Perceived Coercion and Psychiatry
An examination of the inpatient admissions process and community mental healthcare
Katie Sheehan and Tom Burns
In recent decades, there has been an increased focus on patients' rights to make free and informed decisions regarding their own medical care. Legislation and policy has changed to reflect this shift in attitude from professional paternalism to patient autonomy (1) .
Theoretically, the principle of patient autonomy applies equally to all medical disciplines. In psychiatry, however, coercive practices are often used to compel patients to accept hospitalization (2;3) . These include the use of legal and extra-legal pressures, like the threat of sectioning using the Mental Health Act. Patients who feel coerced into accepting hospitalization are believed to be less likely to adhere to treatment following discharge from hospital and less likely to seek treatment in the future.
Clinicians are often reported as having the greatest influence on whether patients feel coerced into psychiatric treatment. Few studies, however, have their own perceptions of the admissions process (4). Furthermore, the locus of mental health treatment has also shifted from the hospital to the community. There has been little research examining whether patients feel coerced to accept treatment in this setting and how the use of leverage tools (including mandated community treatment, housing, criminal sanction, child custody, financial management) may affect these perceptions.
My current research comprises of two studies: one investigating the experiences of patients and clinicians during the inpatient admissions process, and a second examining patients perceptions of coercion during treatment in the community.
This study explores the experiences of pressure and coercion in patients and clinicians during the psychiatric hospital admissions process. The first phase was conducted on five general psychiatric wards in the Oxfordshire Mental Healthcare Trust.
Consecutively admitted patients to these wards participate in a semi-structured interview, which includes a range of recognized assessment instruments (3) . These investigate patients' perceptions of pressure, their opinions of those involved in the hospitalization process and their expectations surrounding admission and treatment. A full review of each patient's medical notes allows for the collection of sociodemographic and clinical information.