Psychotropic Treatment, Coercive Measures, and Nursing Challenges

This essay delves into the multifaceted aspects of mental health treatment, particularly within the Australian healthcare context. It examines the use of psychotropic medications, highlighting their advantages and disadvantages, and explores the controversial application of coercive and restrictive measures in managing psychiatric patients. The paper addresses the ethical dilemmas associated with such practices, especially regarding informed consent, and the potential for re-traumatization. It underscores the importance of recovery-oriented mental health care, emphasizing patient-centered approaches to minimize the need for coercive interventions. The essay also discusses the challenges registered nurses face, including violence from patients and the psychosocial impacts of their work. The conclusion highlights the benefits of recovery-oriented care in reducing the negative impacts of restrictive measures and improving outcomes for both patients and healthcare professionals. The essay provides a comprehensive overview of the complexities of mental health treatment, emphasizing the need for ethical practices and patient-centered care.

Running Head: Mental Health 1
Psychotropic Treatment and Impacts of Restrictive and Coercive Measures
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Introduction
Globally, the incidence and burden of mental illness are significant (Vos et al., 2017).
According to the Mental Health Services in Australia (MHSA) (2020), is that "about 45% of
Australians aged 16 to 85 years will experience a mental disorder in their life.” Mental
illnesses encompass conditions with low prevalence and those with severe consequences that
range from eating disorders to psychotic illness (DoHA 2013). Psychotic illness includes
Schizophrenia, Delusional disorder, Bipolar disorder, and Schizoaffective disorder. The
illnesses are characterized by fundamental thinking distortions, emotional responses, and
distorted perception (Morgan et al., 2011). The treatment of mental disorders varies based on
the type and severity of the illness. Psychotropic medications such as sedatives are used in
managing psychiatric patients through restrictive measures to reduce aggressive behavior that
may hinder treatment. The coercive measures can be achieved by hiding the sedatives in
food or drinks (Latha, 2010). Such practice has its impact, which also touches on the legal
and ethical principles of the patient, as discussed in this paper. This paper intends to discuss
the challenges faced by registered nurses in recovery-oriented mental illness treatment as well
as the impacts of coercive and restrictive measures.
The psychotropic medication exerts its effect by influencing the chemical makeup of
the nervous system and the brain (Roberts, 2019). The use of psychoactive drugs such as
sedatives has several advantages as well as disadvantages. The medication is not always the
first option in treatment but is always required to ensure the staff and patient safety. Mental
ill patients might show challenging behavior such as punching, grabbing, biting, or cause
self-injury, which can limit the safe delivery of excellent care (Parker, 2015). Psychotropics
have disadvantages such as extrapyramidal effects, psychomotor slowing, sexual dysfunction,
and physical health complaints, among others (Ferreira et al., 2017). According to
Stephenson and others (2013), controversy exists in the use of psychotropic medications in

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the management of mental illnesses. For instance, the use of sedatives without the knowledge
of patients is against medical principles such as self-consent and is therefore ethically
inappropriate. Nurses in mental health care in Australia face several challenges while
implementing recovery-oriented practices. According to the Australian Health Ministers'
Advisory Council (AHMAC) (2013), Recovery-oriented mental health practices are centered
around the needs of the patient. Therefore, it is imperative to have the necessary measures in
place to address the challenges faced by nurses in practice.
The controversy of the Use of Sedatives in Coercive Measures
Several controversies exist in the use of psychotropics to treat psychiatric patients. A
major concern is an ethical dilemma faced by nurses, for instance, the administration of
treatment through coercion. According to Latha (2019), Psychotic patients may present non-
adherence during treatment, which may prompt the use of covert medications by the nurses.
Ethically hiding psychotropic medication such as sedatives to reduce the patient's non-
adherence breaches contemporary ethical practices by the health staff and family members
that approve the practice. Such a practice contravenes the paramount ethical principle of
informed consent. Quality recovery-oriented mental health practices involve delivering
trauma-informed, consumer-centered, recovery-focused, and that ensures safety for everyone
(Butterworth and Faugier, 2013). Therefore, nurses must follow the necessary procedure of
administering psychotropics to patients who can't give consent.
Other controversies of psychotropics center around the long-term side effects of the
medications. According to Stroup and Gray (2018), the side effects range from mild issues
such as dry mouth to most severe such as sexual dysfunction, acute dystonia, and life-
threatening conditions such as myocarditis agranulocytosis. The side effects vary from one
psychotropic medication to the other. Electroconvulsive Therapy (ECT) is a psychiatric
treatment that remains controversial though effective (Luty, 2017). The side effects of such

