This week, Mad in America examines three articles around the use of coercion in psychiatry. The first argues that justifications for the use of coercive practices in psychiatry overlook long-term harms. The second finds that the challenging physical environment in inpatient psychiatric wards is a main driver of the use of coercive practices. The third reports that psychiatric staff that experience violence and use coercion against patients themselves are more likely to have a favorable view of these practices, while more years of work experience is linked to more critical views of coercion in psychiatry.
Psychiatric Coercion Reduces Patients to a Risk that Must be Managed, Causing Long-Term Trauma
A new article published in PLOS Mental Health examines the harm of psychiatric detention. This essay, authored by Sandra Ferreira from Aves Mental Health (formerly the Global Mental Health Peer Network), argues that justifications for coercion in psychiatry overlook the significant long-term consequences of these practices. The author calls for a reorientation of mental health services towards serving the best interest of patients and service users rather than allowing institutional logic to continue harming people.
In the article, Ferreira, herself a survivor of psychiatric detention and restraint, writes that she hopes to use her postgraduate degree and professional credibility to speak from a place of lived experience without the fear of retaliation or dismissal faced by others in her position.
Psychiatric coercion typically occurs during an extremely vulnerable moment for the patient, exacerbating an already lopsided power dynamic. Concepts such as “lack of insight,” “impaired capacity,” and “non-compliance” are used to strip autonomy and credibility from the patient, with any resistance framed as further proof of “mental illness.” Ferreira argues that this process prioritizes institutional intent and reduces patients to a risk that must be managed while ignoring the significant, lasting trauma caused to the individual.
Patients’ experiences and testimonies critical of forced psychiatric “care” are systematically dismissed by professionals. The combination of epistemic injustice and psychiatric treatment based on coercion and force rather than empathy results in long-lasting feelings of powerlessness, loss of agency, and fear while severely damaging the patients’ trust in the medical system.
The author makes five recommendations for moving towards a rights-based system of mental healthcare. (1) Advanced directives for mental healthcare made before a crisis occurs should be legalized and honored. (2) Mental healthcare should be decentralized away from hospitals towards peer-led and culturally responsive community environments. (3) Clinical decisions should be guided by international frameworks such as the UN Convention on the Rights of Persons with Disabilities rather than abstract concepts such as “impaired capacity” and “non-compliance.” (4) Clinicians should critically reflect on their own language, biases, and risk-focused thinking. (5) Lived experience should be recognized as core scientific data.
New Study Highlights Ward Environment as Primary Driver of Psychiatric Coercion
A new study published in the International Journal of Mental Health Nursing explores the driving factors of coercive practices within inpatient psychiatric settings. Patient “responses to challenging physical and external stimuli” was the main driver of coercive practices. This study, led by Esario IV Daguman from Southern Cross University in Australia, also identified self-harm and patient aggression targeted towards nursing staff as key drivers of the use of coercive practices.
The goal of this study was to look beyond individual-level patient risk factors to map functional, contextual, and interventional factors linked to the use of coercive practices in inpatient psychiatric units. This study was part of a larger project around coercive practices within multiple psychiatric institutions in Australia.
The authors used data from three acute adult inpatient mental health units in New South Wales, Australia. They examined 2,955 de-escalation events captured in nursing logs and administrative records and analyzed them in terms of coercive outcomes including seclusion, physical restraint, forced administration of psychotropic drugs, physical injuries, and emergency security activation. They then used machine learning to build a predictive model of when coercion was most likely.
The top functional driver, the underlying reason for a patient engaging in a behavior that was escalated towards coercive practices, was the challenging physical environment of the ward. This included factors such as high levels of noise, overcrowding, bright lighting, and lack of privacy. The top contextual factors, the actual behaviors that led to coercive practices being used against patients, were aggression towards nursing staff and self-harm. In plain language, the most common reason for staff using coercive practices against a patient was that patient showing aggression towards nursing staff as a reaction to an overwhelming environment.
The authors note that their focus on underlying functional drivers is unique in research around coercion in psychiatry. Where past research mostly looked at static factors such as diagnosis or age, this research looked at the precipitating factors that most commonly lead to coercion. This frames problematic behaviors, such as aggression towards nurses, as an attempt to communicate an unmet need.
Nurses using de-escalation techniques was also linked to the use of coercive practices. However, the authors note that this link is likely not causal. De-escalation techniques are most frequently used in already tense situations before formal coercion is used.
This study had two main limitations. The data was mostly recorded by nursing staff, but analyzed by the authors using machine learning. Involving frontline staff and people with lived experience of psychiatric coercion in the interpretation of the data could lead to more accurate results. This research was conducted within three mental health wards in New South Wales Australia, limiting generalizability to other populations.
Exposure to Violence and Use of Coercion Linked to Greater Acceptance of Coercive Practices
A new study published in Comprehensive Psychiatry finds that psychiatric staff were more likely to view coercive practices favorably when they had experienced more physical violence and frequently used coercive practices against patients themselves. This research,led by Klara Czernin from the Medical University of Vienna in Austria, also reports that more years of experience working in psychiatry was linked to more critical attitudes towards coercive practices.
The goal of this study was to examine how factors such as experiencing violence at work, emotional burden from verbal abuse and witnessing coercion, years of experience working in psychiatry, and feelings of insecurity at work affected staff attitudes towards the use of coercive practices in psychiatry.
The authors recruited 1,585 mental health professionals from Germany that worked in adult, child, and forensic settings. Each participant completed a self-report survey concerning their attitudes towards coercion and answered questions about how often they experienced things like violence, verbal abuse, feelings of insecurity, and witnessing coercive practices at work.
Several factors were associated with more positive attitudes towards the use of coercion in psychiatric settings. Staff that had higher rates of exposure to violence, felt unsafe, experienced emotional burden after verbal abuse, and those that frequently used coercive practices against patients had more positive views of coercive practices. Older age and working in forensic settings was also linked to more favorable views of coercion in psychiatry.
Staff that experienced emotional burden after witnessing coercive practices and those that had more years of work experience in psychiatry had more critical views of coercion. The authors note that receiving support after a violent incident at work reduced feelings of insecurity. The authors hypothesize that this could prevent violent experiences from translating into more acceptance of coercive practices.
This research had four main limitations. The study’s design means the data can only speak to associations, not causes. The self-report nature of the surveys means the data is susceptible to misremembering, differences in interpretation, and participants giving socially acceptable rather than true answers. The authors measured attitudes towards towards coercion rather than behavior. Some unmeasured factors could have influenced attitudes towards coercion, such as organizational culture, staffing levels, and patient characteristics.
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Czernin, K., Oster, A., Mahler, L., & Baumgartner, J. S. (2026). Staff attitudes towards coercion in psychiatry: The role of violence, emotional burden, and insecurity – evidence from a nationwide study using multiple regression and moderation analyses. Comprehensive Psychiatry, 148, 152711. (Link)
Daguman, E. I., Yoxall, J., Lakeman, R., & Hutchinson, M. (2026). Functional, contextual, and interventional drivers of formal coercion in acute mental health units: A feature analysis. International Journal of Mental Health Nursing, 35(1). (Link)
Ferreira, S. (2026). Held but not healed – why coercive practices undermine mental health and Wellness. PLOS Mental Health, 3(4). (Link)