Attitudes and ethical beliefs of Russian psychiatrists towards the use of coercive treatment practices

Abstract

In many countries little is known about the attitudes and ethical beliefs of practicing psychiatrists towards the use of coercive practices. This is true as regards Russia where coercion was used for political purposes during the Soviet period. However, substantial changes have occurred in the psychiatric system in recent decades with a focus on patients' rights and the idea of consent. This study aimed to investigate the beliefs and attitudes of Russian psychiatrists towards coercive treatment practices in situations of clinical decision making. Data were obtained from 93 (81 % of all practicing) psychiatrists in the Arkhangelsk region in northwestern Russia. The psychiatrists completed three case vignettes to obtain information regarding the use of coercive treatment practices in different clinical situations, and responded to an ethical attitudes inventory. The psychiatrists' decisions regarding coercive treatment, and the extent of information provided to the patients and their relatives were impacted by the severity and risks (violence, suicidality) associated with the patient's disorder. In most instances psychiatrists were not responsive to pressure from the patient's family or other hospital personnel. Very few gender differences in attitudes and practices were found. Psychiatrists generally reported that they encountered different situations with abusive practices primarily in the past. This study suggests that the factors associated with the use of coercive treatment practices by Russian psychiatrists may mirror those in other countries. Further research should elucidate the actual extent to which coercive practices are used in Russian psychiatry and delineate the factors associated with their actual use.