Contextual factors influencing the use of coercive measures in Portuguese mental health care

The use of coercive measures in mental health care is an important indicator of the quality of care being pro-vided, and non-patient-related factors are increasingly recognized to contribute to their use. The study aimed to explore the perspectives of mental health care professionals who have first-hand experience with the use of coercion on the contextual factors that influence the use of coercion in the Portuguese mental health care. Five focus group discussions were conducted among 23 doctors and 17 nurses from five psychiatric departments in urban and rural regions of Portugal. Discussions were audio recorded, transcribed, and analyzed with the aid of MAXQDA. Four broad themes related to insufficient resources, staff-related factors, inefficient services, and socio-legal factors were derived. Participants highlighted how inadequate structures, staff shortages, staff atti-tudes, a lack of training, restrictive ward rules, an inefficient organization of services, the mental health legis-lation, and public attitudes contributed to the use of coercive measures. The COVID-19 pandemic complicated existing shortfalls in the system and increased the use of coercive measures. The study confirms that the use of coercive measures in mental health care is influenced by factors that are independent of patient characteristics. Addressing existing systemic problems is crucial for the successful implementation of interventions to reduce coercion in mental health care.

Automated summary

The study explored the perspectives of mental health care professionals in Portugal who have experience with the use of coercive measures. Through focus group discussions with doctors and nurses from psychiatric departments in urban and rural regions, the study identified insufficient resources, staff-related factors, inefficient services, and socio-legal factors as the main influences on the use of coercion. Factors such as inadequate structures, staff shortages, restrictive ward rules, and the COVID-19 pandemic exacerbated the use of coercive measures.