Dignity, coercion and involuntary psychiatric care: A study of involuntary and voluntary psychiatry inpatients in Dublin
Abstract
OBJECTIVES: There is a paucity of research about psychiatric inpatients' experience of dignity. Most of the limited literature on this topic is qualitative. Our study provides quantitative data about self-rated dignity among involuntary and voluntary psychiatry inpatients. We explore relationships between perceived dignity and legal status, coercion, level of insight, diagnosis, and therapeutic alliance, among other parameters. METHODS: We recruited 107 participants aged 18 years or over from two inpatient psychiatric units in Dublin, Ireland over a 30-month period. Interviews consisted of structured, validated assessment tools. Demographic and clinical data were obtained from patient charts. RESULTS: Patient Dignity Inventory (PDI) score was non-normally distributed (skewed to the right), with a median score of 63.0 out of 125 (inter-quartile range: 40.0-80.0). On multi-variable testing, lower self-rated dignity was associated with higher perceived coercion, better insight and more negative symptoms. There was no association between dignity and gender, employment status, marital status, ethnicity, age, admission status, diagnosis, working alliance, positive symptoms or cognition. CONCLUSIONS: Lack of dignity is linked with perceived coercion and negative symptoms, and is seen in patients with better insight. These links merit further study if we are to understand patient dignity in a more nuanced and useful way.KEYPOINTSWe interviewed psychiatric inpatients using the Patient Dignity Inventory and other structured assessment tools.There was no significant difference between voluntary and involuntary patient groups' self-rated dignity.Less self-rated dignity was seen in patients with higher levels of perceived coercion.Patients with better insight reported lower dignity.Dignity scores were not significantly associated with age, gender, ethnicity, diagnosis or length of stay in hospital.
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Involuntary treatment was generally associated with longer length of stay than was voluntary care.
“Involuntary treatment was generally associated with longer length of stay than was voluntary care (58,68,89,117–120), with the exception of one study (121).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [120]
Other factors such as logistical and bureaucratic issues or bed availability may also affect length of stay for involuntary patients.
“This may be in part because involuntary treatment is often used for people with more severe illness or with conditions such as psychosis that take a greater period of time to resolve (89,118,119), although other factors such as logistical and bureaucratic issues or bed availability may also affect length of stay for involuntary patients (64,68,120).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [120]
Higher perceived coercion scores were associated with lower self-dignity ratings by patients.
“Additionally, higher perceived coercion scores were associated with lower self-dignity ratings by patients [144]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [144]
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The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review
Corderoy, A., Kisely, S., Zirnsak, T., & Ryan, C. J. (2025) · Psychiatry, Psychology and Law · doi:10.1080/13218719.2024.2346734 · Cited by 19 · see citing works
“Theme 9: Length of stay Involuntary treatment was generally associated with longer length of stay than was voluntary care (58,68,89,117 – 120), with the exception of one study (121).”
Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review
Lessard-Deschênes, C., Pariseau-Legault, P., Billé, V., Sergerie-Richard, S., Hudson, E., Silva, B., Drouin, J.-S., Désilets, M., & Goulet, M.-H. (2025) · Healthcare · doi:10.3390/healthcare13151868 · Cited by 10 · see citing works
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- Authors
- Plunkett, R., O’Callaghan, A. K., & Kelly, B. D.
- Affiliations
- Trinity College Dublin (IE)
- Corresponding author
- Plunkett, R.
- Venue
- International Journal of Psychiatry in Clinical Practice
- Publisher
- Informa UK Limited
- Published
- 2022-01-09
- Volume
- 26
- Issue
- 3
- Pages
- 269-276
- ISSN
- 1365-1501 (ISSN-L)
- 1471-1788
- OpenAlex
- W4206685030
- Cited by
- 13
- References
- 54
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 1
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Psychiatry in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Dignity and Privacy
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- patient dignity, involuntary psychiatric treatment, coercion, psychiatric inpatients, Patient Dignity Inventory, insight, negative symptoms, therapeutic relationship, voluntary admission, legal status
- MeSH terms
- Respect, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Hospitals, Psychiatric, Humans, Inpatients
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