Coercive Interventions Mental Health Assignment

Running head: MENTAL HEALTH
Mental health
Name of the student:
Name of the University:
Author’s note

1MENTAL HEALTH
The uses of restrictive and coercive interventions are common in mental health settings
and it mainly involves the use of authority to restrain a person’s autonomy and restrict adverse
behaviours in some way or the others (Brady et al., 2017). Due to the nature of coercive practices
and its role in infringing human and ethical rights, there are many controversies surrounding the
use of this intervention in mental health settings. One such coercive intervention is the use of
psychotropic medications to control behaviour and symptoms for people with mental illness
(Sheehan et al., 2015). The main purpose of this essay to review the controversy regarding the
use of psychotropic medications in mental health and interpret the advantages and limitations
associated with the use of sedative medications in patient. In addition to this, essay will present
findings about the challenges faced by registered nurse in administering such medications to
patients who have risk of self-harm and harm to others.
People diagnosed with mental illness often display challenging behaviours when
progressive deterioration of symptoms occur and the problematic behaviour may be such that it
may threaten the physical safety of the patient or individuals near to him (Brady et al., 2017).
Psychotropic medications like antipsychotic medications, anti-depressants and mood stabilisers
are often provided to such patients (Charlot, Sheehan & Hassiotis, 2019). These medications
should be given for challenging behaviours and such medications should be avoided unless the
patient’s behaviour is very serious and it has not been addressed by the use of other treatment
(Flood, 2018). However, review of research paper by Sheehan et al. (2015) revealed that
concerns has been expressed regarding the use of these drugs as it is overused in patients with
intellectual disability and patients with severe mental illness (SMI). Hjorth et al. (2014)
enlightened the controversy surrounding the use of these medications by stating that prescribing
of high doses of antipsychotic drug is common in clinical practice without the use of appropriate

2MENTAL HEALTH
clinical guidelines. This is considered inappropriate because of negative physical health
implications on patient such as side-effects and dose related toxicity. For instance, weight gain
occurs due to the use of multiple psychotropic medications. In some patients with SMI, it may
also lead to serious side-effects such as tremor, sexual dysfunction, sedation, decreased physical
activity and adverse effects on heart (Moncrieff, Cohen & Porter, 2013). Thus, due to these
disadvantages associated with use of psychotropic medication, there is a strong movement to
control or eliminate practice altogether.
In an attempt to understand the controversy surrounding the use of psychotropic
medicines like sedatives, there is a new to review research literatures related to the impact of
such coercive interventions on consumers as well as health care professionals. Firstly, the essay
will look into aim or advantage of using psychotropic drugs like sedatives with patient and then
consider the challenges linked to the practice. According to Scheppke et al. (2014), staffs in
mental health setting are often confronted with violent and uncooperative patient. These groups
of patient mostly exhibit symptoms of aggressive behaviour and altered sensory behaviour. In
order to gain medical control over these patients, staffs often provide medications like
benzodiazepines and haloperidol which have sedative effects. However, the study reported some
challenges or problems associated with the use of these medications. For example, most of these
patients are given sedative medications in high doses leading to negative hemodynamic and
respiratory side-effects (Schepis et al., 2018). Moreover, Mantovani et al. (2010) reports frequent
use of rapid tranquilization as a type of pharmacological management of agitation in patient with
SMI. The purpose of this intervention is to reduce symptoms without prolonged sedation and
keeping the patient responsive too. However, apart from the advantages, the authors expressed
concern regarding the use of high potency antipsychotic medication. It linked use of these

3MENTAL HEALTH
medications with severe side-effects such as excessive sedation and impaired motor and
cognitive function and this is consistent with the study by (Goldberg & Ernst, 2018). This study
suggests why there is a controversy surrounding use of psychotropic medications. To reduce risk
of harm to patient, mental health professionals must be very careful regarding use of these
medications and even if there is a need to use the drug, it should be given in lowest possible
dose. Instead of completely relying on such pharmacological interventions, the professional
team should be proficient in showing behaviour to effectively manage violent patient and prevent
damage to property or any harm to other patients too (Heckemann et al., 2019).
The review of above literature gave idea about the benefits and harms associated with
psychotropic medications on patient. However, as dealing with violent patient is a professional
responsibility of medical staffs, finding out how use of sedative medication and deciding to use
these types of drug challenge staffs is an area that must be explored too. The main purpose of
psychotropic drug is to restrict violent patient by the use of pharmacological effects like
sedation. However, one of the major concerns for staffs related to deciding about the use of such
coercive practice is the high risk of ethical challenges with the practice (Goldberg & Wagner,
2019). Hem et al. (2018) has discussed about some of these challenges by conducting a
systematic review of literature. As per the ethical principal of beneficence, use of coercion is
justified to promote the best interest of patient. However, as majority of staffs use coercion
techniques without taking patient’s permission, patient autonomy is significantly challenged.
Thus, autonomy infringement during use of coercive practice like using sedative medication
leads to anxiety among staffs. This form of decision making challenge is high for those staffs
who have less experience compared to experienced staffs. Moral distress is a common
behavioural response for such staffs too. How to strike a balance between maleficence versus