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Cited by 84Healthcare Decision-Making and RestraintsEthics in medical practiceEthics and bioethics in healthcare

Coercion in a locked psychiatric ward: Perspectives of patients and staff

Open access
Larsen, Inger B, Terkelsen, Toril B·2014·Nursing Ethics
DOI 10.1177/0969733013503601
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Abstract

BACKGROUND: In spite of a national strategy for reducing coercion in the mental health services, Norway still has a high rate of involuntary treatment compared to other European countries. It is therefore crucial to study various parties involved in involuntary treatment in order to reduce coercion. RESEARCH QUESTION: How do patients and staff in a Norwegian locked psychiatric ward experience coercion? RESEARCH DESIGN: Participant observation and interviews. PARTICIPANTS: A total of 12 patients and 22 employees participated in this study. ETHICAL CONSIDERATIONS: This study is accepted by the National Committee for Medical Health Research Ethics. FINDINGS: The participants experienced coercion in different ways. Patients often felt inferior, while many of the staff felt guilty for violating patients' dignity, although they ascribed responsibility for their actions to the "system." The main themes are (1) corrections and house rules, (2) coercion is perceived as necessary, (3) the significance of material surroundings, and (4) being treated as a human being. DISCUSSION: The discussion draws upon the concepts of vulnerability, guilty conscience, and ethical sensitivity, related to the staffs' divergent views on coercion. CONCLUSION: Especially among staff, there are divergent views of coercion. Professionals being physically and emotionally close to the patient are more likely to understand him or her as a unique person with individual needs. If patients are kept at a distance, professionals as a group change to understand patients as members of a group with common needs and common restrictions.

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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 [104]

    In “Significance of material surroundings” (page not available), a patient likens the locked ward to a prison, and the authors say a medical frame of reference dominated treatment discussions. “Corrections and house rules” reports that rigidly applied rules made many patients feel inferior. The paper studies one ward and does not establish that psychiatric wards were frequently described this way or that medicalization itself caused those feelings. (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 [104]

    In “Corrections and house rules” (page unavailable), the paper reports that many patients found rigidly applied rules provocative and felt diminished by them. It supports the concern about rigid rules, but this study of one ward does not establish that rules and routines were the most consistently reported restrictions across the literature. (LLM, conf=0.84)

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  • 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 [104]

    The 'Corrections and house rules' and 'Significance of material surroundings' sections describe patients experiencing rigid rules, confinement, and ward surroundings as insulting or coercive. The paper also describes patients feeling that staff treated them as less than human. Our copy does not establish resource scarcity or lack of privacy as factors shaping perceptions of coercion (section passages supplied without page numbers). (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Factors that mitigated perceptions of coercion included being treated as an equal human being.

    “Conversely, factors that mitigated perceptions of coercion included being treated as an equal human being [33,104]”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [104]

  • 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 [104]

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Authors
Larsen, I. B., & Terkelsen, T. B.
Affiliations
University of Agder (NO)
ORCID
Terkelsen, Toril B
Venue
Nursing Ethics
Publisher
SAGE Publications
Published
2013-10-07
Volume
21
Issue
4
Pages
426-436
ISSN
  • 0969-7330 (ISSN-L)
  • 1477-0989
DOI
10.1177/0969733013503601
OpenAlex
W2166135452
Cited by
84
References
18
Citations by year
2026: 4 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 5 · 2020: 5 · 2019: 12 · 2018: 10 · 2017: 5 · 2016: 9 · 2015: 4 · 2014: 3 · 2012: 1
FWCI
5.92
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Nursing Ethics (publishedVersion)
  • PubMed (publishedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
coercion, involuntary treatment, psychiatric patients, mental health professionals, patient dignity, vulnerability, ethical sensitivity, professional-patient relationship, Norway
MeSH terms
Attitude of Health Personnel, Coercion, Female, Humans, Inpatients, Interviews as Topic, Male, Medical Staff, Hospital, Norway, Psychiatric Department, Hospital

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