Date of Award

11-2015

Document type

Thesis

Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Professor Kieran C. Murphy

Second Supervisor

Dr. Patrick Devitt

Funder/Sponsor

Mental Health Commission

Keywords

Coercion, Psychiatry, Human Rights, Clinical Practice, Ethics

Abstract

Background

Coercive psychiatric treatment is one of the most controversial practices in medicine with some arguing that it is unfortunately necessary and others arguing that it is unjustified torture. Further research is required to inform clinical decision-making and service development.

Objectives

In study one, I aim to determine predictors and associations of coercion during admission. In study two, I aim to determine the impact of coercion during admission on outcomes one year after discharge. In study three, I aim to illuminate patient perspectives on coercion. In study four, I aim to determine the number of psychiatric hospitals in which security personnel were noted in inspection reports and describe the main themes of those notes.

Methods

This thesis comprised of four studies which emerged from a mix of three methods: observational cohort design (study one and two), thematic analysis of qualitative interviews (study three) and content analysis of inspection reports (study four).

Results

Lower functioning predicted more accumulated coercive events during admission. Higher levels of accumulated coercive events and male gender during admission predicted more inpatient days between discharge and one year follow up. Patients conceptualised pressure primarily as an affective state characterised by intense feelings of stress. Patients experienced this stress across a broad range of contexts throughout their mental health treatment including administration of medication and involuntary admission. The number of psychiatric hospitals in which security personnel were noted increased from 3% - 8% between the years 2008 – 2012. Inconsistent employment details, differing role functions, contrasting perceptions of suitability and unmet training needs in relation to security personnel was evident across inspection reports.

Conclusions

Coercion is unfortunately common in clinical mental health practice but it remains unclear if it leads to clinical or social improvements. Opportunities to conduct randomised controlled trials on coercive interventions should be explored further.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

9.6MB

Comments

A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2015.

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