title: Clinical correlates and predictors of perceived coercion among psychiatric inpatients: A prospective pilot study.
abstract: BACKGROUND
  The current Mental Health Care Bill (MHCB) -2013 in India advocates least restrictive alternatives (LRA) in psychiatric treatment. However, we have little evidence on patient's perspectives of coercion and LRA.
  
  
  METHODS
  This was a hospital-based prospective pilot study. 170 subjects chosen by computer-generated random number sampling were screened. In 83 eligible subjects, all assessments including coercion assessment were completed within 3 days of admission and in 75 subjects reassessment was done within 3 days of discharge.
  
  
  RESULTS
  Perceived coercion as measured by the MacArthur Perceived Coercion Scale (MPCS) decreased significantly from 3.72±1.98 at admission to 1.77±1.8 (<0.001) at discharge. This was accompanied by significant increase in global functioning, insight score (from 1.5±1.0 to 3.8±1.1; p<0.001) and as well as decrease in symptom severity (CGI-S) (from 5.9±1.1 to 1.8±1.9; p<0.001). Coercion is predicted by family type, employment status, socio economic status, severity of illness and level of insight. 87% patients reported that their admission was justified even though many felt coerced during hospital stay.
  
  
  CONCLUSIONS
  Coercion is a dynamic state and changes with treatment and care. Clinical care may result in an improvement in global functioning, insight as well as in reduction in severity of illness consequently leading to less coercion. During the time of discharge, majority of patients reported that their admission was justified, even though they felt coerced during hospital stay and agreed for treatment against their will within a safe, standardised coercive practice.
authors: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. Electronic address: drgsgowda@gmail.com.
authors: Guru S
authors: GS
authors: Gowda
authors: Project leader Dutch Case Register on Containment Measures located Den Dolder Utrecht, the Netherlands and Senior Researcher at GGNet Community Mental Health Centre, PO Box 2003, 7230 GC Warnsveld, The Netherlands.
authors: Eric O
authors: EO
authors: Noorthoorn
authors: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
authors: Channaveerachari Naveen
authors: CN
authors: Kumar
authors: Dharwad Institute of Mental Health and Neurosciences, (DIMHANS), Belgaum Road, Dharwad 580008, India.
authors: Raveesh Bevinahalli
authors: RB
authors: Nanjegowda
authors: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
authors: Suresh Bada
authors: SB
authors: Math
mesh_terms: D000328:Adult; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D005260:Female; D006801:Humans; D007194:India; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Clinical factors; Coercion; India; Inpatients; MHCB – 2013; Patients’ perspective