Satisfaction and coercion among voluntary, persuaded/pressured and committed patients in acute psychiatric treatment

Whereas the distinction between committed and voluntary admissions in mental health is clear from a legal point of view, this clarity is not always present in the patients' experiences. Voluntary patients may be pressured or persuaded and committed patients may want admission.

To compare three groups of patients--committed, voluntary and persuaded--admitted to acute psychiatric inpatient care as regards different aspects of satisfaction, treatment and experienced coercion.

The Sjukvårdens Planerings- och Rationaliseringsinstitut form and the Coercion Ladder were administered to all admitted patients on two acute wards. A total of 189 patients participated (86%). Data were analysed with nonparametric (Kruskal-Wallis, chi-square) and parametric tests (multinominal regression).

A substantial proportion of the patients did not know of their legal status. Many reported restrictions on movement, forced medication and patronising communication. Satisfaction with the treatment was generally high. Compared to the voluntary patients, the two other groups were characterized by lack of influence, forced medication and high satisfaction with the key worker.

Involuntariness was associated with increased likelihood of feeling excluded from participation in the treatment. The key worker seems to have an important position with regard to committed and pressured patients.

The data were limited to the patients' subjective reports.