“Voluntarily Admitted Against My Will”: Patient Perspectives on Effects of, and Alternatives to, Coercion in Psychiatric Care for Self-Injury
Open accessAbstract
Introduction: Various forms of coercion are used in the psychiatric care of patients with self-injurious behaviors, but there is little research on how these are perceived by the patients. The aim of this study was to investigate how 6 patients, who had received care for self-injurious behavior, perceived coercion and how they think coercion could be avoided. Methods: This study employed a qualitative design with 6 semistructured interviews and interpretative phenomenological analysis. Results: Three main themes were identified: keep voluntary care voluntary, apportioning control and responsibility, and dialogue and participation. Constant supervision was described as the most destructive form of coercion. To enable self-responsibility, a reduction of control and supervision was advocated. Calls were made for a treatment based on the assumption that there is a desire, on behalf of the patients, to get better. Conclusions: The use of coercion in the psychiatric care of patients with self-injurious behavior can be reduced by increasing predictability, by listening to the patient with genuine interest, and by involving the patient in decisions regarding their treatment.
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Reported threats included the possibility of outpatient commitment, changes in legal status, discharge, changes in medication, unit transfers, negative consequences, and loss of privileges.
“Reported threats included the possibility of outpatient commitment [65], changes in legal status [130], discharge [110], changes in medication [141], unit transfers [130], negative consequences [47], and loss of privileges [68,110,130,141].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [130]
Constant supervision was identified as the most negative form of informal coercion.
“while constant supervision was identified as the most negative form of informal coercion [130].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [130]
Some patients perceived threats as more coercive than formal measures.
“Notably, some patients perceived threats as more coercive than formal measures [130].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [130]
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Cites
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“The degree of perceived coercion has been found to correlate with the patient’s ratings of the therapeutic relationship (12,14).”
BackgroundTherapeutic relationship in the context of perceived coercion in a psychiatric population
Theodoridou, A., Schlatter, F., Ajdacic, V., Rössler, W., & Jäger, M. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.04.012 · Cited by 147 · cited 2× · see citing works
“Also, the respondents’ description of constant supervision as destructive for their experiences of meaning, competence, and responsibility echo previous findings about “being dehumanized” (14).”
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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
- Authors
- Gerle, E., Fischer, A., & Lundh, L.-G.
- Affiliations
- Lund University (SE)
- Corresponding author
- Gerle, Ellen
- Venue
- Journal of Patient Experience
- Publisher
- SAGE Publications
- Published
- 2018-09-18
- Volume
- 6
- Issue
- 4
- Pages
- 265-270
- ISSN
- 2374-3735 (ISSN-L)
- 2374-3743
- PMC
- PMC6908982
- OpenAlex
- W2890202951
- Cited by
- 10
- References
- 9
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 1 · 2020: 1
- FWCI
- 0.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Patient Experience (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lund University Publications (Lund University) (submittedVersion)
- 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 › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- self-harm, coercion in psychiatric care, patient perspectives, involuntary admission, personal responsibility, patient involvement in treatment decisions, alternatives to coercion
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