Use of coercive measures in psychiatry

Abstract

Introduction. The use of coercive measures in the treatment of medical patients dates back to the origins of psychiatry. The difficult balance between patient protection and safety, patient rights and freedom to choose treatment has provoked strong discussion in the psychiatric practice since the age of Pinel and Moral Treatment. Their short and long-term effectiveness and their influence on treatment adherence as well as the subjective perception of patients submitted to coercive measures and their relationship with the awareness of illness are only some of the questions for which we still have few answers.

Objectives. This article reviews and updates the topic on the use of coercive measures in psychiatric treatment. It forms a part of the EUNOMIA project, a European study evaluating the use of coercive measures in the treatment of psychiatric patients in twelve countries.

Conclusions. a) The use of coercive measures (seclusion, physical and chemical restraint) in the treatment of psychiatric patients is very common in psychiatric hospitalization; b) there is a remarkable lack of experimental studies concerning the use of these measures, and c) from the legal viewpoint, ambiguity still exists in the regulation of the application of these measures.