Formal Coercion and the Moral Division of Labor: Moving Beyond Role Conflicts in Psychiatric Nursing

Abstract

Introduction

Psychiatric nurses are actively involved in involuntary hospitalisations and treatments. However, the scientific literature lacks insights into strategies used to navigate roles and institutional expectations in this regard.

Aim

To achieve a deeper understanding of practices that support the exercise of individual rights in psychiatry during involuntary hospitalisations and treatments.

Method

A situational analysis was conducted. Nineteen (n = 19) mental health workers participated in a semi-structured interview and completed a socio-demographic questionnaire. Case law review (n = 126) and non-participant observations (n = 70 h) were also conducted.

Results

The moral division of labour is a central element in mental health interventions, organising four types of practices: socio-legal assistance, support for exercising rights, intersectoral coordination and ignorance and trivialisation.

Discussion

Our findings reveal that nursing care is predominantly medicalised, confining nurses to a subordinate role. They also indicate marginal practices focused on socio-legal assistance and human rights support. Intersectoral coordination, though crucial, remains an invisible aspect of nursing practice.

Implications for Practice

There remains a significant lack of awareness about human rights issues in psychiatry. This research underscores the importance of considering professional hierarchies, organisational expectations and legal awareness to address role conflicts in psychiatric care.

Relevance Statement

This research highlights the need to study nurses' agency, offering insights into how they interpret and apply psychiatric laws. Such research could deepen knowledge on human rights issues in psychiatry or, at minimum, promote greater recognition of these concerns. Social policy implications are also notable, underscoring the need for integrated socio-legal assistance during involuntary treatments to support patients navigating complex systems and exercising their rights. Finally, the findings point to the importance of examining professional hierarchies, organisational expectations and legal awareness in developing practices that address the emotional, educational and intersectoral aspects of psychiatric coercion.