Determinants of limited resort to coercive measures: on-site research in four French hospitals

Jean-Paul LANQUETIN2, Anais MCCARDELL3, Frederic MOUGEOT1, Yvonne QUENUM2, Loic ROHR2, Sebastien SAETTA1

1Ecole Nationale des Solidarites, de l'Encadrement et de l'Intervention sociale, Villeurbanne, France
2CHU de Saint-Etienne, Pole de psychiatrie, Saint-Priest-en-Jarez, France
3Universite Paris 8, Saint-Denis, France

Introduction

In France, hospitals with psychiatric departments resort to coercion and more specifically to seclusion and restraints in varying degrees across the country. Considering the recent legislative developments and renewed authority of a judge, some French hospitals with higher coercion levels aim to lessen their use of it. Meanwhile, other French hospitals historically resort significantly less to coercion in comparison with national rates, and yet are surprisingly little studied. Based on the PLAID-Care research, this presentation aims to shed light on four hospitals with limited resort to coercive measures.



Methods

The investigation is based on the collection of systematic data relating to hospitals, as well as socio-anthropological methods (70 semi-directed interviews, 62 days of observations and documentary method).



Results

Findings reveal that resorting less to coercion is linked to specific practices and representations such as a priority given by professionals on making themselves available to patients; the centrality of activities; or a positive representation of psychiatric patients. This care work is made possible by an organization at both the department level, such as integration policies or horizontal relationships between professionals; and at the hospital level, such as attractiveness or employment policies or a structured medical steering committee. This becomes a virtuous circle in which the care work provides professional satisfaction, commitment and team stability, while the involvement of the hospital level guarantees the sustainability of policies supporting less resort to coercion. Additionally, an openness culture, collegiality and risk-taking, are other values and principles underpinning these policies in some hospitals.



Discussion

This presentation highlights determinants and levels leading to less resort to coercion in psychiatry and analyzes the links between these different levels. It provides levers for action based on on-site research, which can be of benefit to other facilities aiming to reduce coercion.