Cross-Cultural Notions of Risk and Liberty: A Comparison of Involuntary Psychiatric Hospitalization and Outpatient Treatment in New York, United States and Zurich, Switzerland.

Florian Hotzy,Andres R Schneeberger,Matthias Jaeger,Anke Maatz,Jeff Kerner

doi:10.3389/fpsyt.2018.00267

Abstract

Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.

Highlights

The use of coercion—whilst deeply controversial and ethically problematic—is a global phenomenon in psychiatry
Based on our own experience as practicing psychiatrists in two different regions of the globe, namely New York, U.S, and Zurich, Switzerland, this paper offers a comparative analysis of the laws regulating coercion and of the actual clinical practices in these two regions
New York and Zurich are both high-income regions in the Western world

Summary

Introduction

The use of coercion—whilst deeply controversial and ethically problematic—is a global phenomenon in psychiatry. It comes in many different forms, the most common ones being involuntary hospitalization, forced administration of medication, confinement in seclusion, physical or mechanical restraint, and compulsory treatment in outpatient settings. The legislation and cultural characteristics of Denmark and Finland are less dissimilar, but the latter appears to have one of the highest rates of involuntary hospitalizations in Europe [1]. It is not entirely clear to what extend legislation and cultural aspects account for specific differences in the implementation of coercive measures [2, 6]

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