Coercion in psychiatry

This paper highlights issues in the field of coercion in psychiatry which have gained importance in 2007.

Reviews on 'involuntary hospital admission' demonstrated negative and positive consequences on various outcome domains. Papers on 'coercion and the law' identified cross-national differences of legal regulations, or addressed justice and equality issues. Studies on the 'patient's perspective', and 'family burden of coercion' showed that involuntariness is associated with feeling excluded from participation in the treatment. A review on 'outpatient commitment' recommended the evaluation of a range of outcomes if this specific legislation is introduced. 'Coercion in special (healthcare) settings and patient subgroups' needs to be assessed in detail. This refers to somatic hospitals, establishments for mentally retarded patients, prisons, forensic settings, and coercion mechanisms for addiction treatment, eating disorders, and minors. Empirical findings in other areas focused on attitudes towards involuntary treatment; decision variables for involuntary commitment; guidelines on the use of coercive measures; and intervention programs for staff victims of patient assaults.

Coercion in psychiatry is an important area for future clinical and research initiatives. Because of the linkages with legal, human rights and ethical issues, a huge number of individual questions needs to be addressed.