Abstract
SummaryCoercion 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.
Highlights
What is coercion?Any consideration of coercion requires a clear understanding of what coercion is, a consideration not always made in the empirical literature and debated in medical ethics
In the empirical literature this construct is often called ‘perceived coercion’ in order to mark it as separate from objective interventions that may potentially increase or decrease the prevalence of coercion. This distinction is important as there is a so-called ‘grey zone’ that exists between interventions that may force an individual to undertake a course of action and the subjective experience of being forced or threatened into such action.[6]
EDITORIAL Newton-Howes Coercion in psychiatric care these individuals can be considered to be coerced into treatment
Summary
Any consideration of coercion requires a clear understanding of what coercion is, a consideration not always made in the empirical literature and debated in medical ethics. In the empirical literature this construct is often called ‘perceived coercion’ in order to mark it as separate from objective interventions that may potentially increase or decrease the prevalence of coercion. This distinction is important as there is a so-called ‘grey zone’ that exists between interventions that may force an individual to undertake a course of action and the subjective experience of being forced or threatened into such action.[6] For example, not all legally detained patients experience coercion in the action of detention, describing the process in very positive terms as making them feel safe and increasing their access to care.[7] It is difficult to see how Internal subjective experience. EDITORIAL Newton-Howes Coercion in psychiatric care these individuals can be considered to be coerced into treatment
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