Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward

Nord J Psychiatry. 2019 Nov;73(8):532-538. doi: 10.1080/08039488.2019.1664629. Epub 2019 Sep 16.


Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion. Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685). Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed. Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.

Keywords: DISC; Mental illness; discrimination; patients’ participation; stigma.

Publication types

  • Pragmatic Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Coercion*
  • Decision Making / physiology
  • Female
  • Humans
  • Inpatients / psychology
  • Male
  • Mental Disorders / psychology*
  • Mental Disorders / therapy
  • Middle Aged
  • Patient Participation / psychology*
  • Patient Participation / trends
  • Psychiatric Department, Hospital* / trends
  • Psychotherapy / methods
  • Psychotherapy / trends
  • Self Concept*
  • Social Discrimination / psychology*
  • Social Discrimination / trends
  • Young Adult