Psychiatric ethics and health services research. Concepts and research strategies

In a conceptual frame of reference a distinction is made between different aspects of coercion (formal, perceived and evaluated) and different levels of coercion (hospitalization, treatment and other measures). This frame of reference is used to analyse empirical data from interviews of representative samples of 100 formally committed, the 'probands', and 99 voluntarily admitted sex- and age-matched 'controls'. The results demonstrate that there are many different aspects of coercion; thus, discussions about psychiatric coercion should not be restricted to formally registered commitment. The data also indicate the need to survey the different perceptions of the persons involved in the process of care, in order to understand whether and how coercion has been applied. The results also exemplify the need to include, in all assessments of health care, questions of respect for patient autonomy and integrity.