Background

Despite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them.

Method

Mental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions.

Results

130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled “Internal pressure”, “Emotional impact”, “External pressure” and “Relational involvement”. The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion.

Conclusions

As voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.

中文翻译：

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心理健康专业人员对胁迫的感受和态度

背景

尽管没有明确的证据表明在精神病学中使用强制措施在实践和临床上是有帮助或有效的，但强制措施被广泛使用。当前的做法似乎是基于制度文化和决策者对强制的态度，而不是由科学文献中提出的建议引导的。因此，我们研究的主要目标是描述精神卫生专业人员对胁迫的感受和态度以及与之相关的专业人员的特征。

方法

瑞士洛桑大学医院精神病学系的精神卫生专业人员受邀参加了一项在线调查。一份问卷调查了参与者的社会人口学特征、专业背景和当前的工作环境，以及他们对胁迫的感受和态度。探索性结构方程模型 (ESEM) 用于确定心理健康专业人员对胁迫的感受和态度的结构，并估计社会人口学和专业特征在多大程度上可以预测其潜在维度。

结果

130 名心理健康专业人员完成了调查。即使很多人认为强制是对基本权利的侵犯，但仍有很大一部分人同意强制在精神病学中是必不可少的，并且对患者有益。ESEM揭示，专业人士对胁迫的感受和态度可以用四个主要维度来描述，分别是“内部压力”、“情绪影响”、“外部压力”和“关系卷入”。与精神障碍患者的个人以及专业上的亲近会影响专业人士对胁迫的感受和态度。

结论

由于有声音建议结束精神病学中的强制，尽管缺乏科学证据，但许多精神卫生专业人员仍然相信这是对患者有益的必要工具。应该促进和发展能够加强共同决策并让患者和专业人员有机会分享他们对强制的经验和感受从而减轻他们之间压力的临床方法。