"Coerced into coercion": Ethical challenges for community mental health nurses when responding to acute suicidality

"Coerced into coercion": Ethical challenges for community mental health nurses when responding to acute suicidality

Restrictive practices in psychiatric care are not limited to inpatient settings. Increasing numbers of Australians are subject to coercive interventions in community mental health services through the use of community treatment orders. Community mental health nurses are aware of the potential for harm, human rights issues, and the risk to the therapeutic relationship associated with coercive interventions. However, these nurses may be required to consider and deliver coercive interventions, including involuntary hospitalisation, when responding to the needs of people presenting with acute suicidality. As community mental health nurses consider the best interest of the person, they may experience pressure to respond coercively to acute suicidality from a number of directions including service management, the community mental health team, family members and even the person themselves.

This paper presents preliminary results from a grounded theory study exploring the ethical challenges experienced by nurses in community mental health services when responding coercively to acute suicidality. One-on-one semi-structured interviews with community mental health nurses were thematically analysed using the methods of constructivist grounded theory. One emerging theme is being ‘coerced into coercion’. This theme is about community mental health nurses feeling pressured into making treatment decisions that may be contrary to what the consumer desires, or what the nurse considers to be in the best interest of the person. This pressure may lead to ethical challenges for the nurse and potential moral distress. The potential for moral distress associated with these ethical challenges might be mediated by the nurse's confidence in the beneficence of their decision making, which is informed by contemporary principles of mental health nursing including the provision of person-centred, trauma-informed, and recovery-oriented care. Other factors that may mediate these ethical challenges include the years of experience of the nurse in the treatment setting, and additional qualifications related to mental health nursing.

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