Coercive mental health care - dilemmas in the decision-making process.

Abstract

The use of coercive mental healthcare contravenes the principle of voluntary examination and treatment. However, it should be possible for persons at acute risk to receive imperative health assistance. After evaluating 37 emergency interviews in psychiatric outpatient clinics where the use of coercive mental health care was considered, interviews were conducted with emergency assistance staff. The study includes interviews that resulted in involuntary hospitalisation (n = 15), coerced observation (n = 2), voluntary hospitalisation (n = 14) and follow-up by the outpatient clinic (n = 6). Important factors in assessing the use of coercion were the severity of psychotic symptoms, suicide risk and risk for others, and difficult social circumstances. Three-quarters of emergency assistance staff were in some degree of doubt, and 16 out of 37 experienced uneasiness during the assessment. With a view to enhancing the patient's perception of having been met with respect, the emergency assistance staff emphasised the need for the patient's opinion to be heard. Where the emergency assistance staff were in doubt, a number of professional and ethical issues were highlighted in the process of reaching a decision. Latitude should be given for ethical and professional reflection in relation to assessing the use of coercion in daily clinical practice, as well as training in measures to reinforce patients' experience of participation during the interview.