Patients and their family members perceive the relative levels of coercion and procedural justice occurring at psychiatric hospitals very differently, according to a study in Psychiatry Research.
A team of researchers in Ireland conducted surveys of people who’d been admitted to psychiatric hospitals and people identified as their primary “caregivers” — usually parents or other family members. Sixty-six caregivers and an equal number of service users participated. About 70% of the service users had been officially involuntarily admitted to the hospitals.
The researchers “aimed to determine caregiver’s perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units.” They then compared the perspectives of the caregivers with the perspectives of the respective service users whom they were caring for.
“Caregivers of involuntarily admitted individuals perceived the service users’ admission as less coercive than reported by the service users,” the researchers found. “Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users.”
The researchers also noted that about half of the patients they had initially contacted would not even grant the researchers the right to contact their primary caregivers — suggesting that their research findings were likely skewed strongly in the direction of patients and caregivers who generally got along better. “Our consent rate for the involvement of caregivers is unfortunately consistent with prior research (38-59%),” they added, “suggesting that research to date involving caregivers might potentially under-estimate the disparity in perceptions on coercion and views of acute psychiatric in-patient admission.”
“The purpose of this research is not to identify who has a ‘correct’ or ‘incorrect’ perception of coercion, but rather to identify if there is a disparity between perceptions that could have implications for the future care of service users,” the researchers commented. “For example, caregivers may not understand a service user’s reluctance to be readmitted to hospital, as the caregiver may have perceived an earlier admission as less coercive and more procedurally just. A possible strategy to counteract this disparity may be to engage with caregivers to a greater extent prior to a service user’s discharge from hospital and for everyone to share their perception of the process of admission. This could act as a forum to devise strategies to reduce the risk of future admissions and devise potential advance care directives as to how the service user would like to be treated if there was a future relapse in their mental health and if a future admission was required.”
Ranieri, Veronica, Kevin Madigan, Eric Roche, Emma Bainbridge, David McGuinness, Kevin Tierney, Larkin Feeney, Brian Hallahan, Colm McDonald, and Brian O’Donoghue. “Caregivers’ Perceptions of Coercion in Psychiatric Hospital Admission.” Psychiatry Research. Accessed July 5, 2015. doi:10.1016/j.psychres.2015.05.079. (Abstract)