Attitudes of psychiatric staff toward coercion: nationwide AttCo study.

Abstract

Background: Attitudes of mental health professionals toward coercion are a potential tool in reducing the use of coercive measures in psychiatry.

Aims: This study, part of the nationwide Attitudes toward Coercion (AttCo) project, aimed to assess staff attitudes on a nationwide and multiprofessional scale across adult, child and adolescent, and forensic psychiatric departments.

Method: During 9 weeks in 2023, 1702 psychiatric staff members across Germany filled out a survey including gender, age, profession, work experience and setting, and the validated Staff Attitude to Coercion Scale (SACS). Analyses of variance and multivariate regression analysis for SACS mean overall score were computed to assess group differences.

Results: Participants largely supported that coercion could be reduced with more time and personal contact (mean 4.20, range 1-5), and that coercion can harm the therapeutic relationship (mean 4.08); however, they acknowledged that coercion sometimes needs to be used for security reasons (mean 4.10). Regarding group differences, specialisation (P < 0.001) and professional affiliation (P = 0.008) remained significantly associated with SACS mean score (with a higher score in forensic psychiatric staff compared with staff in adult and child and adolescent psychiatry), when controlling for gender, age and work experience.

Conclusions: Differences in attitudes are predominantly linked to professional training and structural surroundings. Professionals in adult psychiatry and child and adolescent psychiatry are more critical than staff in forensic settings, with an emphasis on patients' rights and individuals' integrity. Further studies are needed on how mental health professionals view coercion, and how actual use of coercion is influenced by staff attitudes.