Attitude of young psychiatrists toward coercive measures in psychiatry: a case vignette study in Japan

A total of 183 young psychiatrists participated as subjects in our study. A questionnaire with a case vignette describing a patient with acute psychosis was sent to the study subjects via the Internet or by mail. This questionnaire included scoring the necessity for hospitalization, and the likelihood of prescribing seclusion and/or restraint, on a 9-point Likert scale (with 9 indicating strong agreement).There was general agreement among the study subjects that the case should be admitted to a hospital (8.91 ± 0.3) and secluded (8.43 ± 1.0). The estimated length of hospitalization was 13.53 ± 6.4 weeks. Regarding the likelihood of prescribing restraint, results showed great diversity (5.14 ± 2.5 on 9-point scale); psychiatrists working at general hospitals scored significantly higher (6.25 ± 2.5) than those working at university hospitals (5.02 ± 2.3) or psychiatric hospitals (4.15 ± 2.6). A two-group comparison of the length of inpatient care revealed a significant difference between those psychiatrists who scored 1-3 (n = 55, 14.22 ± 7.4 wks) and those who scored 7-9 (n = 62, 12.22 ± 4.0) regarding the need to use restraint.Our results may reflect the current dilemma in Japanese psychiatry wherein psychiatrists must initiate coercive measures to shorten hospitalization stays. This study prompted its subject psychiatrists to consider coercive psychiatric treatments.There have always been concerns about human rights infringements for coercive psychiatric measures, such as involuntary admission, forced medication, seclusion and/or restraint [1]. Controlled studies have provided no evidence about the validity of such interventions, primarily because ethical considerations make it difficult to perform randomized controlled trials [2,3]. However, such involuntary treatments are indispensable in many clinical practice scenarios, and they are commonly used as strategies to treat patients exhibiting disruptive and violent behaviors [3-7].The Mental Health Act in Japan was