Department of Psychiatry, Narcology, and Clinical Psychology, Belgorod State National Research University, Belgorod, Russia.
Abstract: (1015 Views)
Objectives: Restriction of the rights of patients in a psychiatric hospital, isolation and fixation, compulsory treatment, and round-the-clock monitoring are negatively perceived by them, contribute to the stigma of a psychiatric hospital, and prevent timely access to psychiatric help We assessed the opinions of patients in psychiatric hospitals and psychiatrists about coercion and violence in the provision of psychiatric care for recommendations on their prevention.
Methods: An anonymous survey of psychiatrists and patients was conducted in psychiatric hospitals in three regions. Data were analyzed using descriptive and non-parametric statistical methods.
Results: Psychiatrists and patients were positive about the coercive measures in the psychiatric hospital. Physical restraint was considered the prerogative of orderlies by 64.5% of psychiatrists and 35.4% of patients. According to 19.6% of doctors and 28.4% of patients, a psychiatrist can independently apply physical restraint to aggressive patients. Injections of sedative drugs by a psychiatrist personally were considered justified by 81.3% of physicians and 64.6% of patients. Most patients and physicians noted that the psychiatrist needed to be involved in the application of physical restraint to an aggressive patient.
Discussion: Psychiatry is currently dominated by an archaic paternalistic model of doctor-patient relations and the delegation of additional functions of social control to psychiatrists. The introduction of a contractual model is required for more effective interaction between the psychiatrist and the patient.
Coresponding author: Natalia Rzhevskaya, E-mail: konst_v@list.ru
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• Anosognosia in psychiatric patients, combined with self-stigmatization, prevents the formation of sustainable compliance and responsibility for one’s own health.
• The paternalistic model of the relationship between the psychiatrist and the patient places the responsibility for treatment and social functioning on the doctor, which can lead to abuse of the mentally ill patient.
• Prevention of coercion and violence in psychiatric hospitals should be based on the contractual model of the relationship between the doctor and the patient, psychoeducation, and regulations for the application of restrictive measures.
Plain Language Summary
In psychiatric hospitals, restrictions on the rights and freedoms of people with mental disorders are often allowed. This study examined the attitudes of patients and psychiatrists toward restrictive measures in psychiatric hospitals. It has been established that the majority of psychiatrists and patients have a positive attitude toward coercion in a psychiatric hospital, which indicates the predominance of a paternalistic model of assistance in psychiatry. It is necessary to move to a contractual model of psychiatrist-patient relationships and increase the responsibility of psychiatric patients for their health.
Article type:
Original Research Articles |
Subject:
Psychiatry Received: 2022/10/16 | Accepted: 2023/05/29 | Published: 2023/09/6