Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries.

PURPOSE: Whilst formal coercion in psychiatry is regulated by legislation, other interventions that are often referred to as informal coercion are less regulated. It remains unclear to what extent these interventions are, and how they are used, in mental healthcare. This paper aims to identify the attitudes and experiences of mental health professionals towards the use of informal coercion across countries with differing sociocultural contexts. METHOD: Focus groups with mental health professionals were conducted in ten countries with different sociocultural contexts (Canada, Chile, Croatia, Germany, Italy, Mexico, Norway, Spain, Sweden, United Kingdom). RESULTS: Five common themes were identified: (a) a belief that informal coercion is effective; (b) an often uncomfortable feeling using it; (c) an explicit as well as (d) implicit dissonance between attitudes and practice-with wider use of informal coercion than is thought right in theory; (e) a link to principles of paternalism and responsibility versus respect for the patient's autonomy. CONCLUSIONS: A disapproval of informal coercion in theory is often overridden in practice. This dissonance occurs across different sociocultural contexts, tends to make professionals feel uneasy, and requires more debate and guidance.

[The patient, an (un-)known being--the subjective view of users]. / Der Patient, das (un-)bekannte Wesen--Die subjektive Sicht der Nutzer.

After a long time medicine has rediscovered the patient and his subjective view. The changing doctor-patient-relationship, the growing influence of user groups and consumer associations, the new model of patients as responsible partners and last not least the increasing financial pressure have resulted in patients being more often and more intensively involved in treatment decisions. This development has influenced psychiatry in general and psychiatric research. Concepts like quality of life and consumer satisfaction were taken up in Germany as well and have stimulated a lot of empirical studies. In addition to traditionally used outcome criteria like severity of disease and symptomatology so called subjective outcome criteria are more and more often applied. Using seven simple questions - why, what for, who, what, in what way, where, when - some general aspects concerning surveys of patient surveys are discussed. Some relevant results are outlined and the actual situation is evaluated. In general the described results of patient surveys refer to patients in hospitals. This can be explained by the structure of our health care system and by the fact that substantial research resources are generally linked to the inpatient sector. Results of inpatient surveys cannot be generalized to outpatients and users of complementary services. In the next years social psychiatric research should bring stronger focus to the subjective perspectives of these patients.