Experience of coercion among nursing professionals in a medium-stay mental health unit: A qualitative study in Spain

WHAT IS KNOWN ON THE SUBJECT?: Coercive measures represent an ethical conflict because they limit the person's freedom, compromising their personal autonomy, self-determination and fundamental rights. The reduction of the use of coercive measures implies not only regulations and mental health systems, but also cultural aspects, such as societal beliefs, attitudes, and values. There is evidence about the professionals' views on coercion in acute mental health care units and community settings, but they remain unexplored in inpatient rehabilitation units. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The knowledge about coercion varied from not knowing at all the meaning of the word, to a proper description of the phenomenon. Coercive measures are considered a necessary evil or normalized in mental health care and considered implicit to daily practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The perceptions and attitudes towards coercion might be influenced by the knowledge about the phenomenon. Training of mental health nursing staff in non-coercive practice could help professionals to detect, be conscious towards, and question coercive measures, thus orienting them to the effective implementation of interventions or programmes with evidenced effectiveness to reduce them.

INTRODUCTION: Creating a therapeutic and safe milieu with the minimum coercive measures requires knowing professionals' perceptions and attitudes towards coercion, but they remain unexplored in medium and long-stay inpatient psychiatric rehabilitation units.

To explore the knowledge, perception and experience of coercion among nursing staff at a rehabilitation medium-stay mental health unit (MSMHU) in Eastern Spain.

Qualitative phenomenological study including 28 face-to-face, semi-structured interviews based on a script. Data were analysed using content analysis.

Two main themes were found: (1) therapeutic relationship and treatment in the MSMHU, which included three subthemes: qualities of the professionals for building the therapeutic relationship; perceptions about the persons admitted to the MSMHU; views of the therapeutic relationship and treatment in the MSMHU; (2) Coercion at the MSMHU, comprising five subthemes: professional knowledge; general aspects; emotional impact of coercion; opinions; alternatives.

Coercive measures are often normalized in mental health care and considered implicit to daily practice. A proportion of participants who did not know what coercion is.

Knowledge about coercion might influence attitudes towards coercion. Mental health nursing staff could benefit from formal training in non-coercive practice, facilitating the operative implementation of effective interventions or programmes.