Caregivers And Patients See Psychiatric Hospital Admission Procedures Very Differently


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)


  1. It is interesting that it is generally assumed that caregivers have the best interest of the patient at heart. This is often true, but is also often false. In fact, many (but certainly far from all or even most) people suffering from severe “mental illness” symptoms have been abused or are continuing to be abused by their caretakers. It does not surprise me that half of the sample did not want the caretaker contacted, nor does it surprise me that the caretakers on the average saw less coercion and more fairness than the patients themselves.

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    • This is very true, especially since psychiatric defamation of character destroys marriages. While I was illegally held against my will by V R Kuchipudi and “snowed.” My husband’s siblings came to town to “set up bank accounts.” By the time I was let out of the hospital, all the money I had been awarded in a lawsuit settlement due to a “bad fix” on a broken bone of mine had been taken out of our bank account. And, of course, I was whacked out of my mind on an antipsychotic even after I was released.

      My husband’s brother worked in the banking industry, and so he knew about all the predatory lenders and recommended my husband go to one, take all MY money out of our house and put it in my husband’s name alone, then no doubt, into his sister’s name. My husband also took most of the money out of my life insurance policy, and his pension fund and ferreted it away in these bank accounts in his sister’s name. And then my husband stopped paying the mortgage. Then he died. One of my in laws told me to “talk to Katy about the money at the funeral.”

      Katy is a thief. And some of my in-laws think gas lighting a person then stealing all her money is clever. Although now that they know I know what they did, and I’ve found the medical proof that the drugs that were forced upon me cause the symptoms of the illness, they’re now getting nervous. My other sister-in-law couldn’t figure out why her husband was acting so paranoid last time I saw them, obviously her husband didn’t tell his nice Catholic wife about his siblings “clever” theivery from their other sister-in-law.

      Definately, sometimes the “caregiver” does not have the best interest of the “patient” in mind.

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  2. Well I went voluntarily to Perth Western Australia mental hospital, nearly 20 years ago……. and no things dont change…… I was VOLUNTARY, as I knew I wasn’t right, ie all clear in hindsight, horrific reaction to one damn valium the gp gave me………
    But when I arrived at said institution Graylands, they had no beds, they gave me medication, that sent me crazier (I wok up quite well after being knocked out for 2 days, waiting for hspital transfer) 🙂 but damn what do they do in a mental hopital? The give ya drugs! So ended up in a locked ward, because there either
    1. were no beds
    2. the same psych ran that ward and mother and baby ward (yeah they forgot to send baby with me?)
    After all these years, I went back to my gp, the one who had no idea a valium could send someone so nuts, and I asked him……….. I said I was told by everyone in graylands, that I was INVOLUNTARY patient………. His reply, and yes, I trust him was “WELL THEY LIED”

    My question, as a voluntary patient, what right did they have to separate me from my newborn, fully breast fed baby (the transport said my baby was with me….. they lied).
    What right did they have to lock me in a locked ward?

    I will be asking these questions now, my 4 children have grown, I am nearly off all the damn poisons, and I got my brain back (well part of it)…………………….

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  3. I also got all my medical records from these torturous horrific three weeks in that place………….. and I got them all, two things struck me.
    1. The records of my medication were sometime indecipherable…. and yes, I challenged what they said, the reply “the records are not clear”………. I know I am a pathologist, and damn I cant decipher them either.
    2. Everyones comments about me were written except all the comments from my then husband were “”erased”……………. why? All this has done, is make me more suspicious of him, if they had left the comments, I could interpret them, in an understanding way………. I will never know.
    Their reasoning for ? I have yet to work out…………….. the assumption I make, is that I was the nutter, he was my carer, and he has more rights than me. Why?

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    • He had more rights than you because you were the identified “patient”. I understand this having grown up with insane people who were allowed to abuse me with the blessing of the “mental health” system after years of abusive upbringing. Sadly, my life isn’t much different now because once you get that DSM tag, you’re never truly free of it.

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    • ” The records of my medication were sometime indecipherable”

      Funny how that works, right? In my documents there is hardly a mention of any drugs let alone the doses. And these are the legal documents based on which the “patient advocacy” (laugh along with me) has determined that they did everything right. Funny that they did not write in their own documents (obviously fixed after the fact and signed by a person who was not even there) that they abused me for no reason and then drugged with huge amounts of 4 different drugs including benzos leading to, among others, almost complete amnesia. How this passes as correct documentation I have no idea.

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    • Don’t be sure you got them all ang.

