Limiting the freedom of action of psychiatric patients causing psychological violence to staff

Background and context: Psychiatric staff are often subject to aggressive behavior. Sometimes violence is physical but as often, it is psychological. Thus, it has been found that threats and verbal abuse are experienced by most nurses during a one-year period. Victims subsequently are required to cope with the negative consequences like anxiety, sick leave etc. A number of studies have been directed towards effective measures to predict and prevent aggression as well as risk management yet much less research has dealt with the judicial aftermaths of violence in terms of criminal prosecution. Likewise, the legal aspects of managing psychological violence has received only scant attention. In this respect, the question could be raised as to which remedies staff members can immediately apply when subject to harsh bullying or sexual intimidation while agreeing with law. It is common in most countries that coercive measures can be used in cases of physical vi olence though in this study the question in focus is to what extent measures aiming at limiting the freedom of action of psychiatric patients causing psychological violence to staff can be legally used. Methods and settings: Danish legislation, case law, case descriptions and comparison with Sweden and Norway. Results: When looking from the perspective of Danish legislation it appears that applying coercive measures to psychiatric patients owing to harassment of staff members lacks a legal basis though coercion (e.g. belt-fixation) can in some situations be applied if other patients are subject to psychological violence. By way of comparison, Norwegian respectively Swedish law in principle legalize coercion to limit the freedom of action of psychiatric patients following harassment of staff members. Danish case descriptions suggest that ‘quasi-coercive’ measures sometimes may take place in terms of, e.g., threats concerning patient privilege limitation, commanding a patient to go to the patient’s ward, and/or ‘crowding’ of staff members. Discussion and conclusion: While physical assaults respectively harassment of other patients may justify coercive measure use, opportunities to limit the freedom of action of psychiatric patients harassing psychiatry staff members seem lacking in Denmark. In some instances, alternative non-legally based measures possibly are applied. This situation may pose a law problem but also may cause difficulties in some situations where, e.g., staff is severely distressed or patient care is obstructed. Further research is merited concerning the legal framework surrounding violence episodes and possible need for extra remedies to control psychological aggression in the psychiatric hospital ward.