This week, Mad in America explores three studies related to the use of coercive psychiatric measures. The first finds that rates of coercive measures in psychiatry are rising in Europe, with similar trends observed in the US. The second finds that patients often feel abused and traumatized by seclusion and mechanical restraint. The third finds that hospital and staffing factors are linked to the use of seclusion and mechanical restraint in inpatient settings. Taken together, these studies tell of increasing numbers of patients exposed to, and traumatized by, coercive psychiatric measures as a result of systemic failures.
Coercive Psychiatric Practices Rising Despite Policies Calling for Reduction
A new study published in European Psychiatry finds that coercive psychiatric practices are rising across Europe, despite calls from both national and international organizations to reduce coercion in mental health. Research shows that similar patterns of increased instances of psychiatric coercion have been observed in the US as well. The current work, led by Tilman Steinhart of Ulm University in Germany, reveals that while involuntary admission was decreasing slightly in some examined countries, exposure to some form of coercive psychiatric measures were increasing in every investigated nation.
The goal of this research was to examine European trends in coercive psychiatric practices, including involuntary admission, seclusion, mechanical restraint, and forced drugging. The researchers asked members of the Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services network (FOSTREN) from 33 European countries to provide data on involuntary admission to psychiatric facilities and coercive measures from their respective countries. To be included in the current work, provided datasets had to cover a period of at least four years and end no earlier than 2020, include the number of admissions or patients exposed to psychiatric detention and coercive practices, and provide or make possible a calculation of population based statistics. Experts from Austria, England, Germany, Norway, Sweden, and Switzerland were able to provide appropriate data.
Germany saw the sharpest rise in involuntary psychiatric detention with a 36.8%, followed by Swtizerland (26.8%), and Norway (12.4%). Involuntary detention fell slightly in England (1.2%), Austria (2.0%), and Sweden (5.4%).
The sharpest rise in coercive measures, including mechanical restraint, forced drugging, and seclusion, were seen in Norway (74.9% increase), followed by Switzerland (55.8%), England (37.8%), Germany (26%), and Austria (10.8%). While overall coercive measure rates were not able to be calculated for Sweden, data indicated that the use of mechanical restraint fell by 6.7%, but both seclusion (38.3% increase), and forced drugging (37.7%) rose sharply.
The authors acknowledge several limitations to this study. Laws and records related to psychiatric coercion vary greatly between countries, complicating comparisons. The time periods represented in the current work were not identical for all countries, further complicating comparisons. Privacy requirements limited the collection of sociodemographic and diagnostic data.
Seclusion and Mechanical Restraint Violate Human Rights, Experienced as Traumatic
A new study published in the Australian Journal of Social Issues finds seclusion and mechanical restraint in psychiatric facilities are often experienced as traumatic. This research, led by Rosiel Elwyn from the University of the Sunshine Coast in Australia, also reports that many people that have experienced inpatient psychiatric care view it as a mental health risk.
The goal of this study was to examine patient experiences of seclusion and mechanical restraint in psychiatric settings. To achieve this aim, the authors conducted a narrative review of previous work around patient experiences of seclusion and mechanical restraint. Studies were excluded if they were not published in English, did not deal with patient lived experiences of seclusion or mechanical restraint, or if the seclusion or restraint occurred outside a clinical setting. Studies including forensic, elderly, pediatric, or intellectually disabled populations were also excluded, as were opinion pieces, editorials, blog posts, and media reports. In total, the authors examined data from 62 studies.
Patients reported numerous harms and human rights violations related to seclusion and restraint. One patient reported urinating on themselves as a result of mechanical restraint and being ignored:
“I don’t ever have a problem urinating myself, never. I could use the bathroom just fine, I can talk just fine, I can walk just fine. But, to urinate myself and do that just because I was not given the chance to use the bathroom…. They refused to come and talk to me. They refused to give me a blanket. They refused to let me go to the bathroom. They refused to give me a pillow. They refused everything. All my rights were gone.”
Another patient recalled being denied water when staff accused them of faking a panic attack.
“I had a huge panic attack, and I just woke up in just urine. I had wet myself, because I’d passed out, and I was knocking the door asking if I could have some water. Look, please can I have some water, and…a slightly sort of bully (responded) ‘oh leave her, she’s only faking it anyway.'”
Patients described a system that pathologized any level of distress, threatening coercive measures without real cause:
“If there was any sort of emotional reaction, then, then they were very quickly there, I mean, they were threatening me with the restraints.”
Another person reported not being able to assert themselves due to a similar complaint of a system eager to pathologize those in its grasps:
“I knew I was skating a fine line between asserting myself and then ending up with a personality [disorder] as well. So I was kind of constantly monitoring the whole time, ‘How’s this going to be perceived?’ Yeah, everything’s pathologised in there.”
