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Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Dr. Whittington is affiliated with the School of Health Sciences, University of Liverpool, Thompson Yates Bldg., the Quadrangle, Liverpool L69 3GB, United Kingdom (e-mail: whitting{at}liverpool.ac.uk). Dr. Bowers and Dr. Simpson are with the Department of Mental Health and Learning Disability, City University, London. Dr. Nolan is with the School of Health, Staffordshire University, Stafford, United Kingdom. At the time of the study, Dr. Neil was with the School of Health Sciences, University of Liverpool, Liverpool, United Kingdom.

OBJECTIVE: This study sought to ascertain the degree to which psychiatric inpatients and staff approved of various coercive measures commonly used in acute inpatient care. METHODS: A cross-sectional design was adopted. The Attitudes to Containment Measures Questionnaire (ACMQ) was completed by 1,361 service users and 1,226 staff (68% nurses) in acute care mental health services from three regions of England. This provided evaluation of 11 coercive measures (for example, seclusion) on six dimensions of approval (for example, whether the coercive measure is seen as being acceptable or safe to use) in a large national sample. Comparisons between groups were tested with independent-samples t tests, chi square analysis, or Spearman correlations. RESULTS: Service users and staff strongly disapproved of net beds and mechanical restraint. The three methods that received the most approval by the service user group were intermittent observation, time out, and PRN (as needed) medication; for the staff group, the three methods that were most approved of were transfer to a psychiatric intensive care unit, PRN medication, and observation. Male staff, older service users, and staff who had been involved in implementing coercion expressed greater approval of coercive measures. CONCLUSIONS: There are clear gender differences in how coercive measures that are used in inpatient settings are viewed. Personal involvement in deploying coercive interventions was linked to greater acceptance, suggesting a link between experience and attitudinal changes.

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