Deborah Oyine Aluh

I had originally planned to write a science communication blog post about my research article on the Contextual factors influencing the use of coercive measures in Portuguese mental health care when Cristina Hashchuk approached me to write a news article on the same topic for her Science Journalism course. She is currently studying for a master’s degree in science communication at FCSH.


Main Factors Triggering Coercive Measures in Mental Health Institutions


Insufficient funding triggers multiple interwoven factors that cause the deployment of coercive measures in national mental health institutions. A new study highlights the urgency of improving the treatment and welfare of people with mental health conditions.


Cristina Hashchuk

Factors such as the environment, healthcare professionals’ training, and a lack of funding and services contribute to the use of coercive measures in psychiatric institutions in Portugal, reveals a study by the Lisbon Institute of Global Mental Health, NOVA University of Lisbon.

Coercive measures are used in the treatment of psychiatric patients to calm and/or restrain them, prevent further harm, and “include involuntary hospitalizations, the use of mechanical and chemical restraints, seclusion, isolation, and other forms of restraint,” says lead author Deborah Aluh.

The study, conducted through focus groups with 40 healthcare professionals, points to the environment, the training of healthcare professionals, and the services provided as the factors that influence the patient’s mental well-being and the relationship between the healthcare professional and the patient.

The factors that impact patient treatment are intertwined, which makes it more difficult to solve problems. Insufficient funding leads to the use of unsuitable spaces and low levels of human resources. “The infrastructure and architecture of mental health buildings aggravate psychiatric patients’ feelings of anxiety,” argues one of the participants.

Insufficient resources result in a shortage of available professionals, which hinders the formation of a good doctor-patient or nurse-patient relationship. Poor therapeutic relationships between professionals and patients lead to mutual distrust and, sometimes, hostility and aggression, and, consequently, the use of coercive measures. This leads to a “snowball effect.”

On the other hand, the COVID-19 pandemic was another factor that impacted the treatment quality of psychiatric patients. According to the focus group discussions, numerous patients were neglected during the pandemic. “Many of them spent several months without taking medication, without even being seen by a relative, let alone a health professional,” argues one of the participants. “The pandemic increased the use of involuntary admissions here.”

“Even though coercive measures are usually employed in psychiatric services all around the world, there is a growing awareness and a movement to reduce and eventually eliminate their use,” argues the researcher, “since it raises ethical and human rights problems and is associated with worse clinical results in the patients.”

The previous Portuguese mental health legislation regulated involuntary admission for people with mental health conditions, but it did not address restraints or isolation of patients. The new legislation is a significant step forward, as it promotes joint decision-making and advanced treatment plans. “While the current law is progressive, future revisions may be necessary to align it with the UN Convention on the Rights of Persons with Disabilities, which includes people with mental health problems.”.


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