Clinical correlates and predictors of perceived coercion among psychiatric inpatients: A prospective pilot study

• Coercion at discharge, decreased significantly compared to coercion at admission in MPCS Scale.
• Improvement in insight and reduction in severity of illness decrease coercion.
• Coercion can be predicted by family type, employment status, socio economic status, severity of illness and level of insight.
• 87% patients reported that their admission was justified even though many felt coerced during hospital stay.
• Perceived coercion is a dynamic state, which changes with clinical care and treatment.

BackgroundThe current Mental Health Care Bill (MHCB) –2013 in India advocates least restrictive alternatives (LRA) in psychiatric treatment. However, we have little evidence on patient's perspectives of coercion and LRA.MethodologyThis was a hospital-based prospective pilot study. 170 subjects chosen by computer-generated random number sampling were screened. In 83 eligible subjects, all assessments including coercion assessment were completed within 3 days of admission and in 75 subjects reassessment was done within 3 days of discharge.ResultsPerceived coercion as measured by the MacArthur Perceived Coercion Scale (MPCS) decreased significantly from 3.72 ± 1.98 at admission to 1.77 ± 1.8 (<0.001) at discharge. This was accompanied by significant increase in global functioning, insight score (from 1.5 ± 1.0 to 3.8 ± 1.1; p < 0.001) and as well as decrease in symptom severity (CGI-S) (from 5.9 ± 1.1 to 1.8 ± 1.9; p < 0.001). Coercion is predicted by family type, employment status, socio economic status, severity of illness and level of insight. 87% patients reported that their admission was justified even though many felt coerced during hospital stay.ConclusionCoercion is a dynamic state and changes with treatment and care. Clinical care may result in an improvement in global functioning, insight as well as in reduction in severity of illness consequently leading to less coercion. During the time of discharge, majority of patients reported that their admission was justified, even though they felt coerced during hospital stay and agreed for treatment against their will within a safe, standardised coercive practice.