The association between perceived coercion on admission and formal coercive practices in an inpatient psychiatric setting
Open accessAbstract
Involuntary care is a feature of mental health services around the world. In addition to involuntary admission and treatment, specific coercive practices include seclusion and physical restraint. Our study aimed to determine the relationships, if any, between these practices and perceived coercion on admission among psychiatry inpatients in Ireland, as well as any relationships between perceived coercion on admission and variables such as age, gender and diagnosis. We included 107 psychiatry inpatients aged 18 years or over who were admitted to the acute psychiatry admission units in Tallaght University Hospital and Connolly Hospital, Dublin, Ireland over a 30-month period between September 2017 and February 2020. Over a quarter (27.1%) of participating patients had involuntary status; nine (8.4%) had experienced at least one episode of seclusion, and ten (9.3%) had experienced at least one episode of restraint. Perceived coercion on admission was significantly associated with involuntary status and female gender; perceived negative pressures on admission were significantly associated with involuntary status and positive symptoms of schizophrenia; perceived procedural injustice on admission was significantly associated with fewer negative symptoms, involuntary status, cognitive impairment and female gender; and negative affective reactions to hospitalisation on admission were significantly associated with birth in Ireland and being employed. Total score across these four subscales was significantly associated with involuntary status and positive symptoms, and had borderline significant associations with birth in Ireland, being employed and female gender. Overall, perceived coercion on admission, assessed in retrospect by the patient, is more closely associated with involuntary status and symptoms than it is with subsequent formal coercive practices, such as seclusion and restraint. The role of gender merits particular attention in future research, especially in relation to procedural injustice on admission and perceived coercion on admission.
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Being employed was associated with lower perceived coercion in three studies.
“Being employed was associated with lower perceived coercion in three studies [116,117,137].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [137]
In Results §3.3 (page unavailable), employment had a negative association with the overall Admission Experience Survey score, but the paper describes it as borderline significant (p = 0.047). Employment was not significantly associated with the survey’s perceived-coercion subscale (Table 2). This supports a qualified association with the overall admission-experience measure, not the claim that employment was associated with lower perceived coercion in this study. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPeople are less satisfied with involuntary care as measured by measures of humiliation and negative affective response.
“In general, most literature indicates that people are less satisfied with involuntary care as measured by structured assessment tools including the Client Assessment of Treatment Scale or the Client Satisfaction Questionnaire (10,13,66,104–110) and measures of humiliation and negative affective response (24,110,111).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [24]
Section 3.3 reports that involuntary status was associated with greater perceived coercion, negative pressures and procedural injustice on admission, supporting a less positive experience of involuntary care. But it does not measure satisfaction or humiliation, and it associates negative affective reactions with birthplace and employment rather than involuntary status. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInvoluntary treatment was associated with an increased risk of the admission being perceived as coercive or procedurally unfair when compared to those receiving voluntary care.
“Involuntary treatment is by definition associated with objective coercion, but it was also associated with an increased risk of the admission being perceived as coercive (for example experiencing a lack of control or agency) or procedurally unfair when compared to those receiving voluntary care (10,11,15,18–31).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [24]
Two studies found no association between seclusion or restraint and perceived coercion at admission.
“However, two studies found no association between seclusion or restraint and perceived coercion at admission [137,151]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [137]
While most studies did not find significant associations, ten did report higher levels of perceived coercion among women.
“While most studies did not find significant associations, ten did report higher levels of perceived coercion among women [35,36,45,71,89,94,96,99,112,137].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [137]
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- Authors
- O'Callaghan, A. K., Plunkett, R., & Kelly, B. D.
- Affiliations
- University Hospital Galway (IE)
- Tallaght University Hospital (IE)
- Venue
- International Journal of Law and Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 75
- Pages
- 101680
- ISSN
- 0160-2527 (ISSN-L)
- OpenAlex
- W3132232109
- Cited by
- 12
- References
- 48
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 3 · 2022: 3
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Law and Psychiatry (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- perceived coercion, involuntary admission, seclusion, physical restraint, coercive practices, psychiatric inpatients, procedural injustice, gender differences, schizophrenia symptoms, negative symptoms, cognitive impairment
- MeSH terms
- Mental Disorders, Coercion, Female, Hospitals, Psychiatric, Humans, Inpatients, Psychiatry, Restraint, Physical
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