Users’ Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study
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INTRODUCTION: Coercion influences mental health services users' experience of care and can hinder their recovery process, so it is essential to understand how it is perceived in rehabilitation settings oriented towards recovery. AIM: To describe and measure users' experience of coercion and explore their perception of the treatment received in an inpatient medium-stay psychiatric rehabilitation unit (IMSPRU). METHOD: This study, in which 75 service users participated, used a mixed methods approach. Twenty participants were administered a semistructured interview and completed quantitative measures for coercion and 55 additional service users completed the quantitative measurements only. The perception of coercion was measured using the Coercion Experience Scale. RESULTS: The content analysis of qualitative data resulted in two main themes: treatment received and experience of coercion in the IMSPRU. The participants made a distinction between good treatment and mistreatment or unfair treatment. Experience of coercion in the IMSPRU included the feeling of freedom or lack thereof in the unit, forms of formal and informal coercion, and the positive or negative impact of rules on the unit. The quantitative data revealed a low perception of formal coercion among the users. DISCUSSION: Individuals had different views of what it meant to be treated well, but all agreed on the importance of communication and the need to feel respected. Informal coercion was the most frequent type of coercion identified, but users were often unaware of its existence. IMPLICATIONS FOR PRACTICE: Knowledge of how IMSPRU users experience the treatment received from nursing staff and how they perceive coercive situations will help to lay the foundations of a system of care oriented towards good treatment and noncoercive practices.
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Psychiatric wards were frequently described as carceral and overly medicalized, contributing to feelings of inferiority.
“Psychiatric wards were frequently described as carceral [104,153,161] and overly medicalized, contributing to feelings of inferiority [104].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [161]
The Qualitative Results (page unavailable) include a participant comparing the unit to a prison, and the Discussion says some users felt imprisoned and stripped of dignity. The paper does not establish that wards were frequently described this way, nor does it describe them as overly medicalized or link medicalization to feelings of inferiority. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdditional 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 [161]
The Qualitative Results (page not provided) describe users feeling unable to make decisions or freely refuse medication, and the Implications for Practice say that disregarding their preferences in rehabilitation planning led to feelings of unfair treatment or coercion. The paper also calls for explaining rules and informing users of their rights, but the passages do not establish inadequate information about treatment and rights as a reported concern. (LLM, conf=0.84)
Experimental — accuracy not yet measuredStudies focusing on procedural justice and informal coercion emphasized key relational dimensions that either contribute to or alleviate feelings of coercion, including transparent and bidirectional communication and information sharing, trust in professionals' intentions and competence, and avoidance of interventions based on threats, manipulation, or other forms of informal coercion.
“Studies focusing on procedural justice and informal coercion further emphasized key relational dimensions that either contribute to or alleviate feelings of coercion. These include transparent and bidirectional communication and information sharing, trust in the professionals’ intentions and competence, and the avoidance of interventions and approaches based on threats, manipulation, or other form”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [161]
The Discussion (page unavailable) links feelings of coercion to interpersonal treatment and reports participants identifying manipulation, blackmail and threats in communication with staff. The Introduction and Implications for Practice (pages unavailable) support transparent communication, explaining rules and taking users’ preferences into account. The paper does not specifically establish trust in professionals’ intentions and competence as a dimension of perceived coercion. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPatients perceived coercion when they were manipulated, persuaded, blackmailed, or restricted from accessing or managing their own affairs.
“when they were manipulated, persuaded, blackmailed, or restricted from accessing or managing their own affairs [161]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [161]
Some patients reported receiving unclear or manipulated information, leading to feelings of loss of control and objectification.
“Some patients reported receiving unclear [163] or manipulated [161] information, leading to feelings of loss of control and objectification [153].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [161]
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 [161]
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Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review
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Ros, M. C., González-Moret, R., Benito, A., & Almodóvar-Fernández, I. (2026) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2026.152257
- Authors
- Aragonés‐Calleja, M., & Sánchez‐Martínez, V.
- Affiliations
- Universitat de València (ES)
- Corresponding author
- Sánchez‐Martínez, Vanessa
- Venue
- Journal of Psychiatric and Mental Health Nursing
- Publisher
- Wiley
- Published
- 2024-10-27
- Volume
- 32
- Issue
- 2
- Pages
- 467-481
- ISSN
- 1351-0126 (ISSN-L)
- 1365-2850
- PMC
- PMC11891418
- OpenAlex
- W4403796653
- Cited by
- 2
- References
- 52
- Citations by year
- 2026: 1 · 2025: 1
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Psychiatric and Mental Health Nursing (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Keywords
- coercion, psychiatric rehabilitation, user experience, treatment quality, informal coercion, recovery-oriented care, nursing staff communication, respect in care, mental health service users
- MeSH terms
- Psychiatric Rehabilitation, Adult, Mental Disorders, Coercion, Female, Humans, Inpatients, Male, Middle Aged, Psychiatric Department, Hospital, Patient Satisfaction, Qualitative Research, Young Adult
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