Perspectives on psychotherapy and pharmacotherapy in the public hospital

It is difficult to discuss the issue of combining medication and psychotherapy without reference to the context in which it is occurring. Within public mental health hospitals, psychotherapy is comparatively unavailable, at least from physicians, because of limited supply. Yet the kind of medication that psychiatrists routinely prescribe are strongly colored by particular meanings germane to their use in involuntary treatment settings, among which is the perception of an element of force or coercion, either in how they are used or in their effects. This problem cannot be ignored by retreating behind an ill-fitting "medical model" of treatment, which leaves the patients overly responsible for rejecting treatment, however much their right to do so may be guaranteed by law.