Application of direct coercive measures. Report of medical staff’s opinions (Part 1)

Abstract

Abstract Introduction: Our research aimed to assess the application of direct coercive measures based on the opinions of medical staff. Materials and methods: A cross-sectional study was held using an original questionnaire, implemented in 2019 and 2020, with 205 medical staff as respondents (including 170 nurses and 23 doctors) in 3 hospitals in Poland. Results: According to healthcare staff opinions, the most frequent reason for the application of direct coercive measures involved the patients’ aggression directed at themselves (active self-abuse, 70.73%) or others (67.80%). Other reasons for coercion (such as damaging or throwing things, disturbing the operation of the facility, and passive self-abuse) accounted jointly for 80.04% of the cases. The main reason for the significantly more frequent application of coercion (once a month or more often) involved alcohol consumption (25.6%) and consumption of other psychoactive substances (18.84%; p < 0.001). It was significantly more frequently used (once a month or more often) for mentally ill patients (24.15%) than for patients with intellectual disabilities (5.8%; p < 0.001). The most frequently used measure was immobilisation (once a month or more often: 37.68%), and the rarest one was seclusion (6.76%). Conclusions: The most frequent reason for the application of coercive measures involved self-abuse or aggression caused by the consumption of psychoactive substances. Frequent application of the measures for other reasons that do not directly threaten human life or health requires further research. In particular, the frequent use of immobilisation compared to the infrequent use of seclusion requires further research. To protect patients’ rights, it is urgently needed to clarify ambiguous terms used to describe reasons for the application of coercive measures by the legislator. Preventing violent behaviour through architectural solutions and preparing staff and wards for crisis intervention would benefit patients and staff. The public funding of the hospital-type facilities from which the respondents came highlights the need for government investment in treatment facilities where people with mental disorders and mental illnesses are located.