Seclusion and mechanical restrain resulted in extreme fear, feelings of powerlessness, betrayal, and abandonment. Patients also framed these practices as neglect and an abuse of power, with one patient stating “I wasn’t there to be assaulted, I was there to be helped.”
Patients also reported having to submit to abusive practices as a means of survival. One person said “It’s of no use to protest; you just have to do what they say.” Another reported being forced to choose between mechanical restraint and forced drugging:
“One of the doctors said: ‘We’ve entered into an agreement, either belts or medication’. So I said it was like choosing between plague and cholera, and that an agreement cannot be entered into by force… and then they were about to put me in belts, but I managed to avoid it by taking medicine.”
Many patients described inpatient treatment as bad for mental health due to increasing distress and retraumatization:
“You go in there seeking help and surviving the traumas in your life, but you end up having to cope with even more trauma. It’s pointless.”
Many people with experience of inpatient psychiatric settings believed that greater compassion, empathy, and understanding could result in improved care and less coercive practices. “If the staff were empathetic enough they may have understood that there was no need for forced restraints/medications.”
The main limitation to the current work was the exclusion of studies not published in English. This means insights from non-English sources were missed. This also limits generalizability of the findings to English speaking populations.
As a result of the harms and human rights violations associated with coercive psychiatric practices, the WHO, the World Psychiatric Association, and the UN have called for a significant reduction or elimination of coercion in mental health.
Hospital and Staffing Factors Linked to Seclusion and Mechanical Restraint
A new study out of France published in BMC Psychiatry finds that the use of seclusion and mechanical restraint in inpatient psychiatric settings is linked to the hospital environment and available resources. This study, led by E. Touitou-Burckard of the Institute for Research and Information in Health Economics in Paris, finds that while patient variables play a significant role in seclusion and mechanical restraint, the type of hospital and the nurse-to-patient ratio are also important factors.
F-code diagnoses including mental retardation, organic mental disorders, and developmental issues, for which psychiatric inpatient care is not recommended, were linked to both increased risk of seclusion (116% increased likelihood) and mechanical restraint (71%). Seclusion was less likely in multidisciplinary hospitals (22% decreased likelihood) and teaching hospitals (42%) compared to psychiatric hospitals. Higher nurse-to-patient ratios were also linked to a 22% decrease in the likelihood of mechanical restraint use.
The current study finds that the use of seclusion and mechanical restraint in inpatient settings are more likely for patients “for which psychiatric inpatient care is not the recommended form of treatment.” These practices are also dictated to some extent by facility factors, such as staffing and specialty. This means patients are exposed to these practices, described by many as abusive and traumatic, due to systemic failings.
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Elwyn, R., Clarke, K., & Jones, C. (2025). Narrative review and meta‐ethnography of seclusion and restraint from the perspectives of adults with lived experience: A human rights issue and application to Australian context. Australian Journal of Social Issues. (Link)
Steinert, T., Björkdahl, A., Flammer, E., Fradley, K., Haines-Delmont, A., Hirsch, S., Kjellin, L., Rugkasa, J., Scharfetter, J., & Richter, D. (2026). Abolition of coercion in psychiatry on the horizon? A descriptive ecologic data study from six European countries. European Psychiatry. (Link)
Touitou-Burckard, E., Coldefy, M., Bourin, C., Ellini, A., Saetta, S., & Gandré, C. (2025). Behind closed doors: Unlocking hospital variations in the use of seclusion and mechanical restraint – a nationwide multilevel analysis in adult mental healthcare in France. BMC Psychiatry, 25(1). (Link)
Numerous people who work for the state government in Massachusetts have tried to coerce me, manipulate me, intimidate me, and scare me into accepting these sick jokes called “mental health services”. There are no mental health services here, there is only abuse and neglect. I have been sick for years with serious illnesses and no one cares if I get harmed further or killed. The lack of compassion from people has ruined my life. I have also been abused by the social security administration. Judge benson, Adam cox, and other terrible people have humiliated me, degraded me, and insulted me for having illnesses. They denied me the help I need when I haven’t bene able to work in years. These pathetic excuses of human beings want to see me in prison, in the psych ward, or dead. They will be damned to see me receive any form of help whatsoever. They are abusive people who believe it’s right to punish people like myself who have been dealing with serious health issues for years. I am immense pain everyday and despite the fact I have told dozens of people this fact there is no help provided to me. They are obtaining some type of sick enjoyment out of making me suffer and making my condition worse. The only conclusion I can reach is that they are influenced and controlled by malicious entities. This isn’t how human beings are supposed to act towards each. They hide behind their institutions and policies like cowards uploading a system of abuse and torture instead of abolishing it..I have applied for SSI numerous times and they keep denying me the help I need for every reason they can think of. This is nothing but a culture of cruelty and sadistic behavior that’s been normalized by society. We live in a sick and twisted society. I don’t deserve to be punished like this. They want me to act out so I will be labeled as the bad person and sent to prison or the psych ward. They would rather let me die than do anything to help me. Such a horrific situation and nobody will help me or even listen to me.
