Users' Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study.

The study was done in one recovery-oriented medium-stay unit in Spain, so it may not apply to acute psychiatric units or other countries. Participants were recruited by convenience sampling, and six of 26 invited users declined audio consent, so selection bias is possible. The qualitative component included 20 interviews and did not test whether any practice reduces coercion. The CES-18 was validated for mechanical restraint, seclusion and forced medication, but not for involuntary admission or compulsory treatment, so the quantitative coercion scores should be read cautiously. The first author worked as a mental health nurse in the unit and all participants had met her, which may have affected what users said. Quantitative recruitment took 3 years, with a pandemic gap, and the unit's care may have changed over time. Some participants gave contradictory accounts, saying they were free at times and coerced at other times.

The authors declared no conflicts of interest. The work was funded by Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO).

Do not read the low median CES-18 result as proof that coercion was absent. The scale was mainly validated for mechanical restraint, seclusion and forced medication, while informal and perceived coercion were explored only in interviews, and some participants described coercion despite low scores.