Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies
Open accessAbstract
Background: Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. Aims: We determined rates of coercive practices and compared them across countries. Method: We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports. Results: The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints. Conclusions: We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.
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Over-use of coercion is not restricted to settings with scarce resources.
“However, over-use of coercion is not restricted to scarce resource settings 37 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [37]
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Cited by
Sorted by citations
Galderisi, S., Appelbaum, P. S., Gill, N., Gooding, P., Herrman, H., Melillo, A., Myrick, K., Pathare, S., Savage, M., Szmukler, G., et al. (2024) · World Psychiatry · doi:10.1002/wps.21230 · Cited by 76 · see citing works
Self-citation
- Authors
- Savage, M. K., Lepping, P., Newton-Howes, G., Arnold, R., Staggs, V. S., Kisely, S., Hasegawa, T., Reid, K. S., & Noorthoorn, E. O.
- Affiliations
- Victoria University of Wellington (NZ)
- Bangor University (GB)
- Children’s Mercy Research Institute (US)
- Kyorin University (JP)
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
- Radboud University Nijmegen (NL)
- Corresponding author
- Savage, Martha K.
- ORCID
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2024-01
- Volume
- 10
- Issue
- 1
- Pages
- e26-e26
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC10790218
- OpenAlex
- W4390741610
- Cited by
- 72
- References
- 24
- Citations by year
- 2026: 30 · 2025: 25 · 2024: 17
- FWCI
- 35.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BJPsych Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by-nc-nd)
- Radboud Repository (Radboud University) (submittedVersion)
- Victoria University of Wellington
- 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
- coercive practices, restrictive practices, seclusion, physical restraint, involuntary medication, involuntary admission, mental health services, cross-national comparison, monitoring strategies, individual autonomy, OECD
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