A brief search on Google Scholar reveals thousands of research papers on coercive practice in mental healthcare, primarily focusing on the ethicality of coercion in psychiatric care. The general consensus of the research available is that coercive practice should be avoided whenever possible. However, there is limited research exploring why coercive practice is so commonplace and how its frequency could be reduced.
One study by Müller et al. (2023) explores the relationship between a patient’s clinical and sociodemographic circumstances and the frequency and duration of coercive measures used in their treatment. The study used data from 8,700 patients admitted to a 320-bed psychiatric hospital in Switzerland over three years. Regression models were applied to identify risk factors that correspond with an increase in coercion.
The study found that coercion was bi-variantly linked to specific variables such as male gender, being widowed, having limited German language skills, displaying psychotic and manic episodes, being involuntarily admitted to the hospital, having lower clinical functioning at admission, having previous hospital admissions, and admission being initiated by a medical clinician. Coercive measures were more likely to be used in the first week of a hospital admission.
The study’s findings suggest that some clinical and nonclinical characteristics of a patient, as well as the nature of their hospital admission, may predict the likelihood of coercive measures being used during their hospital stay. It aims to move beyond ethical debate and into practical application. The study presents strengths in its large sample size and potential for practical application, but its limitations lie in the fact that it was conducted in only one hospital, potentially leading to selection bias. Additionally, the classification measurements used were not all objective.
The study’s findings have limited implications for psychiatry at ground level beyond the specific hospital where the research was conducted. The authors’ ambitious drive for results that could impact patients’ treatment programmes is hindered by the study’s limitations, preventing its results from being applied to a wider population.
