Perceived determinants of the use of coercion in inpatient child and adolescent psychiatry: a qualitative interview study with staff

Background: Understanding factors influencing the use of coercive practices in clinical psychiatry is necessary to develop strategies to reduce their use. However, there is little evidence regarding staff perceptions of such factors, particularly in inpatient child and adolescent psychiatry (CAP). Methods: We conducted semi-structured interviews with nurses, senior consultants and heads of units in inpatient CAP in Sweden 2021 (N = 9). The interviews were transcribed verbatim and analysed using reflexive thematic analysis. Data on informal coercion were analysed separately using a deductive approach based on previously proposed hierarchies for informal coercion. Results: We identified one overarching theme of factors reported to influence the use of coercive practices: “Trust and distrust in coercive and non-coercive approaches”, in turn encompassing the two subthemes “Ward culture” and “Available resources and strain”. Our findings suggest a risk of a negative spiral of coercion emerging when there is low professional trust in non-coercive approaches and high trust in coercive methods. Informal coercion was used frequently and observed to occur in two distinct processes: one concerning continuous coercive escalation, and the other involving sustained efforts at the same coercion level. Conclusions: Trusting the efficacy of non-coercive approaches in inpatient CAP care appears critical for their success; a finding that may inform strategies to reduce coercion and address frequent use with individual patients.