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Cited by 84Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesEthics and bioethics in healthcare

Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study

Katsakou, Christina, Marougka, Stamatina, Garabette, Jonathan, Rost, Felicitas, Yeeles, Ksenija, Priebe, Stefan·2011·Psychiatry Research
DOI 10.1016/j.psychres.2011.01.001
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Abstract

This study aimed to investigate factors linked to perceived coercion at admission and during treatment among voluntary inpatients. Quantitative and qualitative methods were used. Two hundred seventy patients were screened for perceived coercion at admission. Those who felt coerced into admission rated their perceived coercion during treatment a month after admission. Patient characteristics and experiences were tested as predictors of coercion. In-depth interviews on experiences leading to perceived coercion were conducted with 36 participants and analysed thematically. Thirty-four percent of patients felt coerced into admission and half of those still felt coerced a month later. No patient characteristics were associated with perceived coercion. Those whose satisfaction with treatment increased more markedly between baseline and a month later were less likely to feel coerced a month after admission. In the qualitative interviews three themes leading to perceived coercion were identified: viewing the hospital as ineffective and other treatments as more appropriate, not participating in the admission and treatment and not feeling respected. Involving patients in the decision-making and treating them with respect may reduce perceived coercion.

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  • Some studies found no significant association between perceived coercion and legal status at admission.

    “However, some studies found no significant association between perceived coercion and legal status at admission [54,89,156]”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [89]

    The Introduction (p. 1) says legal status is only a crude proxy for experienced coercion, and the Results (p. 3) report that 34% of legally voluntary patients felt coerced at admission. But the study included only voluntary patients, so it did not test whether perceived coercion was significantly associated with legal status at admission. (LLM, conf=0.82)

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  • Additional concerns included inadequate information about treatment and rights, lack of involvement in decision-making, and limited choices and options.

    “Additional concerns included inadequate information about treatment and rights, lack of involvement in decision-making, and limited choices and options [49,89,149,153,161].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [89]

    Section 3.2.1 (p. 4) reports that patients felt inadequately informed, insufficiently involved in treatment decisions, and unable to choose between options. The paper also describes treatment decisions being presented without explanation (p. 5), but the passages do not establish that patients lacked information about their rights. (LLM, conf=0.85)

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  • Rigid rules and routines were the most consistently reported as restrictive in the literature.

    “it was the rigid rules and routines that were most consistently reported as restrictive in the literature [51,89,102,104,114,141,142,145,149,152,153,161].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [89]

    In §3.2.1 (p. 5), patients describe having to follow an unexplained hospital routine, including fixed meal times and no choice about medication timing. This supports the idea that routines felt restrictive to these patients, but the study does not establish that rigid rules and routines were the most consistently reported restriction across the literature. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The experience was particularly distressing when patients were not informed of the rules yet penalized for breaking them or when staff enforced policies rigidly rather than flexibly.

    “The experience was particularly distressing when patients were not informed of the rules yet penalized for breaking them [89,141] or when staff enforced policies rigidly rather than flexibly [104,153,161].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [89]

    In §3.2.1 (p. 5), patients describe having to follow a hospital routine they had not been introduced to, and one patient says staff would not adjust the timing of a sleeping pill. This supports the lack of explanation and inflexibility, but the paper does not say patients were penalized for breaking unknown rules. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • These studies shed light on how structural factors such as rigid ward rules, locked units, lack of privacy, resource scarcity, and dehumanizing practices deeply influence individuals' perceptions of coercion.

    “For instance, these studies shed light on how structural factors such as rigid ward rules, locked units, lack of privacy, resource scarcity, and dehumanizing practices deeply influence individuals’ perceptions of coercion [51,89,102,104,114,141,142,145,149,152,153,161].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [89]

    In §3.2.1 (pp. 3, 5), patients linked perceived coercion to confinement, lack of privacy, inflexible routines, and feeling disrespected or dehumanized by staff. The paper does not identify resource scarcity as a factor, and its account of feeling 'locked up' does not establish that the units themselves were locked. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. American Psychiatric, Association, 1994. Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. American Psychiatric Association, New York.

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Authors
Katsakou, C., Marougka, S., Garabette, J., Rost, F., Yeeles, K., & Priebe, S.
Affiliations
  • University of London (GB)
  • St George's, University of London (GB)
  • The Tavistock and Portman NHS Foundation Trust (GB)
  • Warneford Hospital (GB)
Corresponding author
Katsakou, Christina
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2011-05
Volume
187
Issue
1-2
Pages
275-282
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2011.01.001
OpenAlex
W2111853734
Cited by
84
References
36
Citations by year
2026: 1 · 2025: 8 · 2024: 6 · 2023: 7 · 2022: 1 · 2021: 5 · 2020: 7 · 2019: 10 · 2018: 5 · 2017: 3 · 2016: 6 · 2015: 7 · 2014: 3 · 2013: 8 · 2012: 3
FWCI
5.87
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Psychiatry Research (publishedVersion)
  • PubMed (publishedVersion)
  • Staff Publications Online (The Tavistock and Portman) (acceptedVersion)
  • Open Research Online (The Open University) (submittedVersion)
Funders
European Commission (Quality of life and Management of Living Resources Programme (QLG4-CT-2002-01036)
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 › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
perceived coercion, voluntary admission, involuntary hospitalisation, psychiatric inpatients, patient experience, treatment satisfaction, patient involvement in treatment decisions, respect for patients
MeSH terms
Adult, Mental Disorders, Coercion, Emotions, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Patient Admission, Perception, Prospective Studies, Regression Analysis, Retrospective Studies, Observation, Young Adult

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