Coerced medication in mental health care – what matters to patients?




Poster session 2


Monday 17 September 2018 - 12:30 to 14:00

All authors in correct order:

Steiro A1, Dahm K2, Stromme H1, Brurberg K1
1 Norwegian Institute of Public Health, Norway
2 Norwegian Institute of Public Health, Norway
Presenting author and contact person

Presenting author:

Asbjorn Steiro

Contact person:

Abstract text
Background: Coerced medication in mental health care is controversial and incorporating experience in terms of what matters to patients is crucial.

Objectives: The Norwegian Institute of Public Health was commissioned by the Centre for Medical Ethics at the University of Oslo to scope research on the experiences of patients, relatives and consumers of coerced medication in mental health care.

Methods: We performed a systematic scoping review of coerced medication for adult patients. We search for systematic reviews and primary studies in the following databases: Epistemonikos, CDSR, DARE, CENTRAL (Cochrane Library), HTA Database (Centre for Reviews and Dissemination), MEDLINE, Embase, PsycINFO, CINAHL ISI Web of Science and SveMed+.

Results: We identified 1601 references and assessed 77 studies in full text. We included eight systematic reviews and 25 primary studies. We identified several research questions and an increased volume of published articles in the period 1987-2016 (table 1). The population was mainly patients with diagnoses of schizophrenia, bipolar disorder and psychosis. Systematic reviews identified research questions (table 2) and primary studies (table 3) according to patient perspectives.

We used Arksey and O'Malley's framework for scoping reviews to categorise the included studies. Coerced medication was poorly reported in both systematic reviews and primary studies. We therefore classified coerced medication into the following categories: 1) short-term drugs used as a coerced means, 2) long-term coerced treatment with drugs and 3) coerced medication in an outpatient institution. The following emerged from our review of primary studies: there were mixed results, with patients reporting both positive and negative experiences with CM, different preferences, fear of harmful effects, lack of insights, and high or low satisfaction with staff or medication. We also identified some gaps in the research literature around why and how patients refuse medication. A good care model is warranted, strengthening the patient's right to autonomy and leading to a reduction in the use of coerced medication.

Conclusions: Review of patients' preferences and experiences showed mixed results. Good clinical engagement, listening skills and a respectful relationship was appreciated as essential for patients' recovery. Furthermore, despite the high volume of research, synthesis of patients perspectives, with quality assessment, is needed.


Relevance to patients and consumers: 

We identified mixed results in SR; patients experienced coercive measures negatively, but retrospectively agreed with this treatment. Staff factors such as use of temporary staff, lack of confidence in ward staff and ineffective ward structure were perceived negatively. The knowledge of why and how patients refuse medication is lacking. We identified knowledge of both reasons for adherence and non-adherence. Patients have positive and negative perceived impact of coercive situations and professionals’ ability and willingness to interact and communicate respectfully. Preliminary data in Attachments, more results available in september!