Changes in patterns of coercion during a nine-year period in a Norwegian psychiatric service area

Objective There is debate regarding the use of coercion in the psychiatric services and how to minimize its use. We examine changes in the use of coercion in one Norwegian psychiatric service area during a nine-year period. Methods All patients receiving psychiatric services during the periods 2003-2006 and 2008-2012 in the study area were identified, subsequently also only those who had been involuntarily admitted or subjected to involuntary outpatient treatment. Yearwise rates of patients admitted to coercion and coercive treatment-episodes throughout the study period were calculated. Results The overall number and the rate of coerced patients decreased to the total patient population. Most of the reduction were initially of the observational period. However, the number of coercive episodes per coerced patient increased. The pattern of outpatient versus inpatient modes of coercion both reflected this main trend. Conclusion The use of coercion seem to be reduced overall, although the increase in treatment-episodes per patient may indicate a complex pattern in use and registration of coercion. The results may be related to legislative changes, restructuring of psychiatric services, or/and modified attitudes of health-personnel to coercion following a range of efforts to reduce it.