The use of coercive measures (e.g., seclusion, physical and mechanical restraint, forced medication) in psychiatric patients is a massive invasion in their integrity and freedom. As a result, the usage of coercion is controversially discussed since the beginning of modern psychiatry and certain approaches have tried to reduce its rates (1). Although some of those approaches were successful, there are still many patients in which coercion is used. Often the usage of coercion seems necessary when the patients are a danger for themselves or for others due to an underlying psychiatric disorder (2, 3). These situations are always associated with an
ethical dilemma. On one side coercion shall help to protect the patient’s or other’s integrity (2, 3). On the other hand it restricts the freedom of the person which is one of the basic human rights (4). Being a threat to oneself or others may have different reasons in psychiatric patients. In some situations patients are delusional and feel threatened by others which leads to the reaction to protect themselves and can result in threats to other patients or staff (5). Also in situations where the patients are threatening themselves or have suicidal ideations caused by the symptoms of their psychiatric disorder, coercive measures might become necessary to secure the patients survival.
The use of coercion distinguishes psychiatry from other medical disciplines where informed patients can decide to accept or reject a specific measure. Psychiatry at one hand aims to help
the patients to develop a self-determined life without burden of psychiatric symptoms. On the other hand psychiatry is legally determined to reject the patients freedom to move (involuntary hospitalization) but also the freedom to reject a specific measure (forced medication, physical or mechanical restraint, seclusion) if harm to self or others has to be disrupted.
It is obvious that such situations are challenging for the patients but also for the therapeutic team. Those challenges were topic of previous studies where it was shown that patients who experienced coercive measures often describe feelings of helplessness (6, 7), fear (8), anger (9, 10) and humiliation