      I know my documents demonstrate a number of serious criminal offenses including kidnapping.

      The response to requests by the Law Centre for them? Clinical Director authorises what they call “editing” after ‘formal investigation’ and destroys the documents that prove the crimes. The fraudulent set of edited documents is then distributed to any and all asking questions.

      The Chief Psychiatrist appears to be happy to accept this method of dealing with complaints about criminals within the system. Just make sure the wrong questions are asked in the right places.

      Graylands? From what I’ve heard and seen over the years, you’ve been lucky to survive.


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      • I did think for a while that I was fortunate to have slipped through the cracks and obtained the documents demonstrating the crimes.

        Ever been to a police station with absolute evidence of crimes by a fellow police officer? In for a fun ride if you have. They try to have you detained using the MHA, bring charges when a complaint has not been made against you, claim you are “hallucinating” when documents demonstrate ‘spiking’, and well, given that our large Police Station doesn’t have a copy of the Criminal Code according to one Police Sgt they are having trouble deciding if it is an offense to stand near a crosswalk with the intention of using it.

        Gaslighting can be such a subtle method of killing people who hold inconvenient truths.

        Good luck.

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  4. My experiences are that those charged with caring for the “mentally ill” are mentally ill themselves and promote abuse by invalidating a persons experiences. When you medicate a problem you make it something about a person that is wrong strengthening lived abuse scenarios that many, many diagnosed people experienced. The abusers are granted impunity and the right to use the system to further remain in control over the secrets and abuse.
    It isn’t shocking in the least that there are different perspective about this. NAMI actually uses this information to allow families to control and be empowered to sustain abusive practices over those with labels because people with DSM labels are marginalized not only by family members but society as a whole (and most certainly by main stream mental health).
    I am not saying that there aren’t family members who do take such actions out of genuine concern. But, even they are under duress when a crisis exists and we know that that state of mind doesn’t lead to clarity of perception. And, how can we ever separate the variable of how we have systemically been led to believe that mental health systems are “helping” and “treating” when it is a false but perceived truth? Obviously if a treatment is working you should see a lower prevalence in the condition treated.
    Thought provoking article most certainly!

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    • You are right, squash, and this is why programs like Open Dialogue, are seeing the lowest schizophrenia rates in the world. “Professionals” actually listening with an open mind to the perspectives of all involved, rather than just defaming and tranquilizing one person, based upon the lies of others, which is what our current bio-bio-bio psychiatric system in the US is doing, is much wiser.

      What was described to me as the “dirty little secret of the two original educated professions” is no longer a secret. Having someone defamed and tranquilized by psychiarists is the absolute best way of covering up child abuse and stealing from your “loved” ones the world has ever devised. And all the evil people now know this.

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    • I’m here in Keene, NH, and this is the first I’ve heard of it. Funny, huh?…. Here in Keene, in District Court, Judge Edward J. Burke was on the Board of Directors of “Monadnock Family (and Mental Helth) Services”, and then, “MFS” set up a blatantly UN-Constitutional “mental health court”, with MFS as the largest contracted “service provider”. It’s institutionalized crookedness and corruption, and profiting off vulnerable persons….

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    • Btw, I have informed my family and friends that were they ever to call psychiatrists on me or participate in putting me into one of these Guantanamo-like holes also perversely called “hospitals” I will never speak to them again.

      The only reason that your close one is justified in doing so if he/she is doing it for the first time and has been brainwashed to think this is a place where you get “help”.

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  5. My “care givers” in that hellhole called a hospital that inspired me to take part in the fight for human rights in psychiatry are just lucky that I live hundreds of miles away and didn’t have to worry about running into me in a public place when I was still really pissed.

    It was fun asking them what are you going to do when its just you and me outside when this is all over.

    You guys all park in that lot out back right ?

    Take these pills or we hold you down and inject you… Goto hell.

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  6. Service user perspectives on coercion
    and restraint in mental health

    Joint crisis plans or advance directives are coun­
    selled by many as a means of reducing incidents of
    restraint and of listening to the needs of service
    users (Papageorgiou et al, 2002; Amering et al,
    2005). Approaches that include peer facilitators
    and improvements to the frequency and quality
    of communications are crucial. Some existing
    institutional systems make good communication a
    practical impossibility.
    From the perspective of service users, coercion
    and restraint are mostly harmful and must stop
    being legitimised. There is an urgent need to chal-­
    lenge and address these practices as they represent
    gross human rights violations according to the
    stipulations of the CRPD. UK compliance with
    the legislation is due to be monitored in the next
    2 years.

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