This week, Mad in America examines three new studies related to coercion and psychiatric detention. The first finds that children that experience physical restraint in inpatient psychiatric settings report lingering fear and mistrust long after the incident. The second finds that Veterans’ fear of psychiatric detention affects how willing they are to disclose suicidal thoughts and behaviors during screening. The third finds that younger age, immigrant status, low socioeconomic status, and specific diagnoses such as bipolar disorder are linked to increased risk of mechanical restraint, forced drugging, and seclusion in inpatient psychiatric settings.
Children Report Lingering Fear After Physical Restraint
A new UK based study published in the International Journal of Mental Health Nursing finds that physical restraint of children and adolescents in inpatient settings had a negative emotional and psychological impact. The authors, led by Simon Nielson from the University of Liverpool in the UK, highlight how the negative impacts of physical restraint start even before the restraint itself, and linger long afterwards.
The researchers recruited eight participants between the ages of 10 – 13 that had experienced physical restraint from three inpatient facilities in England. The authors conducted and audio recorded semi-structured interviews with each participant. They then assessed the interview data for common themes.
The authors present the three overarching themes using the metaphor of a thunderstorm: (1) the gathering – before restraint, (2) the thunderstorm – during restraint, (3) the aftermath – after restraint. Before restraint, participants reported that they could recognize that restraint was coming, often due to the way staff was positioning themselves around them. This resulted in fear, anxiety, frustration, and uncertainty. Previous experiences of restraint increased anxiety before the actual restraint occurred. Some participants believed that staff did not recognize or respond to their distress early enough, resulting in situations escalating until they were physically restrained.
During restraint, participants reported feeling loss of control, freedom, and personal autonomy, fear, anger, embarrassment, distress, and confusion about what was happening. Some participants felt that staff was not listening to, or understanding their needs. According to participants, staff often made threats and ultimatums rather than using deescalation techniques.
After restraint, participants reported lingering fear, distress, and upsetting memories. Many participants did not understand why they had been restrained and had a desire to discuss why it had occurred. They also felt that restraint had made their admission worse, damaged their trust in staff, and negatively affected their recovery. Some also reported having negative associations with everyday activities and environments as a result of experiencing physical restraint. Six of the eight participants were still experiencing the emotional aftermath of restraint when they gave their interviews. Although the current work did not establish an exact duration, the findings suggest that the psychological impact of being physically restrained persist well beyond the incident itself.
This research had 5 main limitations. The small sample size, while appropriate for a qualitative study, limits generalizability of the findings. Participants were aged 10- 13, again limiting generalizability to populations of older adolescents and younger children. The participants all came from three inpatient facilities in England, further limiting generalizability to other populations. The lead researcher was a mental health nurse that worked with child and adolescent populations. This may have introduced bias into the interpretation of the findings. The participants were discussing previous experiences of restraint. This data could have been biased by misremembering or misreporting.
Veterans’ Fear of Psychiatric Detention Makes Them Less Likely to Disclose Suicidal Thoughts and Behaviors During Screening
A new article published in the Journal of Clinical Psychology finds that veterans’ fear of involuntary hospitalization influences their willingness to disclose suicidal thoughts and behaviors during suicide risk screening. The authors, led by Annabelle Rynerson from the VA HSR Center to Improve Veteran Involvement in Care in Portland, report that trust, staff training, and transparent communication are important factors in reducing veterans’ concerns about divulging suicidal thought and behaviors.
The authors recruited 143 participants, 90 veterans who had undergone screening for suicidal thoughts and behaviors and 53 Veterans Health Administration (VHA) clinical staff members, to take part in semi-structured interviews. The researchers then analyzed the interview data for recurring themes related to the fear of psychiatric detention during suicide risk screening.
Veteran participants consistently reported that they feared disclosing suicidal thoughts or behaviors during screening could result in psychiatric detention. This fear often discouraged veterans from openly discussing suicidal thoughts and behaviors with mental healthcare staff. This means that screening responses may not accurately reflect a veteran’s actual suicide risk.
Both veteran and staff participants suggested that a trusting therapeutic relationship could reduce veterans’ fear around disclosing suicidality. Veterans also reported feeling more comfortable discussing suicidal thoughts and behaviors when they believed mental healthcare staff would listen without immediately resorting to psychiatric detention.
