Psychiatric coercion and violence: ethical, legal and preventive aspects

Introduction. Violence and coercion cause harm not only to the physical health but also to the mental condition and social well-being; it makes an impact on the effectiveness of direct care, prevents a favorable therapeutic alliance. Aim. The objective of this review was to provide an analysis of the ethical, legal, and preventive aspects of coercion and violence measures applied in a psychiatric hospital based on literature data. Material and Methods. We analyze research articles, mainly over the last 5 years, related to the problem of coercion and violence against patients in psychiatric hospitals in different countries from computer databases, PubMed, Medical-Science, E-Library, Web of Science, Scopus. Results and Discussion. The patients of psychiatric hospitals are subjected at every turn to coercion and violence by medical staff and come across difficulties in protecting their rights and legitimate interests. In conditions of a psychiatric hospital, coercion affects directly the process of hospitalization, delivery of psychopharmacotherapy, organizing a protective regimen in departments, rendering urgent medical aid for psychomotor agitation, and other conditions, applying measures of physical coercion and isolation, and realization other essential patients’ rights. The absence of a clear legal framework, clinical criteria, and ignoring the principles of bioethics are accompanied by abuses by medical staff, the use of various forms of violence against mental health patients’, breaking their essential rights to their bodily integrity, freedom of movement and privacy. Conclusion. It is required to develop regulatory legal acts controlling the procedure of restriction of the rights of persons with mental disorders and medical criteria. A bioethical approach to psychiatric care delivery, the use of psycho-educational programs, and psychosocial rehabilitation promote to increase patients’ compliance and an effective therapeutic alliance with a psychiatris