Changing attitudes to the use of Coercion, through education

Background: When trying to reduce or eliminate the use of coercion e.g. mechanical restraint in Mental Health Care, one of the key elements is to change the staff attitudes and beliefs towards coercion as a phenomenon. Then it later would be possible, for them, to change their behaviour and actions towards the psychiatric patients. To change staff attitudes, many organisations offers education to staff, but can education change staff attitudes, even though the teaching is activating, diverse, and involving (1-4)? Objectives: This study explores, if it is possible to change staff attitudes towards the use of coercion, e.g. mechanical restraint, through activating, diverse, and involving teaching. Methods: An investigation on attitudes towards the use of coercion and mechanical restraint, was performed using Poll´s (Poll Everywhere), on 122 staff (six classes), before and after 6 hours of education, in how to prevent physical coercive interventions. The questions used to describe the attitudes was translated to Danish and back-translated. One question were developed by Colton (5), Cronbach’s Alpha (between .6 to .8) indicated strong reliability of each construct. The other were derived from “A Snapshot of Six Core Strategies…” (6). Trends will be analysed using Wilcoxon Signed-Ranks Test. The analyses were performed using IBM SPSS Statistics for Windows, Version 22. Results: In Table 1. the Wilcoxon Signed-Ranks Test indicated that two of the three, median pre-tests ranked were statistically different in a positive way, than the median post-test ranked (Z = -0.41, p > 0.05, Z = -2.00, p < 0.05, and Z = -2.20, p < 0.05). In Table 2. the Wilcoxon Signed-Ranks Test indicated that one of the five, median pre-tests ranked were statistically different in a positive way, than the median post-test ranked (Z = -2.21, p < 0.05, Z = -0.74, p > 0.05, Z = -1.57, p > 0.05, Z = -1.58, p > 0.05, and Z = -1.22, p > 0.05). Conclusions: The data could point in the direction that it is possible to change staff attitudes towards the use of coercion, e.g. mechanical restraint, through activating, diverse, and involving teaching. Discussion: the method used, fitted the research question, the statistical model fitted the data. The results showed three significant differences from the pre-test to the post-test and the others pointed in the same positive direction. The conclusion is not very strong, because the design is not adequate. Probably many factors (confounders) influence the change in staff attitudes in “the real world”, as the culture they come from, and return to after the education, the quality of planning the education, the qualifications of the teacher, etc. The end-goal is to change staff, patients, and relative’s attitudes and beliefs, towards each other. Change the culture of the Mental Health Community in the direction of empowerment, resilience, and recovery. But we must start “little by little” by changing the individual’s beliefs and attitudes, and hopefully they subsequently change their behaviour and actions.