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What’s even worse is that people have retaliated against me for showing emotion. I was crying because of how much pain I’ve been in the last several years and Bethany slack who works for the town of billerica threatened me by saying she would call the “crisis clinician” who is a joke by the way. She also sent this fake “crisis clinician” to my house when I spoke out against the emotional abuse my family was doing to me. They keep acting in completely unethical and immoral ways and are never held responsible for any of the harm they cause. They are utterly clueless people who act in malicious ways when you say something they don’t like or want to hear. They are the dangerous people in society. Yet they keep acting like I am a bad person because I call out their abusive and coercive behavior. It’s not fair to me at all. All these unethical people want to do is harm me with poisons and imprison me in a psych ward. They’re both terrible human beings and so are the people that work for the police department. They go along with these abusive people even though some of them know what they are doing is wrong. There are no words to express how disappointed I am. They have failed me completely. I used to think I could make a difference and I wanted to become a police officer. Now instead of doing that I am fighting every day for my life and my right to exist as part of this world. I don’t deserve to be abused like this. There is no reason to treat anyone this way other than people are too prideful to admit when they are wrong. So they keep harming others instead. It’s such a sick joke. I will be so happy when I finally leave this town. It’s a terrible place to live and the abuse and neglect gets worse everytime I interact with any person who claims to be there to “help others”. Such a blatant lie but the truth is most people don’t care unless their lives are affected. I live in such a selfish, hostile, uncaring, aggressive, ignorant, and dysfunctional society. It it making my illnesses worse everyday and nobody cares except for me. This is beyond disgraceful and pathetic.
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Well, this bad news is no great surprise.
It seems my own solution to the problem – restrain the psychiatrists – has not yet caught on.
It is a sad commentary that this would be the best solution at this point!
There are two interacting factors (as I see it) operating at this point. One is psychopathy among the psychiatric profession – and we could say in Medicine as well. And the other is lack of workable treatment technologies, and in fact a conscious rejection of them. The psychopaths in the profession of course lead the way in rejecting treatments that might actually be beneficial. There are others (I presume) who would use those treatments if they knew about them. A wider force that seems to encompass most of academia has led to the systematic discrediting of beneficial therapies. So those therapies are largely blocked from use in Psychology as well, even though – being non-medical – they could easily be adopted at that level.
With scientific data on the subject at what could only be ungraciously termed retarded levels, a clearer view of the situation is not possible. The argument for more nurses would make sense only if there were truly a need for them, and they had access to beneficial treatment technologies. Without those factors present, we can only say good riddance. If we could only get officials to stop feeding the psych hospitals and wards with more “patients,” the demise of Psychiatry as we know it would be closer to complete.
Meanwhile, the regulating agencies need to learn which side of their toast is buttered. The demands on Psychiatry to reform itself are falling on deaf ears. It is time to stop giving them any legitimacy. Psychiatry has become a total failure.
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Psychiatry, psychiatrists have re-inserted (following on from pre WWll cleansing of the disabled and mentally ill) themselves via stealth and “expertism” into the highest echelons of societies – Governments, Politics, Economics, Health, Education, Policies, Advisors, Working Groups. They sit at the top. They rule by consensus. Machiavellian fear mongers at best.
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Agreed! spiritual warfare is intense in this “mission”!
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How to break people 101, goes hand-in-hand with drumming up business.
Is this a new version V2, of the purification processes and systems or is it the same one pre WWll V1, that never went away and is now re-surfacing from the “shallow depths” ? ?
Psychiatry, psychiatrists rule most facets of life via their inserted “expertise-ism” hugely influencing politics , economics, education, health, life-styles, et cetera, at high levels of Government, Governance and Policies in the majority of sectors.
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Voluntary, Involuntary, makes no difference – once in, there is no out unless the doctors (plural) agree and allow it.
Voluntary/Involuntary – “take those tablets now; if you don’t take them right now I’ll come over and shove them down your throat” said the young female nurse to the recently arrived person.
Beyond staff ratios the importance and necessity of witnesses is crucial – not just one other staff member but at least two others. Unless all three collude!
Don’t be alone or out of sight with one staff member.
For safety, hangout with the other detainees pper se and or visitors.
Be visible to reception and office staff.
Maintain your hygiene and your needs as independently and as best as you can.
Imagine that they, the staff, are not being paid to be nice and just like danger money, be nice money would not make them nice.
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systemic failings
Systematic failings
Power hierarchies
Maximising government benefits and insurance claims while –
Deliberate cost cutting measures for the less worthy, less normal, inferior clientele that must cause staff cognitive dissonance of having to pretend to care for such nuisances while collecting a pay check to meet their own needs, wants, desires.
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