[NYAPRS Enews] SD: Forced Psych Meds Used Despite Lack of Evidence

[Matt Canuteson]

Coerced Medication Used In Psychiatric Care Despite Lack Of Clinical
Evidence

Science Daily   December 5, 2008

 

Researchers are calling for more studies into the practice of forcing
psychiatric patients to take medication, after a research review showed
that there have been very few rigorous investigations of the procedure.

The review, published in the latest Journal of Advanced Nursing,
suggests that patients receiving coerced medication (CM) are more likely
to be in their thirties with a diagnosis of schizophrenia, bipolar
disorder or another psychotic disorder.

CM is used more often in the UK than in other countries where other
forms of restraint are more common.

Most of the patients featured in the studies that were reviewed had been
admitted to psychiatric care on an involuntary basis.

"It is clear from our review that there is little clinical evidence on
the use of CM and more research is needed to examine all aspects of this
contentious practice" says Manuela Jarrett, a registered mental health
nurse from the Health Service and Population Research Department at the
Institute of Psychiatry in London.

Jarrett, who co-authored the paper with Professor Len Bowers and Dr Alan
Simpson from City University London, carried out a detailed analysis of
14 papers from seven countries, published between 1987 and 2004. These
studies included interviews with 543 patients and 263 staff and analysis
of 1,165 forms and records from the UK, USA, Sweden, Finland, Germany,
Canada and Denmark.

"Legislation for involuntary psychiatric treatment exists in all
European Union member states and in other western countries, where an
increased risk to self and others provides the ethical and legal grounds
for detaining and treating psychiatric patients without their consent"
she says. "The fact that there is legislation in different countries
suggests recognition of the seriousness and ethical uncertainty of such
procedures.

"Perceived risk to others emerged as an important factor in the decision
by staff to give a patient CM. But although half the researchers
interviewed patients about their views on receiving CM, they didn't ask
them whether they perceived themselves to be a risk to their self or
others at the time when CM was administered.

"The studies showed that patients experienced a range of negative
feelings when they received CM, including fear, embarrassment, anger and
helplessness. Despite this, many said that they retrospectively agreed
with the practice."

Research papers included in the review showed a notable lack of detailed
exploration into the events leading up to the CM incidents and a
complete absence of investigation into alternatives.

"This may reflect variations in the way conflict is managed in
inpatients settings in different countries" suggests Jarrett. "CM is
more likely to be used in the UK than in other countries, in which other
forms of restraint such as seclusion or physical restraint are employed.
Previous research by Professor Bowers showed that in some countries,
such as the Netherlands, injecting someone against their will is seen as
a serious violation of the body, yet the use of mechanical restraints is
acceptable."

Jarrett and colleagues conclude that their review has highlighted a lack
of clinical evidence on which to base CM, pointing out that the practice
may discourage people from seeking help from, and engaging with, mental
health services.

"Earlier and more effective interventions might be useful in minimising
the use of CM, while better training in skills such as de-escalation
strategies might also be valuable in avoiding coercion" says Jarrett.

The authors also feel that more research is needed into the use of CM.

"While there has been a lot of research into the pharmacological
effectiveness of particular medications for quick and effective
sedation, the reasons for the compulsory administration of powerful
sedative and neuroleptic drugs have not been scrutinised closely or
frequently. And there is little evidence that alternatives have been
explored.

"The staff views reported in the literature and small number of studies
available suggests that CM is a 'taken for granted' practice in
inpatient psychiatry. We feel that this is unacceptable and more needs
to be done to establish sound clinical evidence and viable alternatives
to this contentious approach."

Journal reference: Journal of Advanced Nursing. 64.6, p538-548.
(December 2008) 

________________________________

Wiley - Blackwell (2008, December 5). Coerced Medication Used In
Psychiatric Care Despite Lack Of Clinical Evidence. ScienceDaily.
Retrieved December 5, 2008, from http://www.sciencedaily.com-
/releases/2008/12/081204074644.htm 

 

 

 

 

 

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