Refusing Medication Therapy in Involuntary Inpatient Treatment—A Multiperspective Qualitative Study
Open accessAbstract
Objective: From June 2012 to February 2013 two decisions by the Federal Constitutional Court in Germany restricted the so far common practices of using involuntary medication treatment in inpatients who were involuntarily hospitalized. Up to then, involuntary medication was justified by a judge’s decision on involuntary hospital stay and could be applied according to clinical judgment even against the declared will of a patient in those cases. Since then, all domestic laws related to involuntary treatment had to be revised. In an interim time of several months, involuntary medication was only allowed in case of emergency. We were interested in how these limitations affected the experiences of patients, their relatives, and the clinical professionals during that time Methods: 32 interviews were analyzed qualitatively using a Grounded Theory Methodology framework. Results: As a result of the restrictions to involuntary medical treatment special efforts by nursing and medical staff and relatives were required in terms of de-escalation, ward management, promotion of trust and treatment commitment, and coping with the idiosyncrasy and the obvious lack of insight in patients. The family carers were quite concerned about their ill family member and wanted to protect him or her, but at the same time they often welcomed the use of coercion if the patient seemed to lack insight into the condition. Most of the interviewed patients did not perceive their new freedom to refuse medication as such but rather complained about the general limitations they were subjected during involuntary hospitalization. While patients and family members assessed the refusal of medication from a biographical perspective, the mental health care professionals’ focus was on the patients’ symptoms and they understood the situation from a professional perspective. It was obvious that in any of the four perspectives the problem of feeling restricted was crucial and that all groups strived to gain back their freedom of action. Conclusion: In order to prevent compulsion and its negative consequences in inpatient treatment it is indispensable to be aware of the diverging perspectives and to elaborate cooperative and client-centered treatment structures.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A negative attitude towards medication does not represent a symptom of psychotic disorders.
“This confirms the assumption that a negative attitude towards medication does not represent a symptom of psychotic disorders.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [38]
A recent qualitative study found that professionals considered patients' refusal to take medication to be an aspect of their disease, whereas patients and their relatives sorted the refusal into a coherent biographical perspective.
“They found that the professionals considered the patients’ refusal to take medication to be an aspect of their disease and considered medication as a necessary treatment, whereas patients and their relatives sorted the refusal into a coherent biographical perspective.”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [38]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Qualitative research & evaluation methods
Patton, M. Q. (2002) · Sage eBooks · Cited by 15,530 · see citing works
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-013-0528-y · Cited by 12,038 · see citing works
Grounded theory: Grundlagen qualitativer Sozialforschung
Strauss, A. L., Corbin, J. M., Niewiarra, S., & Legewie, H. (1996) · Cited by 1,931 · see citing works
Grounded Theory Research: Procedures, Canons, and Evaluative Criteria
Corbin, J., & Strauss, A. (1990) · Zeitschrift fur Soziologie · doi:10.1515/zfsoz-1990-0602 · Cited by 1,710 · see citing works
The Burden of Schizophrenia on Caregivers
Awad, A. G., & Voruganti, L. N. P. (2008) · PharmacoEconomics · doi:10.2165/00019053-200826020-00005 · Cited by 811 · see citing works
Penttilä, M., Jääskeläinen, E., Hirvonen, N., Isohanni, M., & Miettunen, J. (2014) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.127753 · Cited by 716 · see citing works
Decisional Capacity for Informed Consent in Schizophrenia Research
Carpenter, W. T. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.6.533 · Cited by 506 · see citing works
The Problem-centered Interview
Witzel, A. (2008) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.17169/fqs-1.1.1132 · Cited by 502 · see citing works
Steinert, T., Lepping, P., Bernhardsgrütter, R., Conca, A., Hatling, T., Janssen, W. A., Keski-Valkama, A., Mayoral, F., & Whittington, R. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0132-3 · Cited by 382 · see citing works
Self-citationLysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247 · see citing works
Medication adherence in schizophrenia
Acosta, F. J. (2012) · World Journal of Psychiatry · doi:10.5498/wjp.v2.i5.74 · Cited by 215 · see citing works
Therapeutic 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 1× · see citing works
“As expressed by our respondents, too, perceived loss of autonomy went hand in hand with a more negative relationship between the patients and the clinicians (21).”
