Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: A qualitative interview study with staff

Background: Legislators often want to positively affect psychiatric inpatient care and reduce coercion by strictening relevant judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal strictening in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. Methods During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Also, we used an implementation outcomes framework to relate data to a wider implementation science context. Results Consistent with prior quantitative studies, primarily from adult general psychiatry, our results suggest that the legal strictening did not substantially reduce coercion. Instead, it may have increased a sense of uncertainty among mental health staff and inadvertently contributed to a tendency to disregard the legislation in more complex clinical situations. Conclusion At least in a short-term perspective, stricter legislation alone is likely ineffective in reducing coercion in child and adolescent psychiatric inpatient care. Further research should address how to optimize the effects of legal strictening on coercive practices.