Patients' perception of coercion in acute psychiatric wards. An intervention study.

A project based on the "Breakthrough series" for reducing the patients' perception of coercion in psychiatric acute wards is presented. Three different measures were chosen: 1) engagement of the patients in the formulation of the treatment plan, 2) frequent and regular joint patient and staff evaluations, and 3) renegotiation of treatment plans if necessary. A 5-week baseline was followed by a 12-week intervention period. Anonymously administered self-rating scales were used: the Coercion Ladder and the SPRI questionnaire. Two questions addressing aversive events (verbal and physical) were added. Participation rates were 86% (patients). Data from 190 admissions were analysed. The interventions resulted in only marginal changes in two of eight parameters (the staff's respect and understanding and on total satisfaction with the received help) and no change in experienced coercion. Seclusion accounted for 46% of the explained variance (62%) and participation in the formulation of the treatment plan for only 8% in regression analyses where perceived coercion was the dependent variable; a third of the patients had experienced insulting communication from the staff, and 10% physical harassment during their stay. It was concluded that: 1) the average value of experienced coercion was low, 2) taking part in the planning and evaluation of the treatment had marginal effect on experienced coercion, and 3) the main predictor of felt coercion was seclusion. Actions taken primarily to control behaviour were more strongly related to perceived coercion than aspects of compulsory treatment. More thorough analysis of seclusion and improved routines for its implementation are needed.