BackgroundShiraishi, N., & Reilly, J. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1617-8 · Cited by 142 · see citing works
Tingleff, E. B., Bradley, S. K., Gildberg, F. A., Munksgaard, G., & Hounsgaard, L. (2017) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12410 · Cited by 127 · see citing works
Good communication in psychiatry – a conceptual review
Priebe, S., Dimić, S., Wildgrube, C., Janković, J., Cushing, A. M., & McCabe, R. (2011) · European Psychiatry · doi:10.1016/j.eurpsy.2010.07.010 · Cited by 113 · see citing works
Paksarian, D., Mojtabai, R., Kotov, R., Cullen, B., Nugent, K. L., & Bromet, E. J. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201200556 · Cited by 109 · see citing works
Janković, J., Yeeles, K., Katsakou, C., Amos, T., Morriss, R. K., Rose, D. S., Nichol, P. F., McCabe, R., & Priebe, S. (2011) · PLoS ONE · doi:10.1371/journal.pone.0025425 · Cited by 103 · see citing works
An ethical framework for psychiatry
Bloch, S., & Green, S. A. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.188.1.7 · Cited by 80 · see citing works
S3-Leitlinie Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen
Steinert, T., & Hirsch, S. (2019) · Der Nervenarzt · doi:10.1007/s00115-019-00801-2 · Cited by 72 · see citing works
Self-citationOne-year incidence and prevalence of seclusion: Dutch findings in an international perspective
Noorthoorn, E. O., Lepping, P., Janssen, W. A., Hoogendoorn, A. W., Nijman, H. L. I., Widdershoven, G. A. M., & Steinert, T. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1094-2 · Cited by 68 · see citing works
Self-citationPrice, O., Baker, J. A., Bee, P., Grundy, A. C., Scott, A., Butler, D., Cree, L., & Lovell, K. (2017) · Journal of Advanced Nursing · doi:10.1111/jan.13488 · Cited by 60 · see citing works
Flammer, E., & Steinert, T. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00153 · Cited by 54 · see citing works
Self-citationGibson, S., Brand, S. L., Burt, S., Boden, Z., & Benson, O. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-153 · Cited by 53 · see citing works
Posttraumatic reactions to psychosis: a qualitative analysis.
Lu, W., Mueser, K. T., Rosenberg, S. D., Yanos, P. T., & Mahmoud, N. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00129 · Cited by 52 · see citing works
Murphy, R., McGuinness, D., Bainbridge, E., Brosnan, L., Felzmann, H., Keys, M., Murphy, K., Hallahan, B., McDonald, C., & Higgins, A. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201700008 · Cited by 50 · see citing works
Patients' attitudes towards and acceptance of coercion in psychiatry.
Krieger, E., Moritz, S., Weil, R., & Nagel, M. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.029 · Cited by 49 · see citing works
Flammer, E., & Steinert, T. (2018) · Psychiatrische Praxis · doi:10.1055/a-0665-6728 · Cited by 42 · see citing works
Self-citationFlammer, E., & Steinert, T. (2016) · Psychiatric Services · doi:10.1176/appi.ps.201500476 · Cited by 26 · see citing works
Self-citationIndividuals' experiences of involuntary admissions and preserving control: qualitative study
McGuinness, D., Murphy, K., Bainbridge, E., Brosnan, L., Keys, M., Felzmann, H., Hallahan, B., Mcdonald, C., & Higgins, A. (2018) · BJPsych Open · doi:10.1192/bjo.2018.59 · Cited by 23 · see citing works
Nach der Reform ist vor der Reform
Gerlinger, G., Deister, A., Heinz, A., Koller, M., Müller, S., Steinert, T., & Pollmächer, T. (2018) · Der Nervenarzt · doi:10.1007/s00115-018-0612-3 · Cited by 23 · see citing works
Self-citationMedikamentöse Zwangsbehandlung in der Psychiatrie
Steinert, T., & Kallert, T. W. (2006) · Psychiatrische Praxis · doi:10.1055/s-2005-867054 · Cited by 22 · see citing works
Self-citationFlammer, E., & Steinert, T. (2014) · Psychiatrische Praxis · doi:10.1055/s-0034-1370069 · Cited by 22 · see citing works
Self-citationComparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin
Reisch, T., Beeri, S., Klein, G., Meier, P., Pfeifer, P., Buehler, E., Hotzy, F., & Jaeger, M. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00529 · Cited by 22 · see citing works
Mey, G., & Mruck, K. (2010) · VS Verlag für Sozialwissenschaften eBooks · doi:10.1007/978-3-531-92052-8_43 · Cited by 18 · see citing works
Caregivers' perceptions of coercion in psychiatric hospital admission
Ranieri, V. F., Madigan, K. V., Roche, E., Bainbridge, E. D., McGuinness, D., Tierney, K. J., Feeney, L., Hallahan, B. P., McDonald, C., & O'Donoghue, B. N. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.05.079 · Cited by 15 · see citing works
Service users’ perspective of their admission: A report of study findings
O’Donoghue, B., Roche, E., Lyne, J., Madigan, K., & Feeney, L. (2017) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2016.13 · Cited by 12 · see citing works
Steinert, T., Hirsch, S., & Gerlinger, G. (2019) · Springer eBooks · doi:10.1007/978-3-662-58972-4 · Cited by 7 · see citing works
Self-citationSchellinger, U. (2008) · Forum qualitative Sozialforschung · doi:10.17169/fqs-1.3.1033 · Cited by 4 · see citing works
Steinert, T., Keyßner, S., Schmid, P., & Flammer, E. (2019) · Fortschritte der Neurologie · Psychiatrie · doi:10.1055/a-0893-6507 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
1 of the 40 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [17]Hüther FTC Jaeger S Steinert T Behandlungsverweigerung, Patientenautonomie und Zwangsmedikation [Dissertation]. Köln: Psychiatrie Verlag; Psychiatrie Verlag GmbH (2018).
