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Acceptance of covert coercion in mental health care in different countries: A focus group study with mental health professionals

Centre for Psychiatry

Funding Body: East London NHS Foundation Trust
Project Investigator: Stefan Priebe


Covert coercion refers to the exercise of any coercive measure that falls outside the realm of mental health legislation. This includes measures such as persuasion, interpersonal leverage, inducement and threat [1].

Covert coercion in mental health care is the subject of current ethical debate. Some argue that coercion is unethical because it infringes patients' human rights, while others say that coercion is potentially beneficial for patients and families because it reduces readmission rates [2, 3].

Attitudes to covert coercion are further determined by psychiatric tradition (societal values) and culture (social values). The role of psychiatric traditions in understanding and using covert coercion has so far been explored only anecdotally. By examining the attitudes and experiences of mental health professionals with covert coercion, we may be able to develop a better understanding of the role of covert coercion in mental health care.

This study aims to explore and compare what type and level of covert coercion is acceptable to mental health professionals. We will assess attitudes to covert coercion as it might be applied in community mental health care of patients with severe mental illness and explore the views of qualified psychiatrists, social workers and nurses who work with patient groups who might also be subjected to formal coercion in mental health care.

Activities & Outputs

The study uses a focus group methodology. It is being conducted in the United Kingdom, Canada, Italy, Spain, Germany, Sweden, Croatia, Mexico and Chile. Researchers will hold four focus groups in each country, comprised of mental healthcare professionals working in outpatient services. The transcripts will later be qualitatively analysed using thematic analysis, comparing themes within and across countries. The findings will offer insight into the attitudes towards and practices of covert coercion in outpatient mental health care.

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