Patients' attitude towards coercion and violence in providing stationary psychiatric aid: ethical and preventive aspects

Abstract

Background: People with mental disorders are most vulnerable in respect to their rights and legitimate interests wile obtaining psychiatric aid. The aim of the study: To develop recommendations for improving the conditions of stay and treatment of persons with mental disorders in psychiatric clinics based on the study of the frequency and forms of coercion and violence applied to patients, and their personal assessment. Materials and methods: Using the medico-sociological method and the modified Bogardus social distance scale, 271 patients were examined in 3 regional psychiatric hospitals: 110 men and 161 women. Results: Patients of psychiatric clinics are socially maladapted, uncritical to their disease. They prefer not to have close relationships with people with mental disorders. Women are often subjected to coercion and violence in a psychiatric clinic. Patients justify coercion in treatment by psychiatrists. The use of physical restraint is considered the prerogative of junior medical staff, but the personal participation of a psychiatrist or the involvement of other patients in cases of threat to others is allowed. A quarter of patients speak out against the use of coercion in the hospital. Compulsory treatment of persons with mental disorders is justified by most patients if their well-being or public safety is in danger. The hospital considers it necessary to control drug treatment and force-feeding when patients refuse to eat. Most patients are not completely satisfied or indifferent to the conditions of living and treatment in the clinic. Conclusion: Creating a comfortable environment in psychiatric clinics requires the development of standards for equipping the wards and premises of the department. Minimization of the use of physical restraint and coercion requires clinical and legal regulation of their use, training of medical personnel in medical bioethics, education of patients and their families.