A biopsychosocial rationale for coerced community treatment in the management of schizophrenia

Coerced community treatment in its various forms is receiving increasing attention and generating considerable controversy. Few attempts, however, have been made to articulate a rationale for its use. The author presents material in support of the concept that schizophrenia can be viewed as a set of biopsychosocial deficits and that some of the deficits can be efficaciously addressed using coerced community treatment. The biological, psychological, and social deficits are each examined and then a biopsychosocial-coerced intervention hypothesis is generated. The underpinning of the use of coerced community treatment in this model is its ability to affect structure and motivation and thereby to alter the customary community living equation. The charge that one can just treat the deficits and then coercion becomes superfluous is answered. The concerns that the employment of coercion could become too widespread or be used in lieu of adequate community resources for mental health services are also considered. The conclusion is that coerced community treatment is a logical component of the treatment of schizophrenia in outpatient settings.