title: Staff and caregiver attitude to coercion in India.
abstract: OBJECTIVE
  The objective of this study was to assess attitudes of Indian psychiatrists and caregivers toward coercion.
  Methods: The study was conducted at the Department of Psychiatry, Krishna Rajendra Hospital, Mysore, India. Staff Attitude to Coercion Scale (SACS), a 15-item questionnaire, was administered to self-selected psychiatrists across India and caregivers from Mysore to measure attitudes on coercion. Data were analyzed using descriptive statistics and investigating differences in subgroups by means of Chi-square test, Student'st-test, and analysis of variance. Reliability of the SACS was tested in this Indian sample.
  
  
  RESULTS
  A total of 210 psychiatrists and 210 caregivers participated in the study. Both groups agreed that coercion was related to scarce resources, security concerns, and harm reduction. Both groups agreed that coercion is necessary, but not as treatment. Older caregivers and male experienced psychiatrists considered coercion related to scarce resources to violate patient integrity. All participants considered coercion necessary for protection in dangerous situations. Professionals and caregivers significantly disagreed on most items. The reliability of the SACS was reasonable to good among the psychiatrists group, but not in the caregiver group (alpha 0.58 vs. 0.07).
  
  
  CONCLUSIONS
  Caregivers and psychiatrists felt that the lack of resources is one of the reasons for coercion. Furthermore, they felt that the need on early identification of aggressive behavior, interventions to reduce aggressiveness, empowering patients, improving hospital resources, staff training in verbal de-escalation techniques is essential. There is an urgent need in the standardized operating procedure in the use of coercive measure in Indian mental health setting.
authors.affiliation: Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad.
authors.forename: B N
authors.initials: BN
authors.lastname: Raveesh
authors.affiliation: Co-ordinator, Centre for Mental Health Law and Policy, Indian Law Society, Pune.
authors.forename: S
authors.initials: S
authors.lastname: Pathare
authors.affiliation: Head of research GGnet Community mental Health Centre, PO Box 2003, 7230 GC Warnsveld, the Netherlands and main researcher of the Dutch Information Centre for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, Netherlands.
authors.forename: E O
authors.initials: EO
authors.lastname: Noorthoorn
authors.affiliation: Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru.
authors.forename: G S
authors.initials: GS
authors.lastname: Gowda
authors.affiliation: Honorary Professor (Bangor University and Mysore Medical College and Research Institute, India), Consultant Psychiatrist (BCULHB), Centre for Mental Health and Society, N Wales, UK.
authors.forename: P
authors.initials: P
authors.lastname: Lepping
authors.affiliation: Professor of Biology and Society, Vrije Universiteit, Amsterdam, Netherlands.
authors.forename: J G F
authors.initials: JG
authors.lastname: Bunders-Aelen
keywords: Attitude; caregiver; coercion; staff