Institutional Abuse and Care Quality in Psychiatric Facilities

This page will host a collection of policy work and research on care quality, institutional coercion, and abuse in psychiatric facilities. The institutional abuse includes staff-against-patient abuse and neglect and restraint and seclusion, and any studies on reduction of such. These articles may contain pathologizing language.

We will make note of whether the full text is available for free, or if payment is required for people without academic access or journal membership.

This page is under construction.



  • Patient allegations of sexual abuse against psychiatric hospital staff. Gen Hosp Psychiatry. 1994 Sep;16(5):335-9. Berland DI, Guskin K.
    • (Abstract only; payment required for full PDF for users without academic access)
    • “We conclude that patient allegations of staff sexual abuse… are not isolated, rare events.” Note: Talks a lot about the impact on the accused workers.


  • A restraint on restraints: the need to reconsider the use of restrictive interventions. by Wanda K. Mohr, M.M. Mahon, and M.J. Noone at Psychiatric Nursing, Volume 12, Issue 2, April 1998.
    • (Abstract only)
    • “Preliminary data are presented from an ongoing study that is investigating the experiences and memories of formerly hospitalized children. Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force.”


  • Coercion, Involuntary Treatment and Quality of Mental Health Care: Is There Any Link?, by Hans Joachim Salize; Harald Dressing, Curr Opin Psychiatry. 2005; 18(5): 576-584.
    • (Full text available online at Medscape)
    • “Nevertheless, involuntary inpatient commitments may also have long-lasting consequences, as they seem to be significantly associated with a higher rate of readmission, as was found in a retrospective analysis of a large US patient file database.”


  • Perceived coercion and the therapeutic relationship: a neglected association? by K.A. Sheehan, T. Burns at Psychiatric Services, Volume 62, Issue 5, May 2005.
    • (Abstract only)
    • “RESULTS: High levels of coercion were experienced by 48% of voluntarily and 89% of involuntarily admitted patients. A high perceived coercion score was significantly associated with involuntary admission and a poor rating of the therapeutic relationship. The therapeutic relationship confounded legal status as a predictor of perceived coercion.”
  • Black Boxing Restraints: The Need for Full Disclosure and Consent, by by Wanda K. Mohr and Michael A. Nunno at Journal of Child and Family Studies, Volume 20, Issue 1, page 8-47, February 2011.
    • (Full PDF available for download)
    • “We… contend that if restraints are used they must pose less risk than the behavior they are trying to alleviate. We also opine that if restraints are misused by mental health or child welfare treatment settings, then their misuse may be considered a subject of a patient maltreatment, abuse, criminal or civil action. A central thesis of the article is that informed consent must be seen as an integral and dynamic process of treatment.”



  • Who is Subjected to Coercive Measures as a Psychiatric Inpatient? A Multi-Level Analysis by E. Flammer, T. Steinert, F. Eisele, J. Bergk, and C. Uhlmann.
    • (Full text available online and as PDF)
    • “Patients with aggressive behaviour in the 24 hours prior to admission had a three times higher risk of coercive measures compared to non-aggressive patients. Severity of illness increased the risk of coercion markedly. With each level of severity, the risk of coercion was doubled. Voluntariness of stay appeared to be the best protective factor against coercive measures. If a patient stayed voluntarily, this reduced the risk of coercion by more than two thirds.”