Coercive measures remain routine in psychiatric hospitals, yet new evidence suggests they do far more harm than good. A longitudinal study of 111 inpatients in southern Spain links restraints, isolation, and forced medication to immediate trauma symptoms, long-term functional decline, and a higher likelihood of readmission within five years. The authors conclude that practices justified in the name of safety instead undermine recovery and violate fundamental human rights, echoing repeated warnings from the World Health Organisation and the United Nations.
The study led by Jesús Herrera-Imbroda from the University General Hospital of Málaga analysed the impact that coercive measures and practices have on traumatic stress, suicidality, overall functioning, and readmission during and after experiences of psychiatric hospitalisation from the perspective of service users.
The authors write:
“This study highlights the importance of protecting human rights and the dignity of users of mental health hospitalisation units and including, as much as possible, the user in the decision-making process related to their treatment.”
Survivors, ex-patients, and critical clinicians have long argued that coercion is counter-therapeutic and incompatible with human rights. This study supplies fresh empirical support for that position, documenting how forced measures deepen trauma and hurt long-term recovery. It underscores demands from the consumer-survivor movement to shift power toward those most affected, end involuntary interventions, and fund community-based, peer-led responses that respect autonomy and dignity.
To begin, the authors establish that coercive measures are standard in psychiatric environments, including mechanical restrictions, isolation, and forced and involuntary medication. For many, these experiences are a key factor in their lived experiences of psychiatric hospitalisation, finding them dehumanising, punitive, and humiliating to service users.
The study draws from data establishing that the use of force in mental health settings is a human rights violation and has adverse long-term impacts on service users’ ability to recover.
Participants for the study were recruited from two public hospitals in Spain: 93 from the Hospital Universitario Regional de Málaga and 18 from the Hospital General de Jerez de la Frontera. To participate, individuals had to be in inpatient units, have undergone a coercive measure within the last 48 hours, be between the ages of 18 and 65, and be capable of understanding and providing informed consent. Those with severe intellectual or language disabilities were not eligible to participate in the study.
To analyse their data, the researchers observed perceived coercion, satisfaction with treatment, changes in functioning, and post-traumatic stress and employed a multivariate analysis of variances. Further, they used an observational longitudinal study and reviewed clinical records of the participants to evaluate re-entry and suicidality five years after their initial evaluation.
First, they found that perceived coercion increased the risk of traumatic stress and reduced satisfaction with treatment. They also found that coercive measures have detrimental effects on recovery. These increased re-entries into psychiatric hospitalisation also prevented people’s ability to recover in ways that support their functioning or quality of life.
Their principal findings were that post-hospitalisation trauma was associated with coercive measures and that coercive measures led to worse long-term outcomes related to overall functioning and emotional well-being.
They write:
“The use of coercive measures in mental health settings is a controversial subject and frequently involves a conflict between maintaining the user’s autonomy and the safety of those in charge of their care, their fellows, and/or the users themselves. Moreover, their use increases the risk of serious negative events that range from mental trauma and physical injuries to death. Their use could constitute a violation of patients’ human rights, and patients who have experienced coercive measures frequently perceived these as antitherapeutic, punishing, humiliating, or traumatising.”
This study demonstrates that coercive practices in psychiatry have long-term adverse effects on people’s mental health. Additionally, it places a question mark on the idea that coercive measures are necessary for the “well-being” of service users. Finally, it reinforces the urgent need for compassion and human rights-based models.
“These results indicate that organisational and humanising measures during the application of coercive measures are recommended to improve patient satisfaction and reduce the risk of trauma. Likewise, the results indicate that the use of combined coercive measures should be avoided during hospitalization, as they may be a risk factor for poorer recovery and a worse long-term prognosis.”
These findings add to growing evidence that coercion in mental health settings has worse long-term outcomes than compassion-based approaches and is not justified due to the cumulative harm it causes. The use of coercion is often justified under the idea of “safety”, specifically when providers encounter behaviours that are risky to others, including themselves and other service users. However, research suggests that instead of utilizing coercion, creating plans and having conversations with service users on how best to address them in moments of high emotional distress is beneficial to them and those who surround them.
The therapeutic benefits of psychiatric hospitalisation have been questioned by the World Health Organisation and the United Nations, which have called for the elimination of coercive practices in these settings. In fact, service users report experiencing adverse events and human rights violations during their stays in psychiatric hospitals. Further, studies have found that psychiatric hospitalisations increase the risk of suicide during and after admissions, erode service user dignity, and lead to or increase traumatic stress.
Alternatives to coercive practices and measures are beneficial for recovery and healing from emotional distress. Soteria houses, peer respites, therapeutic farms, the hearing voices movement, and open dialogue, among others, have all shown that human rights-based and compassionate-based approaches benefit individuals and their communities and are also more cost-effective in the long run. Further, addressing the social determinants of health is imperative to understanding human suffering and how to mitigate it.
This article was first published here on Mad in America.
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Herrera-Imbroda, J., Carbonel-Aranda, V., García-Illanes, Y., Aguilera-Serrano, C., Bordallo-Aragón, A., García-Spínola, E., … & Guzmán-Parra, J. (2025). An Exploratory Study about Factors and Outcomes Associated with the Experience of Coercive Measures in Mental Health Settings. Psychiatric Quarterly, 1-12. https://doi.org/10.1007/s11126-024-10110