Coercion in a locked psychiatric ward

BACKGROUND: In spite of a national strategy for reducing coercion in the mental health services, Norway still has a high rate of involuntary treatment compared to other European countries. It is therefore crucial to study various parties involved in involuntary treatment in order to reduce coercion. RESEARCH QUESTION: How do patients and staff in a Norwegian locked psychiatric ward experience coercion? RESEARCH DESIGN: Participant observation and interviews. PARTICIPANTS: A total of 12 patients and 22 employees participated in this study. ETHICAL CONSIDERATIONS: This study is accepted by the National Committee for Medical Health Research Ethics. FINDINGS: The participants experienced coercion in different ways. Patients often felt inferior, while many of the staff felt guilty for violating patients' dignity, although they ascribed responsibility for their actions to the "system." The main themes are (1) corrections and house rules, (2) coercion is perceived as necessary, (3) the significance of material surroundings, and (4) being treated as a human being. DISCUSSION: The discussion draws upon the concepts of vulnerability, guilty conscience, and ethical sensitivity, related to the staffs' divergent views on coercion. CONCLUSION: Especially among staff, there are divergent views of coercion. Professionals being physically and emotionally close to the patient are more likely to understand him or her as a unique person with individual needs. If patients are kept at a distance, professionals as a group change to understand patients as members of a group with common needs and common restrictions.