The Use of Coercion in Clinical Mental Health Practice
Coercive psychiatric treatment is one of the most controversial practices in medicine with some arguing that it is unfortunately necessary and others arguing that it is unjustified torture. Further research is required to inform clinical decision-making and service development.
In study one, I aim to determine predictors and associations of coercion during admission. In study two, I aim to determine the impact of coercion during admission on outcomes one year after discharge. In study three, I aim to illuminate patient perspectives on coercion. In study four, I aim to determine the number of psychiatric hospitals in which security personnel were noted in inspection reports and describe the main themes of those notes.
This thesis comprised of four studies which emerged from a mix of three methods: observational cohort design (study one and two), thematic analysis of qualitative interviews (study three) and content analysis of inspection reports (study four).
Lower functioning predicted more accumulated coercive events during admission. Higher levels of accumulated coercive events and male gender during admission predicted more inpatient days between discharge and one year follow up. Patients conceptualised pressure primarily as an affective state characterised by intense feelings of stress. Patients experienced this stress across a broad range of contexts throughout their mental health treatment including administration of medication and involuntary admission. The number of psychiatric hospitals in which security personnel were noted increased from 3% - 8% between the years 2008 – 2012. Inconsistent employment details, differing role functions, contrasting perceptions of suitability and unmet training needs in relation to security personnel was evident across inspection reports.
Coercion is unfortunately common in clinical mental health practice but it remains unclear if it leads to clinical or social improvements. Opportunities to conduct randomised controlled trials on coercive interventions should be explored further.