S22-04 - Community psychiatry and coercive treatment: a delicate relationship

Abstract

IntroductionPsychiatry has always had a special position among the medical disciplines. Patients were perceived by the public as potentially dangerous, psychiatrists as representatives of an uncontrolled “total” institution. The mental health reforms initiated during the 2nd half of the 20th century focussed on a “normalization” of this special position by means of a reduction of coercion to the absolute minimum and to an adaptation of the principles of treatment and care to that of all other medical specialities.ResultsIn all European countries, the prevalence of mentally disordered offenders is on the rise. As, surprisingly, the same holds good for the rates of involuntary admissions to psychiatric hospitals, a supposed transfer of coercive measures from the civil to the penal law sector seems to be unlikely. According to epidemiologic data, there is also no direct relation with the reduction of general mental hospital beds or with the sometimes insufficient provision of community services. Rather, the changed attitude of mental health professionals in dealing with a subgroup of “difficult-to-treat” patients seems to be crucial factor.DiscussionRecent data confirm an association between psychosis and violence. Not least for that reason psychiatry does have - against all affirmations - a special position among the medical disciplines. The denial of this fact by the representatives of modern community psychiatry was not able to reduce coercive measures against mental patients - rather, coercion is now applied in a hidden way, obviously insufficient so damaging the reputation of both psychiatry and its patients.