The authors highlighted three strategies for addressing veteran’s fears around psychiatric detention. (1) adequate staff training could help mental healthcare staff assess suicide risk accurately and respond appropriately to disclosures. (2) Building trust between veterans and staff could encourage open communication. (3) Transparent communication meant that staff should clearly explain the screening process, including the circumstances that could result in psychiatric detention.
This research had three main limitations. The participants were US veterans and VHA clinical staff, limiting generalizability to other populations. The participants self-reported their experiences. This means the data could be biased by misremembering or reporting what was socially acceptable rather than what was accurate. The authors did not assess clinical outcomes, including whether staff training, transparency, or trust reduced suicide attempts.
Younger Age, Low Socioeconomic Status, and Bipolar Disorder Diagnosis Linked to Higher Risk of Mechanical Restraint, Seclusion, and Forced Drugging
A new preprint article from Sweden finds that several demographic and clinical risk factors, including younger age, being born outside of Europe, low socioeconomic status, and specific diagnoses, are linked to increased rates of mechanical restraint, forced drugging, and seclusion in inpatient psychiatric settings. The study, led by Christian Ruck from the Karolinska Institutet in Sweden, reports that seclusion, forced drugging, and\or mechanical restraint occurs during 25% of involuntary psychiatric hospitalizations in Sweden.
The authors used data from the Swedish register on all adult involuntary psychiatric hospitalizations that occurred in Stockholm County between 2012 and 2023. In total, the final sample included 49,873 instances of psychiatric detention for 23,567 patients.
Mechanical restraint, forced drugging, and/or seclusion were reported in 25% of involuntary hospitalizations. Forced medication occurred in 19%, mechanical restraint in 12%, and seclusion in 11%.
Several sociodemographic factors were linked to increased risk of coercive measures. Compared to older patients (65+), 18 – 24-year-olds were at 32% increased risk of experiencing forced drugging, mechanical restraint, or seclusion. This risk generally lowered with advancing age. Patients born outside Europe were 20% more likely to face coercive measures compared to Swedish-born patients. Females faced a 13% increased risk of forced drugging, while males were more likely to be mechanically restrained. Low-income patients (15% increased risk) were more likely to experience coercive measures, as were those with just a primary education (10%), and those who were single (15%).
Patients with a bipolar disorder diagnosis (57% increased risk) had the greatest risk of facing seclusion, mechanical restraint, or forced drugging, followed by patients diagnosed with “other psychiatric disorders” (a category encompassing diagnoses such as ADHD and delirium; 48%), and substance-induced psychosis (46%). Mechanical restraint was more likely for people diagnosed with a personality disorder, while forced drugging and seclusion were more common for people with a diagnosis of bipolar and psychosis. The authors also note that patients with a history of intellectual disability faced a 22% increased risk of coercive measures.
This study had four main limitations. Data from the Swedish register that did not differentiate between physical and mechanical restraint were omitted. This means mechanical restraint was likely underestimated. Inconsistent reporting and misclassification of coercive practices could have affected the findings. While the authors present evidence that some groups are more likely to face mechanical restraint, seclusion, and forced drugging that others, this data cannot definitively say that membership in these groups is causing increased risk of experiencing coercion. This study is in preprint, meaning it has not undergone peer review.
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Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2026). ‘in the midst of a thunderstorm’: Young people’s experiences of physical restraint in inpatient mental health services in the UK. International Journal of Mental Health Nursing, 35(1). (Link)
Ruck, C., Grossmann, L., Johnson-Singh, C. M., Gubi, E., Brenner, P., Gardner, R., Wallert, J., & Johansson, F. (2026). Absolute and Relative Risk of Mechanical Restraint, Forced Medication, and Seclusion during Involuntary Psychiatric Hospitalisation: A Population-Wide Cohort Study. (Link)
Rynerson, A., Newell, S., Gade, P., Bahraini, N., Denneson, L. M., & Dobscha, S. K. (2026). Fear of involuntary hospitalization impacts veteran responses to suicide screening: Veteran and staff perspectives. Journal of Clinical Psychology. (Link)
