Application of direct coercive measures. Report of medical staff’s opinions (Part 1)

Iwona Radlińska, Marta Kożybska, Marcin Kolwitz, Artur Kotwas, Beata Karakiewicz


Introduction: Our research aimed to assess the application of direct coercive measures based on the opinions of medical staff.
Materials and methods: A cross-sectional study was held using an original questionnaire, implemented in 2019 and 2020, with 205 medical staff as respondents (including 170 nurses and 23 doctors) in 3 hospitals in Poland.
Results: According to healthcare staff opinions, the most frequent reason for the application of direct coercive measures involved the patients’ aggression directed at themselves (active self-abuse, 70.73%) or others (67.80%). Other reasons for coercion (such as damaging or throwing things, disturbing the operation of the facility, and passive self-abuse) accounted jointly for 80.04% of the cases. The main reason for the significantly more frequent application of coercion (once a month or more often) involved alcohol consumption (25.6%) and consumption of other psychoactive substances (18.84%; p < 0.001). It was significantly more frequently used (once a month or more often) for mentally ill patients (24.15%) than for patients with intellectual disabilities (5.8%; p < 0.001). The most frequently used measure was immobilisation (once a month or more often: 37.68%), and the rarest one was seclusion (6.76%).
Conclusions: The most frequent reason for the application of coercive measures involved self-abuse or aggression caused by the consumption of psychoactive substances. Frequent application of the measures for other reasons that do not directly threaten human life or health requires further research. In particular, the frequent use of immobilisation compared to the infrequent use of seclusion requires further research. To protect patients’ rights, it is urgently needed to clarify ambiguous terms used to describe reasons for the application of coercive measures by the legislator. Preventing violent behaviour through architectural solutions and preparing staff and wards for crisis intervention would benefit patients and staff. The public funding of the hospital-type facilities from which the respondents came highlights the need for government investment in treatment facilities where people with mental disorders and mental illnesses are located.


coercion; behaviour control; seclusion; physical restraint; aggression

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Chieze M, Hurst S, Kaiser S, Sentissi O. Effects of seclusion and restraint in adult psychiatry: a systematic review. Front Psychiatry 2019;10:491.

Doedens P, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff attitudes and characteristics on the use of coercive measures in acute mental health services – a systematic review. J Psychiatr Ment Health Nurs 2020;27(4):446-59.

Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011;189(1):10-20.

Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, et al. Aggression on the psychiatric ward: prevalence and risk factors. A systematic review of the literature. PLoS One 2021;16(10):e0258346.

Van Der Merwe M, Muir-Cochrane E, Jones J, Tziggili M, Bowers L. Improving seclusion practice: implications of a review of staff and patient views. J Psychiatr Ment Health Nurs 2013;20(3):203-15.

Raboch J, Kalisová L, Nawka A, Kitzlerová E, Onchev G, Karastergiou A, et al. Use of coercive measures during involuntary hospitalization: findings from ten European countries. Psychiatr Serv 2010;61(10):1012-7.

Ustawa z dnia 19 sierpnia 1994 r. o ochronie zdrowia psychicznego. Dz. U. z 2020 r. poz. 685 ze zm.

Flaga-Gieruszyńska K, Radlińska I, editors. Przymus bezpośredni stosowany wobec osób z zaburzeniami psychicznymi. Szczecin: Wydawnictwo Pomorskiego Uniwersytetu Medycznego w Szczecinie; 2021.

Amos PA. New considerations in the prevention of aversives, restraint, and seclusion: incorporating the role of relationships into an ecological perspective. Res Pract Pers Sev Disabil 2004;29(4):263-72.

Curran MB, editor. Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC). 3rd ed. Oakbrook Terrace. Illinois: Joint Commission Resources; 2022. p. 990.

United States General Accounting Office (USGAO). Mental health: extent of risk from improper restraint or seclusion is unknown. GAO/HES-99. Washington DC: States General Accounting Office; 1999. p. 1-16.

Care Quality Commission. Out of sight – who cares? Newcastel: Care Quality Commission; 2020. p. 1-74.

Giacco D, Conneely M, Masoud T, Burn E, Priebe S. Interventions for involuntary psychiatric inpatients: a systematic review. Eur Psychiatry 2018;54:41-50.

Gutheil TG. Observations on the theoretical bases for seclusion of the psychiatric inpatient. Am J Psychiatry 1978;135(3):325-8.

Beghi M, Peroni F, Gabola P, Rossetti A, Cornaggia CM. Prevalence and risk factors for the use of restraint in psychiatry: A systematic review. Riv Psichiatr 2013;48(1):10-22.

Benjaminsen S, Gøtzsche-Larsen K, Norrie B, Harder L, Luxhøi A. Patient violence in a psychiatric hospital in Denmark: rate of violence and relation to diagnosis. Nord J Psychiatry 1996;50(3):233-42.

Huckshorn KA. Re-designing state mental health policy to prevent the use of seclusion and restraint. Adm Policy Ment Health 2006;33(4):482-91.

Happell B, Harrow A. Nurses’ attitudes to the use of seclusion: a review of the literature. Int J Ment Health Nurs 2010;19(3):162-8.

Riahi S, Thomson G, Duxbury J. An integrative review exploring decision--making factors influencing mental health nurses in the use of restraint. J Psychiatr Ment Health Nurs 2016;23(2):116-28.

Laukkanen E, Vehviläinen-Julkunen K, Louheranta O, Kuosmanen L. Psychiatric nursing staffs’ attitudes towards the use of containment methods in psychiatric inpatient care: an integrative review. Int J Ment Health Nurs 2019;28(2):390-406.

Krieger E, Moritz S, Weil R, Nagel M. Patients’ attitudes towards and acceptance of coercion in psychiatry. Psychiatry Res 2018;260:478-85.

Gowda GS, Lepping P, Noorthoorn EO, Ali SF, Kumar CN, Raveesh BN, et al. Restraint prevalence and perceived coercion among psychiatric inpatients from South India: a prospective study. Asian J Psychiatr 2018;36:10-6. doi: 10.1016/j.ajp.2018.05.024.

Dressing H, Salize HJ. Compulsory admission of mentally ill patients in European Union Member States. Soc Psychiatry Psychiatr Epidemiol 2004;39(10):797-803.

United Nations. Department of Economic and Social Affairs. Convention on the Rights of Persons with Disabilities (CRPD). (12.01.2023).

Kelly BD. An end to psychiatric detention? Implications of the United Nations Convention on the Rights of Persons with Disabilities. Br J Psychiatry 2014;204(3):174-5.

Oostermeijer S, Brasier C, Harvey C, Hamilton B, Roper C, Martel A, et al. Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review. BMJ Open 2021;11(7):e046647.

Ulrich RS, Bogren L, Gardiner SK, Lundin S. Psychiatric ward design can reduce aggressive behavior. J Environ Psychol 2018;57:53-66. doi: 10.1016/j.jenvp.2018.05.002.

Muskett C. Trauma-informed care in inpatient mental health settings: a review of the literature. Int J Ment Health Nurs 2014;23(1):51-9.

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). National Guidelines for Behavioral Health Crisis Care. Best Practice Toolkit. Rockville: Substance Abuse and Mental Health Services Administration, U.S. De-partment of Health and Human Services; 2020. p. 1-80.


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