Guru S Gowda1, Eric O Noorthoorn2, Channaveerachari Naveen Kumar3, Raveesh Bevinahalli Nanjegowda4, Suresh Bada Math3. 1. Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. Electronic address: drgsgowda@gmail.com. 2. Project leader Dutch Case Register on Containment Measures located Den Dolder Utrecht, the Netherlands and Senior Researcher at GGNet Community Mental Health Centre, PO Box 2003, 7230 GC Warnsveld, The Netherlands. 3. Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. 4. Dharwad Institute of Mental Health and Neurosciences, (DIMHANS), Belgaum Road, Dharwad 580008, India.
Abstract
BACKGROUND: The current Mental Health Care Bill (MHCB) -2013 in India advocates least restrictive alternatives (LRA) in psychiatric treatment. However, we have little evidence on patient's perspectives of coercion and LRA. METHODOLOGY: This was a hospital-based prospective pilot study. 170 subjects chosen by computer-generated random number sampling were screened. In 83 eligible subjects, all assessments including coercion assessment were completed within 3 days of admission and in 75 subjects reassessment was done within 3 days of discharge. RESULTS: Perceived coercion as measured by the MacArthur Perceived Coercion Scale (MPCS) decreased significantly from 3.72±1.98 at admission to 1.77±1.8 (<0.001) at discharge. This was accompanied by significant increase in global functioning, insight score (from 1.5±1.0 to 3.8±1.1; p<0.001) and as well as decrease in symptom severity (CGI-S) (from 5.9±1.1 to 1.8±1.9; p<0.001). Coercion is predicted by family type, employment status, socio economic status, severity of illness and level of insight. 87% patients reported that their admission was justified even though many felt coerced during hospital stay. CONCLUSION: Coercion is a dynamic state and changes with treatment and care. Clinical care may result in an improvement in global functioning, insight as well as in reduction in severity of illness consequently leading to less coercion. During the time of discharge, majority of patients reported that their admission was justified, even though they felt coerced during hospital stay and agreed for treatment against their will within a safe, standardised coercive practice.
BACKGROUND: The current Mental Health Care Bill (MHCB) -2013 in India advocates least restrictive alternatives (LRA) in psychiatric treatment. However, we have little evidence on patient's perspectives of coercion and LRA. METHODOLOGY: This was a hospital-based prospective pilot study. 170 subjects chosen by computer-generated random number sampling were screened. In 83 eligible subjects, all assessments including coercion assessment were completed within 3 days of admission and in 75 subjects reassessment was done within 3 days of discharge. RESULTS: Perceived coercion as measured by the MacArthur Perceived Coercion Scale (MPCS) decreased significantly from 3.72±1.98 at admission to 1.77±1.8 (<0.001) at discharge. This was accompanied by significant increase in global functioning, insight score (from 1.5±1.0 to 3.8±1.1; p<0.001) and as well as decrease in symptom severity (CGI-S) (from 5.9±1.1 to 1.8±1.9; p<0.001). Coercion is predicted by family type, employment status, socio economic status, severity of illness and level of insight. 87% patients reported that their admission was justified even though many felt coerced during hospital stay. CONCLUSION: Coercion is a dynamic state and changes with treatment and care. Clinical care may result in an improvement in global functioning, insight as well as in reduction in severity of illness consequently leading to less coercion. During the time of discharge, majority of patients reported that their admission was justified, even though they felt coerced during hospital stay and agreed for treatment against their will within a safe, standardised coercive practice.
Authors: B N Raveesh; S Pathare; P Lepping; E O Noorthoorn; G S Gowda; J G F Bunders-Aelen Journal: Indian J Psychiatry Date: 2016-12 Impact factor: 1.759
Authors: B N Raveesh; S Pathare; E O Noorthoorn; G S Gowda; P Lepping; J G F Bunders-Aelen Journal: Indian J Psychiatry Date: 2016-12 Impact factor: 1.759
Authors: Mark H de Jong; Margreet Oorschot; Astrid M Kamperman; Petra E Brussaard; Esther M Knijff; Roland van de Sande; Arthur R Van Gool; Cornelis L Mulder Journal: BMC Psychiatry Date: 2017-10-24 Impact factor: 3.630
Authors: Guru S Gowda; Abel Thamby; Vinay Basavaraju; R Nataraja; Channaveerachari Naveen Kumar; Suresh Bada Math Journal: Indian J Psychol Med Date: 2019 Mar-Apr
Authors: Guru S Gowda; Peter Lepping; Sujoy Ray; Eric Noorthoorn; Raveesh Bevinahalli Nanjegowda; Channaveerachari Naveen Kumar; Suresh Bada Math Journal: Indian J Psychiatry Date: 2019 Mar-Apr Impact factor: 1.759