Psychiatric Care Pathways and the Use of Coercion : From Pre-Hospital to Inpatient Settings

Article Article scientifique Article Psychiatric Care Pathways and the Use of Coercion : From Pre-Hospital to Inpatient Settings eng 2026-07-21 author Emery Benjamin Division of Adult Psychiatry, University Hospital of Geneva, Geneva, Switzerland. benjamin.emery@hug.ch. 755089 author Suppan Laurent Division of Emergency Medicine, Department of acute care medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of anaesthesiology, pharmacology, intensive care and emergency medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 505697 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Kaiser Stefan 0000-0002-3013-2034 Division of Adult Psychiatry, University Hospital of Geneva, Geneva, Switzerland. 868946 Département de psychiatrie (PSYAT) author Ambrosetti Julia Division of Emergency Medicine, Department of acute care medicine, Geneva University Hospitals, Geneva, Switzerland. 864890 Département de psychiatrie (PSYAT) author Wullschleger Alexandre Division of Adult Psychiatry, University Hospital of Geneva, Geneva, Switzerland. 595667 Département de psychiatrie (PSYAT) 10.1007/s10597-026-01693-8 42479369 0010-3853 https://link.springer.com/10.1007/s10597-026-01693-8 The use of coercive measures in psychiatry raises ethical and clinical concerns, particularly given their potential psychological harm and long-term consequences. While most studies focus on inpatient settings, little is known about coercion applied earlier in the care pathway.This retrospective observational study included all patients (N = 695) admitted through the psychiatric emergency department (ED) to the adult psychiatry division of Geneva University Hospitals in 2019. Data were extracted from electronic medical records and included sociodemographic variables, clinical characteristics, and the use of coercion (seclusion, restraint, or forced medication) in three settings: ambulance, ED, and inpatient wards. Bivariate analyses and logistic regressions were conducted to identify predictors of inpatient coercion.Overall, 33.7% of patients experienced coercion in at least one setting: 22.4% during hospitalization, 20.7% in the ED, and 4% during ambulance intervention. Logistic regression identified several factors independently associated with inpatient coercion: coercion in the ED (p < .001), involuntary admission (p= .009), ambulance intervention (p = .035), younger age (p = .039), higher aggression score at admission (HoNOS item 1; p < .001), and a diagnosis of psychotic or bipolar disorder (p = .001).This study highlights that coercion often begins before psychiatric hospitalization and that early coercive experiences significantly predict subsequent inpatient coercion. A comprehensive evaluation of the entire psychiatric care trajectory is essential to better understand and reduce coercion. Targeted preventive strategies-such as pre-hospital crisis interventions, ED de-escalation protocols, and early pharmacological treatments-may help promote more ethical and patient-centered care. Ambulance Coercion Emergency Hospitalization Psychiatry Switzerland Dewey 616.89 Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 60 Département de psychiatrie 225 false 1236 Psychopathologie clinique et expérimentale 987 Community mental health journal df663b09-3050-450e-b2af-1d34ce9a3eb8 Article (Published version) Public Article_scientifique_from_unpaywall.pdf 1020806 application/pdf CC BY-4.0 8d019c57860dbf6c54e8d1472b932ce2916ebed675645707db1618ee92d15f2a openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de psychiatrie

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Psychiatric Care Pathways and the Use of Coercion : From Pre-Hospital to Inpatient Settings	Community mental health journal			2026	1	0

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Emery, Benjamin