Study Examines Perceptions of Coercive Treatment and Satisfaction with Care among Veterans Hospitalized for Severe Mental Illness
Satisfaction with inpatient mental healthcare has been associated with quality of life and prognosis, global improvement, level of functioning, incidence and length of readmission, and outpatient follow-up and continuity of care following an index hospitalization. However, in general, patients with a psychiatric diagnosis report less satisfaction with psychiatric and medical hospitalizations and primary care than those without psychiatric diagnoses. "Coercive" treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence patients' perceptions of coercion and its effects on satisfaction. This study examined associations between perceptions of coercive treatment and satisfaction with care among psychiatric inpatients (n=240) at one VAMC. Investigators identified Veterans who had been diagnosed with a severe mental illness (e.g., schizophrenia, bipolar disorder, PTSD) and were treated between 3/04 and 12/05, and then analyzed data from chart review and structured interviews conducted during the index admission after the patient was deemed psychiatrically stable and as close to planned discharge as possible. Variables that were assessed included socio-demographics, substance use, self-rated health, satisfaction with care, and perceived coercion. Coercion was measured using true/false statements about having freedom, choice, idea, control, and influence regarding the current hospital admission, including voluntary compared to involuntary admission.
Findings show that both involuntary commitment status and perceptions of coercion were independently and negatively associated with patient satisfaction with psychiatric inpatient hospitalization. Among the 240 Veterans who were psychiatric inpatients in this study, 15% were involuntarily admitted, 40% reported prior involuntary admissions, and nearly half endorsed the perception of some coercion during their index admission. In addition, self-reported history of being denied a requested medication during psychiatric hospitalization (a potentially coercive treatment) may influence appraisal of care during the current hospitalization. Self-reported lifetime rates of other coercive treatment experiences ranged from 22% reporting being forced to take medications to 46% reporting ever being transported to the ER or hospital by law enforcement. The high prevalence of current and lifetime coercive treatment experiences observed in this cohort is consistent with previous reports in similar inpatient cohorts.
Strauss J, Zervakis J, Stechuchak K, Olsen M, Swanson J, Swartz M, Weinberger M, Marx C, Calhoun P, Bradford D, Butterfield M, and Oddone E. Adverse impact of coercive treatments on psychiatric inpatients’ satisfaction with care. Community Mental Health Journal September 28, 2012;e-pub ahead of print.
This research was partly supported by HSR&D (PCC 02-054). Dr. Strauss was supported by an HSR&D Research Career Development Award; Dr. Weinberger was supported by an HSR&D Senior Research Scientist Award. Drs. Strauss, Olsen, Weinberger, Calhoun, and Oddone are part of HSR&D Center for Health Services Research in Primary Care in Durham, NC.