Research shows that coercive practices — subtle and overt — remain deeply embedded in everyday psychiatric care.

A 2023 qualitative study by Aragonés-Calleja and Sánchez-Martínez asked nursing staff at an inpatient psychiatric unit about their knowledge and experience of coercion. More than a third of participants had never heard the word or couldn’t define it — despite having worked in mental health for years. And yet every single one of them described situations where a patient’s rights or freedom had been compromised.

A 2025 scoping review by Beeri and colleagues mapped out just how complex this gets. Coercion isn’t only restraints and forced medication — those are formal coercive measures, regulated by law and documented in charts. Informal coercion is something else entirely. It lives in communication patterns, in the way information gets withheld or selectively shared, in the subtle application of institutional pressure, in the difference between a genuine conversation and a conversation where the outcome has already been decided. It’s not legislated. It’s not in clinical guidelines. It leaves almost no paper trail.

The ethical problem isn’t just that these things happen. It’s that they often happen with good intentions — and good intentions have become a kind of ethical shortcut in psychiatric care. Staff justify coercive interventions by saying they’re acting in the patient’s best interest, and that framing tends to end the conversation rather than deepen it. But patients frequently only recognize after the fact that their autonomy was constrained. The experience of being coerced doesn’t become less harmful because the person doing it meant well.

Both papers point to the same uncomfortable truth: how staff think about patients shapes how they treat them. Participants who described patients with empathy and dignity were more likely to view coercion as a last resort. Participants who framed patients as manipulative or incapable of knowing what was good for them were more likely to normalize coercive approaches. 

Patients in psychiatric settings are already in some of the most vulnerable positions a person can be in. They deserve care that starts from their dignity rather than arriving at it as an afterthought.

References

Aragonés-Calleja, M., & Sánchez-Martínez, V. (2023). Experience of coercion among nursing professionals in a medium-stay mental health unit: A qualitative study in Spain. Journal of Psychiatric and Mental Health Nursing, 30(5), 983–993. https://doi.org/10.1111/jpm.12921

Beeri, S., Baumberger, E., Zwakhalen, S., & Hahn, S. (2025). Conceptualisation of informal coercion in inpatient psychiatry: A scoping review. International Journal of Mental Health Nursing, 34, e70076. https://doi.org/10.1111/inm.70076