Informal Coercion Experienced by Adolescents in Mental Health Care-A Systematic Review.
Tiina Överlund, Tella Lantta
PMID 41821228WHAT IT FOUND
Adolescents in mental health care reported subtle pressures: being silenced, pressured into treatment, threatened with more coercion, and controlled by rigid rules.
They described distress, disempowerment and coping such as pretending wellness; one study also saw structure as protective.
Key findings
01The review identified seven previously recognised forms and two additional forms, silencing and exclusion and manipulation; the most frequent were treatment pressure (17), silencing and exclusion (14), and referring to rules and routines (12).
02The review identified 41 consequence expressions that could be linked to informal coercion: reactive coping (15), emotional wellbeing (13), relational impacts (9), impacts on recovery (3), and impacts on health behaviour (1).
03None of the included studies reported ambivalent consequence expressions, and only one study reported positive emotional experiences tied to safe, consistent structures.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 12 studies and 242 participants, so it cannot show how common these experiences are across all adolescent mental health services. None of the included studies made informal coercion their primary research focus, so the coercion findings came from secondary interpretation of existing qualitative data. The studies were mostly from Western countries, with only one non-Western study, which limits transferability to culturally diverse settings. Male underrepresentation was notable, including two studies with no male participants. The numbers are counts of coded expressions across studies, not counts of adolescents or measured effects. Some participant ages extended beyond the defined adolescent range, and one study did not report its sample size. Two studies were retrospective, relying on recollections from months to years earlier.
Declared interests
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The easy way to misread this
Do not read the listed forms as measured prevalence or proof of harm. They are coded qualitative expressions from secondary analyses, and none of the studies made informal coercion their primary focus.