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treatments are highly emotive and tend to be viewed negatively by the politicians and the
general public. Such negative views may result in the demotion of some applications of the
antipsychotics, which can affect the delivery of quality mental health care. Psychotropic,
treatments such as the use of coercive measures have more benefits compared to
shortcomings that result in controversies.
Recovery-Oriented Mental Health Care
This approach offers the transformative conceptual context of service-delivery,
practice, and culture in mental health care. The framework is built around the lived
experiences of the mentally ill patient and their families. The approach helps to map the
experience and journey of the patients, which helps in affirming their identity beyond the
restraints of the diagnosis. Recovery-oriented care challenges the traditional notions whereby
professional power is used to contain the mental issue. This is because the approach
combines the expertise of professionals with the patient's values, which helps in breaking
down demarcation between the staff and the consumer (AHMAC, 2013). Focusing on the
needs of the patients in recovery-oriented practice may be essential in reducing the use of
restrictive and coercive measures in mental health care.
Impact of Restrictive and Coercive Measures
Coercive measures in mental health treatment include restraint, seclusion, and forced
medication. The measures might have positive and negative outcomes. International
guidelines outline that coercive measures should only be used when other, less restrictive
procedures fail (Fiorillo et al., 2011). Advantages of coercive measures include safety to
nurses and the patient as well as other facility users and easier delivery of services. According
to the Victorian Government Department of Health (2013), restrictive measures have
negative consequences. They include the re-traumatization of patients with existing trauma
histories and damaging of therapeutic relationships between the nurses and the consumers.

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The negative impacts of restrictive and coercive measures have led to the formulation of
strategies aimed at eliminating the practices.
A significant positive impact of coercive measures is that it gives nurses and other
staff time to administer treatment procedures safely. Mental health patients may be abusive,
which can sometimes derail the morale of nurses. According to Jalil and colleagues (2017),
nurses reported anger related provocation when exposed to verbal abuse and aggressive
behavior from the patients. The same nurses said that their irritation was drastically
minimized when they endorsed the use of restrictive without their actual involvement in the
restraint episodes. Therefore, the use of coercive and restrictive measures ensures that the
workers remain uncompromised, and therefore they deliver quality health services.
According to Malamed (2017), one goal of mental health workers is patient comfort.
The use of coercive measures helps achieve that goal. For instance, the use of sedatives in
mental health care helps to reduce a patient's awareness of their external stimuli, thus
reducing anxiety and violent behavior. Restrictive measures such as restraint can also be used
instead of medicines. The measures help to reduce injury associated with the aggressive
behavior associated with some types of mental illness. For example, psychiatric patients may
be violent at times and cause significant injury to themselves and other patients as well as the
health staff through biting, punching, or even throwing things. According to Niu and others
(2019), nurses working in psychiatry environments experience more than 20 times physical
violence episodes than other health workers. Such violence is also related to high nurse
turnover, thus limiting the quality of healthcare afforded to patients. Therefore, the use of
restrictive and coercive measures is imperative to retaining staff and ensuring the safe
delivery of quality care in mental health treatment procedures.
Psychotropic medicines are sometimes used to coerce psychiatric patients or when the
behavior of the mentally ill puts the involved parties at risk (N.H.S., 2013). The use of these

