms of treatment satisfaction, the results of the study of McLaughlin et al . () do not coincide with the present study which found that involuntary medication was associated with a higher treatment satisfaction in comparison with combined measures. These inconsistent results may be due to other variables intervening and affecting patients’ perceived satisfaction and coercion.…”

“…In addition, being involuntarily medicated, but not secluded or restrained, has been specifically associated with the patient's disapproval of treatment (McLaughlin et al . ). Furthermore, given the complexity of the subject of study, few studies have analysed the aversive consequences associated with the use of different types of coercive measures.…”

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

“…Coercive measures are widely used in psychiatric settings (McLaughlin, Giacco, & Priebe, ) and have been classified by Völlm and Nedopil () into mainly four types: seclusion, mechanical restraint, physical restraint/holding and forced medication (see definitions in Table ). 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, ).…”

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

“…MR is defined as a device attached to a patient with the aim of restricting movement (McLaughlin et al . ; Völlm & Nedopil ). It is widely recognized that knowledge of patients’ perceptions of coercive measures, for example, MR, is crucial if their use is to be reduced and to ensure evidence‐based patient care (Soininen et al .…”