The Experience of Coercion and Violence: Service User, Professional and Informal Caregiver Perspectives

The focus of this chapter is to describe the views of service users, staff, and informal caregivers on violence, aggression, and coercion. Service users, staff, and informal caregivers usually have different views on why aggression and violence occur in mental health care settings. Staff and informal caregivers see the root of violence in the service user’s mental disorder and behaviour. Service users often describe staff behaviour as provocative and disrespectful, and therefore as the main trigger for violence. Also, their views on coercion vary significantly, reflecting a complex landscape of perspectives and challenges. Most service users oppose coercive practices, viewing them as violations of their rights and triggering past and future traumas. Conversely, staff and informal caregivers often see coercion as necessary to address aggressive behaviour or self-harm and maintain a safe environment. However, staff generally regard coercion as a last resort. Informal caregivers tend to be critical of coercive measures, feeling to be excluded and insecure as a result. All parties recognise the distressing impact of coercion on service users and its potential to disrupt therapeutic relationships. If clinical practice aims to minimise violence and coercion, service users must be actively involved on an equal basis in the development of alternatives and the promotion of shared and supported decision-making in mental health care.