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Coercion in psychiatric care: where are we now, what do we know, where do we go?

  • Giles Newton-Howes (a1)
Summary

Coercion is a subjective response to a particular intervention and has been considered an unfortunate but necessary part of the care of people with psychiatric illness. Its ethical underpinnings, evidence base and clinical implications are not commonly considered in day-to-day care; however, this requires reconsideration as the potential for an increase in coercion stretches beyond the boundaries of the hospital into the community. Much of the research that has been undertaken highlights the prevalence of coercion, the ‘grey zone’ between compulsory interventions and the experience of patients and patient outcomes in the light of coercion. Policy makers need to consider the evidence for interventions that increase the experience of coercion in order to reduce its impact. Clinicians need to understand the principles of procedural justice, minimise the use of legal detention and be mindful that implied consent for one intervention may lead to experiences of coercion involving linked management strategies.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Giles Newton-Howes (giles.newton-howes@imperial.ac.uk)
Footnotes
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*

See original paper pp. 221–225, and special articles pp. 243–247, this issue.

Declaration of interest

None.

Footnotes
References
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Coercion in psychiatric care: where are we now, what do we know, where do we go?

  • Giles Newton-Howes (a1)
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eLetters

Defining coercion

Thomas Szasz, Professor of psychiatry emeritus
04 October 2010

To define coercion as a subjective response to a particular intervention that is an unfortunate but necessary part of the care of people with psychiatric illness is astonishing!1

This Orwellian definition cannot go unchallenged.

Dictionaries define coercion as: “The act of compelling by force of authority; compulsion.“ - “The act, process, or power of coercing .... arm-twisting, force, compulsion, constraint, duress, pressure.” - “Power based on the threat or use of force.” And so forth.

“If Slavery Is Not Wrong, Nothing Is Wrong,” declared Abraham Lincoln. Slavery is depriving a person of liberty because of who he is, not because of what he does or has done. If psychiatric slavery – involuntary mental hospitalization – is not wrong, nothing is wrong.2

Thomas Szasz

1. Newton-Howes, G., Coercion in psychiatric care: where are we now, what do we know, where do we go? The Psychiatrist 2010; 34: 217-220

2. Szasz, T., Coercion as Cure: A Critical History of Psychiatry. NewBrunswick, NJ: Transaction Publishers, 2007.
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