Cited by
Sorted by citations
Coercion in psychiatric and mental health nursing: A conceptual analysis
Paradis-Gagné, É., Pariseau‐Legault, P., Goulet, M., Jacob, J. D., & Lessard‐Deschênes, C. (2021) · International Journal of Mental Health Nursing · doi:10.1111/inm.12855 · Cited by 61 · see citing works
Bartl, G., Stuart, R., Ahmed, N., Saunders, K. R. K., Loizou, S., Brady, G., Gray, H., Grundy, A. C., Jeynes, T., Nyikavaranda, P., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05914-w · Cited by 35 · see citing works
Price, O., Armitage, C. J., Bee, P., Brooks, H. L., Lovell, K., Butler, D., Cree, L., Fishwick, P., Grundy, A. C., Johnston, I., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05920-y · Cited by 32 · see citing works
Jina-Pettersen, N. (2022) · Journal of Patient Experience · doi:10.1177/23743735221079138 · Cited by 24 · see citing works
Cooper, R. E., Mason, J., Calton, T., Richardson, J. M., & Moncrieff, J. (2021) · Psychosis · doi:10.1080/17522439.2021.1930119 · Cited by 26 · see citing works
Kaikoushi, K., Middleton, N., Chatzittofis, A., Bella, E., Alevizopoulos, G., & Karanikola, M. N. K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.602274 · Cited by 17 · see citing works
Hirsch, S., Thilo, N., Steinert, T., & Flammer, E. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02083-z · Cited by 9 · see citing works
Self-citationRosyanti, L., & Hadi, I. (2021) · Health Information Jurnal Penelitian · doi:10.36990/hijp.v13i2.412 · Cited by 6 · see citing works
Steinert, T., & Wiedmer, J. (2024) · Psychiatrische Praxis · doi:10.1055/a-2225-2162 · Cited by 3 · see citing works
Self-citationLukina, Y. V., Кутишенко, Н. П., Zagrebelny, A. V., Ginzburg, М. L., Martsevich, S. Y., & Drapkina, O. M. (2024) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2024-3040 · Cited by 1 · see citing works
Kaikoushi, K., Bella, E., Middleton, N., Andreas, C., George, A., Stylianou, C., Kinnis, E., & Maria, K. (2019) · doi:10.21203/rs.2.18633/v1
Durns, T. A., O'Connell, P., Shvartsur, A., Grey, J. S., & Kious, B. M. (2021) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2021.101695
Abdulhussein, M. (2025) · Journal of Humanistic Psychology · doi:10.1177/00221678251396670
Alshammare, E. H. D., Alanazi, T. F., AlShammari, R. A. D. R., Al-Anzi, A. B. G., Aljuhani, M. S. S., Alshammari, A. M. S., Alayaf, K. A. A., Alanazi, M. O. M., Asiri, T. A., Alruwailiy, N. A. Q., et al. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.4689
Koçyiğit, Y., Varlı, M. R., Çetin, K. Ö., & Bıçakcı, Ş. (2026) · Cyprus Turkish Journal of Psychiatry and Psychology · doi:10.35365/ctjpp.26.3.12
- Authors
- Jaeger, S., Hüther, F., & Steinert, T.
- Affiliations
- Universität Ulm (DE)
- Corresponding author
- Jaeger, Susanne
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2019-05-09
- Volume
- 10
- Pages
- 295-295
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC6520436
- OpenAlex
- W2944709110
- Cited by
- 15
- References
- 40
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2022: 1 · 2021: 6 · 2019: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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 › Health, Medicine and Society
- Keywords
- involuntary medication, medication refusal, involuntary psychiatric hospitalization, Federal Constitutional Court decision, coercion in mental health care, family caregivers, patient perspectives, mental health professionals, de-escalation, freedom of action
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
