Morandi Stéphane, Silva Benedetta, Mendez Rubio Monserrat, Bonsack Charles, Golay Philippe
Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland..
Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland.
Int J Law Psychiatry. 2021 Jan-Feb;74:101665. doi: 10.1016/j.ijlp.2020.101665. Epub 2021 Jan 2.
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.
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.
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.
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.
尽管缺乏明确证据表明在精神病学中使用强制手段在实际操作和临床方面有帮助或有效，但强制手段仍被广泛使用。当前的做法似乎基于机构文化以及决策者对强制手段的态度，而非由科学文献发布的建议所引领。因此，我们研究的主要目标是描述心理健康专业人员对强制手段的感受和态度，以及与之相关的专业人员特征。
邀请瑞士洛桑大学医院精神病科工作的心理健康专业人员参与一项在线调查。一份问卷探究了参与者的社会人口学特征、专业背景和当前工作环境，以及他们对强制手段的感受和态度。探索性结构方程模型（ESEM）用于确定心理健康专业人员对强制手段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。
130名心理健康专业人员完成了调查。即使很多人认为强制手段侵犯了基本权利，但仍有相当比例的人认为强制手段在精神病学中是不可或缺的，且对患者有益。ESEM显示，专业人员对强制手段的感受和态度可以由四个主要维度来描述，分别为“内部压力”、“情感影响”、“外部压力”和“关系参与”。与精神障碍患者的个人及专业亲近程度会影响专业人员对强制手段的感受和态度。
尽管有声音建议在精神病学中停止使用强制手段，且缺乏科学证据，但许多心理健康专业人员仍然坚信这是对患者有益的必要工具。应促进和发展能够增强共同决策并让患者和专业人员有机会分享他们对强制手段的经验和感受从而减轻他们之间压力的临床方法。
