Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study

Abstract

This study aimed to investigate factors linked to perceived coercion at admission and during treatment among voluntary inpatients. Quantitative and qualitative methods were used. Two hundred seventy patients were screened for perceived coercion at admission. Those who felt coerced into admission rated their perceived coercion during treatment a month after admission. Patient characteristics and experiences were tested as predictors of coercion. In-depth interviews on experiences leading to perceived coercion were conducted with 36 participants and analysed thematically. Thirty-four percent of patients felt coerced into admission and half of those still felt coerced a month later. No patient characteristics were associated with perceived coercion. Those whose satisfaction with treatment increased more markedly between baseline and a month later were less likely to feel coerced a month after admission. In the qualitative interviews three themes leading to perceived coercion were identified: viewing the hospital as ineffective and other treatments as more appropriate, not participating in the admission and treatment and not feeling respected. Involving patients in the decision-making and treating them with respect may reduce perceived coercion.

Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study

“…The study findings add to a large body of evidence indicating that the patients appreciate receiving support for their mental health problems and having access to a safe place during a crisis [7,[13][14][15]. Nonetheless, they feel aggrieved when they believe that they are not involved in the treatment decisions and that their autonomy is violated [15][16][17][18][19][20][21][22][23].…”

“…Nonetheless, they feel aggrieved when they believe that they are not involved in the treatment decisions and that their autonomy is violated [15][16][17][18][19][20][21][22][23].…”

“…Effective ways to address and negotiate such disagreements remain to be found [34][35][36]. Nonetheless, evidence indicates that when patients believe that their opinions are taken into account and that decisions are made with their best interests in mind, they feel less coerced, even when treated against their will [15,16,[37][38][39][40]. Advance statements might also contribute to patients feeling empowered, valued and more actively involved in their care [23,41].…”

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

“…It is now well recognised that legal status is not synonymous with the level of coercion experienced and more is being learnt about the 'coerced voluntary' group. Katsakou et al (2011) identified that over onethird of voluntarily admitted service users felt coerced into hospital (using a cut-off of 3 on the MacArthur perceived coercion scale) and undertook qualitative interviews with 36 of these service users (Katsakou et al 2011). A number of themes associated with high levels of perceived coercion emerged, including service users viewing the admission and treatments as ineffective not participating in the admission and not feeling respected.…”

Das letzte Mittel? Ein Überblick über die politische Diskussion und den Forschungsstand zum Einsatz medikamentöser Zwangsbehandlung in der Psychiatrie

“…Ferner wird moniert, dass Gespräche nicht oder nicht hinreichend stattgefunden hätten [Andreasson und Skärsäter, 2012;Finzen et al, 1993;Haglund et al, 2003]; zudem werde Behandlung mit Medikation und Verwahrung gleichgesetzt und daher der Wunsch nach einem ganzheitlicheren Behandlungsansatz und psychotherapeutischer Versorgung geäußert [Katsakou et al, 2011;Olofsson und Jacobsson, 2001]. Es fehle zudem an direkten Kontaktpersonen und tragfähigen Beziehungen, die zu einem erhöh-ten Sicherheitsgefühl beitragen könnten [Olofson und Norberg, 2001].…”