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psychotropics might have undesirable side effects. Tranquilizers used for coercion may cause
intoxication to the patient if not used in the right doses. In severe circumstances, tranquilizers
can suppress breathing and cause death. Long term usage of such medications to restrain or
reduce the aggressive behavior of patients may result in effects such as cardiac issues, sexual
dysfunction, and weight gain. Using psychotropics to restrict a patient's aggressive behavior
may impact their future health negatively rather than benefiting them.
Coercive measures violate the patient’s dignity (Luciano et al., 2014). Respecting
patients’ dignity is a well-established principle in nursing practice. The needs of the patient
always drive delivery of medical care. Applying restrictive measures to mentally ill patients
affects their recovery and, to some extent, denies them their comfort (Zirak et al., 2017).
Dignity also implies allowing the patients autonomy and protecting their privacy. Restrictive
and coercive measures mean that the patient will not be told facts regarding their disease and
denies them the most needed emotional support. If the patients are not treated with respect,
they tend to lose their good therapeutic relationships with the health care provider in the long-
run (Luciano et al., 2014). Poor relationships with patients are reflected as low quality of
health care. Therefore, restrictive measures destroy therapeutic relationships between health
care staff and staff, thus lowering the quality of care.
When coercive measures are used other than to restore the autonomy of mentally ill
patients, they breach essential ethical and legal principles that guide health care (Prinsen et
al., 2009). A patient has the right to know and authorize the type of medication to be
administered. Therefore, when coercion is used to forcefully manage treatment, the patients'
principle of self-rule is violated. The use of restrictive measures might traumatize the patient
even more. This is because they might feel as neglected and ‘lesser’ persons in their sick
state. Apart from impacting the patients, the measures affect staff ethics. For instance, the

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mental health staff experiences significant distress as they are often left to make decisions
that will breach their ethical code of conduct.
Challenges faced by Nurses in Psychiatry Treatment.
Registered nurses encounter several challenges while administering treatment to
mentally-ill patients. One such problem is violence from the patients. The NHS Business
Services Authority (2015), for instance, their staff encountered assault from the psychiatric
patients, whereby 68,683 cases were reported in which 53, 484 were carried out with the
perpetrators not knowing what they were doing. Niu and her colleagues also showed that
nurses working in psychiatry departments encounter 20 times more incidences of violence
compared to staff working in other departments. Most mentally ill patients show aggressive
behavior. The violence resulting from the behavior of the patients can be verbal or physical
and may hinder the efficiency of care delivery. Most nurses in a study carried by
Badnapurkar and others (2017), responded by saying the violence they encounter from
psychiatric patients hinders service delivery.
Psychiatric nurses experience psychosocial and psychological challenges in delivering
mental healthcare (Zarea et al., 2018). The nurse's quality of life, personal and work life is
affected after encountering several difficulties while dealing with psychiatry patients. For
instance, fights constantly arise in the psychiatry wards, and nurses are often involved to calm
the situation. They may intervene by restraining the patients. The nurses may get irritated and
depressed when they constantly get involved in such circumstances. Negative social
perspectives of nurses working in psychiatry wards affect their quality of life. The constant
fear of being harmed by the patients or worrying that the patients might hurt themselves,
affect the nurse's psychological well-being.

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Conclusion
Coercive measures have benefits but are always obscured by the shortcomings linked
to the procedures. Administration of recovery-oriented mental health care is essential in
lowering the negative impacts of restrictive and coercive measures. This is because it adapts
to the needs of patients, thus providing evidence-informed therapy, treatment, psychosocial
support, and rehabilitation, which helps to achieve the best outcomes. Recovery-oriented
mental health emphasizes self-determination and choice that are within medico-legal
requirements, thus reducing the risks associated with psychotropic medication. Adopting
interventions that aim to improve the skills and coping mechanisms for dealing with the
behavior of mentally ill patients may significantly benefit registered psychiatric nurses.

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