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EV1062

Why are some patient groups more frequently subjected to coercive measures? A qualitative study of clinician perspectives

WHY ARE SOME PATIENT GROUPS MORE EXPOSED TO COERCIVE MEASURES? A QUALITATIVE STUDY OF CLINICIANS’ PERSPECTIVES

Clinicians’ accounts suggest that group differences in the use of coercive measures may arise from interactions between patients’ needs, staff interpretations of risk, and organizational conditions.

The study aimed to explore clinicians’ explanations for why selected patient groups are more frequently subjected to coercive measures, their recommendations for reducing coercion, and their reasoning about when and how coercion is used. This qualitative study followed a population-wide register study covering 49,873 involuntary psychiatric admissions involving 23,567 individuals in Stockholm between 2012 and 2023; mechanical restraint was used in 12% of these admissions, forced medication in 19%, and seclusion in 11%. The register data showed that younger patients and patients with intellectual disabilities were more frequently subjected to all three measures; patients born outside Europe to forced medication and seclusion; those with personality disorders particularly to mechanical restraint; and those with psychotic or bipolar disorders primarily to forced medication and seclusion. Data were collected through 6 profession-specific focus groups and 6 individual follow-up interviews with psychiatrists, resident physicians, nurses, and nursing assistants. Reflexive thematic analysis yielded four interconnected themes, each with two subthemes: interpreting urgency and risk, shared understanding and trust, organizational capacity for alternatives to coercion, and the functions and forms of coercion. Participants linked perceived urgency to agitation, self-harm, impaired reality testing, and perceived physical strength. They described how language differences and unfamiliar expressions of distress could lead to distress being misinterpreted as a threat, the possibility that cultural or racial bias could influence risk assessment, how limited staffing and time pressures narrowed the range of less restrictive options, and how coercion could undermine trust. Recommendations for reducing coercion included early recognition of deterioration, sufficient time and staffing for de-escalation, timely access to professional interpreters, competence in cross-cultural care, individualized crisis plans, and ward environments that accommodate diverse needs. The poster notes that the findings represent possible processes rather than established causes of the differences observed in the register data, that they are based solely on clinicians’ accounts, that patient and family perspectives were not included, and that the proposed strategies were not evaluated.

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