Coercion in psychiatry: A cross‐sectional study on staff views and emotions

• Published in: Journal of psychiatric and mental health nursing Vol. 28; no. 2; pp. 149 - 162
• Main Authors: Krieger, Eva, Moritz, Steffen, Lincoln, Tania M., Fischer, Rabea, Nagel, Matthias
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2021
• Subjects: Attitudes; compulsory treatment; Cross-sectional studies; Emotions; forced medication; involuntary admission; mechanical restraint; Medical personnel; Mental health care; Nursing; Patients rights; Psychiatric-mental health nursing; Questionnaires; seclusion; Germany; seclusion; involuntary admission; mechanical restraint; compulsory treatment; forced medication
• ISSN: 1351-0126; 1365-2850
• DOI: 10.1111/jpm.12643

Accessible summary
What is known on the subject?
Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort.
The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions.
Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression.
Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role.
What the paper adds to existing knowledge?
Most staff members surveyed had a rather critical view of coercion and considered it a “necessary evil.”
Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists.
Emotions play an important role in decision‐making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups.
Staff members consider reflective interventions, such as team supervisions or post‐seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely.
Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI.
What are the implications for practice?
To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions.
Structured post‐seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members’ ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions.
Introduction
Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures.
Aim
The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI.
Method
Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members’ emotions and views on coercion.
Results
Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post‐seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI.
Discussion
The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience).
Implications
The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI.