Coercion in psychiatry : the effects on the inpatient experience

Abstract

Despite the un-standardised definition, coercion in clinical psychiatry refers to applied actions that influence the patient’s will in acting against their volition. Despite the different forms of coercion, this literature review will focus on the formal means of coercion as defined by Chieze et al. (2021). This includes seclusion and restrictive practices that are regulated and documented. Nevertheless, their use remains controversial due to ethical factors. This literature review will analyse the effects of coercive measures on the inpatient experience of psychiatric patients. Thus, the research question reads: “In adults suffering from psychiatric illnesses will the use of coercion affect the inpatient experience?” The PEO framework consisted of adults suffering from psychiatric illnesses as the population, coercion as the effect and the effects on the inpatient experience as the outcome. The inclusion criteria of the search strategy entailed peer reviewed articles published in the last ten years and available in English. Moreover, the studies had to include adult patients and the effects of coercion in psychiatric settings. Grey literature, anecdotal sources, and articles focusing on staff perceptions or outpatient settings were excluded. Following the search strategy, six studies were selected for their review. These studies were appraised using the CASP, MMAT, and the Rapid Critical Appraisal of a Descriptive Study tools and their ethical considerations were noted accordingly. Despite the indication of the overall negative effects of these measures, their impact on the inpatient experience remains unclear due to several associated factors. Nevertheless, it is highlighted that these measures should be used when other less restrictive alternatives fail. Several recommendations for practice, research, education and policy development were made.