Contextual factors influencing coercion in mental health care: Insights from Nigeria and Portugal

Introduction: Understanding the contextual factors has the potential to enhance our comprehension of broader macro- and meso-level factors that contribute to the use of coercive measures in mental health care. The presentation is from a PhD research that explored the contextual factors influencing the use of coercion using Nigeria and Portugal as case studies for developing and developed countries.



Methods: Focus group discussions and semi-structured interviews were used to obtain information from both service users and providers in both countries. The selection of research methodologies was guided by practical considerations of what was feasible in each context. A narrative synthesis of literature was also conducted.



Results: The narrative synthesis showed that various factors beyond patient characteristics, such as mental health legislation, demand and supply of mental health resources, impactful events like economic recessions and COVID-19, and staff-related factors like attitudes, traits, and qualifications, along with public attitudes and stigma, contribute to the use of coercive measures in mental health care. These factors interact with each other, rather than independently, to reinforce their impact on the reliance on coercive measures for the care of mental disorders. In Nigeria, the outdated mental health law, limited accessibility to mental health care and social services, deeply rooted stigma and misconceptions surrounding mental disorders, and public attitudes were important factors influencing the use of coercive measures in mental health care. In Portugal, socio-legal factors, staff-related factors, inefficient services, and insufficient resources were identified as contextual factors influencing the use of coercion in mental health care.



Discussion: Fundamental problems within the mental health care system must be resolved to deliver high-quality mental health care. By involving all stakeholders, and fostering collaboration, all countries, regardless of income level, can strive for reform and establish mental health systems that prioritize human rights, dignity, and recovery.