Which values are important for patients during involuntary treatment? A qualitative study with psychiatric inpatients
Abstract
Involuntary hospital treatment is practised throughout the world. Providing appropriate treatment in this context is particularly challenging for mental health professionals, who frequently face ethical issues as they have to administer treatments in the absence of patient consent. We have explored the views of 59 psychiatric patients who had been involuntarily admitted to hospital treatment across England. Moral deliberation theory, developed in the field of clinical bioethics, was used to assess ethical issues. Interviews were audio recorded and transcribed verbatim, and analysed through thematic content analysis. We have detected a number of circumstances in the hospital that were perceived as potentially conflictual by patients. We have established which patient values should be considered by staff when deliberating on ethically controversial issues in these circumstances. Patients regarded as important having freedom of choice and the feeling of being safe during their stay in the hospital. Patients also valued non-paternalistic and respectful behaviour from staff. Consideration of patient values in moral deliberation is important to manage ethical conflicts. Even in the ethically challenging context of involuntary treatment, there are possibilities to increase patient freedoms, enhance their sense of safety and convey respect.
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Involuntary psychiatric admission and treatment is stigmatizing.
“and stigmatizing [44,46]”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
Some people who have experienced involuntary psychiatric admission and treatment felt they would not have accepted treatment otherwise.
“and others have documented perspectives that participants felt they would not have accepted treatment otherwise [15,46,50]”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
In involuntary psychiatric admission and treatment, people are treated like children.
“being treated like children [15,45,46]”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
Some people who have experienced involuntary psychiatric admission and treatment feel they have benefited from their treatment.
“Some studies have shown that people who have experienced involuntary psychiatric admission and treatment feel they have benefited from their treatment”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
Patients receiving involuntary psychiatric treatment report not being provided information about the reasons for their detention.
“This is not the first study in which patients receiving involuntary psychiatric treatment report not being provided information about the reasons for their detention [15,46]”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
Clinicians listening to, understanding, and respecting patients builds trust and improves quality of care during psychiatric treatment.
“The importance of clinicians listening to, understanding, and respecting patients [15,46] to build trust to improve the quality of care during psychiatric treatment [45] is a common theme in the literature on involuntary psychiatric treatment.”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
Medication and restraints are the main interventions used during involuntary psychiatric admission and treatment, with little use of other beneficial interventions such as psychotherapy and meaningful recreational, educational, or occupational activities.
“As in this study, previous research describes medication [15,44] and restraints [15] as being the main interventions used during involuntary psychiatric admission and treatment, with little use of other interventions that could be beneficial, such as psychotherapy and meaningful recreational, educational, or occupational activities [44,46].”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [46]
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“Previous studies have reported that involuntary inpatient treatment may be experienced by patients as a necessary safety measure [19, 49].”
BackgroundTvang i psykisk helsevern: En sammenligning av holdninger blant pasienter og ansatte
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“…medication [15,44] and restraints [15] as being the main interventions used during involuntary psychiatric admission and treatment, with little use of other interventions that could be beneficial, such as psychotherapy and meaningful recreational, educational, or occupational activities [44,46].”
Influential
- Authors
- Valenti, E., Giacco, D., Katasakou, C., & Priebe, S.
- Affiliations
- Queen Mary University of London (GB)
- Corresponding author
- Valenti, Emanuele
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2013-10-15
- Volume
- 40
- Issue
- 12
- Pages
- 832-836
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W2146415670
- Cited by
- 49
- References
- 26
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 3 · 2016: 2 · 2015: 2
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research (0230072)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- involuntary psychiatric treatment, patient values, moral deliberation, clinical ethics, psychiatric inpatients, patient consent, freedom of choice, patient safety, ethical conflicts, mental health law
- MeSH terms
- Adult, Attitude of Health Personnel, Mental Disorders, Choice Behavior, England, Female, Freedom, Hospitals, Psychiatric, Humans, Informed Consent, Inpatients, Male, Middle Aged, Nurse-Patient Relations, Physician-Patient Relations, Surveys and Questionnaires, Research Design, Sampling Studies, Volition, Personal Autonomy, Ethical Theory, Moral Obligations, Qualitative Research, Patient Safety
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