Compulsory admissions, mechanical restraints and staff attitudes toward coercion in a sample of psychiatric wards in Italy.

Although the frequency of compulsory admissions (CA) to inpatient psychiatric care in Italy is low, it remains a sensitive component of psychiatric practice, together with coercion and mechanical restraint (MR). In such practices, the staff's attitude may play a role. We wanted to identify risk factors for CAs and MRs in Italian psychiatric services. A total of 18 General Hospital Psychiatric Wards (GHPWs) collected data over 12 months, reporting GHPWs' features, staff, training on CAs reduction, restrictions, protocols with Emergency, user involvement and right advocacy, number and characteristics of CAs and number of MRs. The Italian version of the Staff Attitude to Coercion Scale - SACS assessed staff attitudes. 1246 CAs (19% of all admissions) occurred in the period (median 19.2), involving 1032 individuals. No correlations between GHPW characteristics and CAs emerged. MR was used in 18% of CAs. Three GHPWs reported no MR use during the study period. MR risk was higher for males, longer CAs, personality disorder, CA confirmation in the Emergency. MRs were fewer in GHPWs with a room for meetings and no restricted access to common spaces. Total SACS score and its subscales correlated with a greater frequency of MRs. The prevalence of CAs in Italy warrants careful monitoring. Although limited acceptance of coercion among professionals, MRs remain frequent and related to contextual factors. Benchmarking would support mobilizing stakeholders' will in improving the quality of care, human rights respect and professionals' well-being in mental health settings.