An Exploration of Patient Experiences Concerning Coercive Measures: A Qualitative Study in Closed Psychiatric...

Coercive measures in psychiatry are sometimes necessary to prevent harm, but raise significant ethical and clinical concerns and can negatively impact patients. Despite extensive research on coercion in Western settings, studies from the Middle East, particularly Iran, remain scarce, leaving gaps in understanding the cultural and structural factors influencing coercion. This study examines the experiences of patients subjected to formal and informal measures in locked psychiatric wards in Iran.

A qualitative content analysis was conducted involving 13 patients from locked psychiatric wards. Participants were selected through purposive sampling to ensure a diverse range of experiences with coercive measures. Data were collected using semi-structured interviews, allowing for a comprehensive understanding of patients' experiences, feelings and perceptions of coercion.

The data analysis revealed three primary themes, each of which has sub-themes that enhance understanding of the participants' experiences. (1) Experiences of coercion: Patients reported experiencing trauma from physical and mechanical restraint, as well as the coercive atmosphere of the wards. Patients reported alternatives to coercive measures, emphasising therapeutic relationships, addressing irritability causes and flexible ward routines as key preventive strategies. (2) Roots of coercion: Poor staff communication, patient disturbing behaviours and restrictive environments were key triggers prompting staff to use coercive measures. (3) Consequences of coercive measures on patients: Psychological distress (e.g., fear, anger and suicidal ideation), distrust in care and violations of dignity were reported as negative consequences of coercive measures.

This study highlights the intricate nature of patient experiences with coercive measures in psychiatric settings. The findings underscore the need for improved provider-patient communication and the implementation of alternative approaches that prioritise patient dignity and autonomy. Addressing these issues is crucial for enhancing the quality of psychiatric care and minimising the reliance on coercive practices.

This study was primarily informed by the perspectives and experiences of psychiatric patients with regard to coercive measures. Their direct participation provided essential data for analysis and findings. Patients participated in the study through in-depth interviews, which ensured that the research captured authentic narratives about the impacts of coercion, preventive alternatives and systemic challenges. These narratives formed the basis of the findings and guided the ethical and clinical implications discussed in the manuscript. The study design and conclusions are deeply rooted in patients' experiences and prioritise their voices when identifying areas for improvement in psychiatric care practices.