Coercive Measures in Psychiatry Can Hardly Be Justified in Principle Any Longer-Ethico-Legal Requirements Versus Empirical Research Data and Conceptual Issues

Overview

Journal J Psychiatr Ment Health Nurs

Specialties Nursing
Psychiatry
Psychology

Date 2024 Oct 25

PMID 39450670

Authors

Dirk Richter

Affiliations

Soon will be listed here.

Abstract

Aim: To review the scientific and empirical evidence that is usually accepted for the ethical and legal justification of coercion in psychiatry.

Method: Five key criteria are examined as follows: (1) the demonstrable existence of a mental disorder; (2) the effectiveness of psychiatric measures; (3) the use of coercion as last resort and as least possible restriction; (4) the benefit of the person affected by the coercive measure and (5) the restoration of the affected person's autonomy.

Results: (1) The existence of a demarcation between a mentally ill and a mentally healthy state cannot be confirmed; (2) Pharmacological and psychotherapeutic interventions in psychiatry are not even moderately effective; (3) Coercive measures are usually not used as last resort and as least restrictive measure; (4) Most people affected by psychiatric coercion do not benefit from the measures; (5) It is at least unclear whether autonomy is affected by a mental illness and whether it can be restored through a coercive psychiatric measure.

Discussion: None of the central ethical and legal criteria for the use of coercion in psychiatry are clearly and unambiguously fulfilled according to current research.

Implications: Psychiatric coercion can hardly be justified any longer.

References

Vruwink F, Wierdsma A, Noorthoorn E, Nijman H, Mulder C . Number of Seclusions in the Netherlands Higher in the 7 Years Since the End of a Nationwide Seclusion-Reduction Program. Front Psychiatry. 2021; 12:778793. PMC: 8678042. DOI: 10.3389/fpsyt.2021.778793. View

Chieze M, Hurst S, Kaiser S, Sentissi O . Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Front Psychiatry. 2019; 10:491. PMC: 6673758. DOI: 10.3389/fpsyt.2019.00491. View

Gadsby J, McKeown M . Mental health nursing and conscientious objection to forced pharmaceutical intervention. Nurs Philos. 2021; 22(4). DOI: 10.1111/nup.12369. View

van den Hooff S, Goossensen A . How to increase quality of care during coercive admission? A review of literature. Scand J Caring Sci. 2013; 28(3):425-34. DOI: 10.1111/scs.12070. View

Kerman N, Kidd S, Stergiopoulos V . Involuntary Hospitalization and Coercive Treatment of People With Mental Illness Experiencing Homelessness-Going Backward With Foreseeable Harms. JAMA Psychiatry. 2023; 80(6):531-532. DOI: 10.1001/jamapsychiatry.2023.0537. View

Kersting X, Hirsch S, Steinert T . Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review. Front Psychiatry. 2019; 10:400. PMC: 6580992. DOI: 10.3389/fpsyt.2019.00400. View

Manderius C, Clintstahl K, Sjostrom K, Ormon K . The psychiatric mental health nurse's ethical considerations regarding the use of coercive measures - a qualitative interview study. BMC Nurs. 2023; 22(1):23. PMC: 9875520. DOI: 10.1186/s12912-023-01186-z. View

Banner N . Unreasonable reasons: normative judgements in the assessment of mental capacity. J Eval Clin Pract. 2012; 18(5):1038-44. PMC: 3472025. DOI: 10.1111/j.1365-2753.2012.01914.x. View

Lilienfeld S, Treadway M . Clashing Diagnostic Approaches: DSM-ICD Versus RDoC. Annu Rev Clin Psychol. 2016; 12:435-63. PMC: 5154554. DOI: 10.1146/annurev-clinpsy-021815-093122. View

10.

Haines S, Stanton R, Anderson C, Welch A . Ethical challenges for nurses delivering coercive interventions in community mental health settings: A scoping review. Int J Ment Health Nurs. 2024; 33(4):750-759. DOI: 10.1111/inm.13290. View

11.

Huber C, Schneeberger A, Kowalinski E, Frohlich D, von Felten S, Walter M . Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15 year, observational study. Lancet Psychiatry. 2016; 3(9):842-9. DOI: 10.1016/S2215-0366(16)30168-7. View

12.

Birkeland S, Steinert T, Whittington R, Gildberg F . Abolition of coercion in mental health services - A European survey of feasibility. Int J Law Psychiatry. 2024; 94:101992. DOI: 10.1016/j.ijlp.2024.101992. View

13.

Zeng L, Yao L, Wang Y, Han M, Granholm A, Nampo F . Presentation approaches for enhancing interpretability of patient-reported outcomes in meta-analyses: a systematic survey of Cochrane reviews. J Clin Epidemiol. 2023; 158:119-126. DOI: 10.1016/j.jclinepi.2023.03.027. View

14.

Aguilera-Serrano C, Guzman-Parra J, Garcia-Sanchez J, Moreno-Kustner B, Mayoral-Cleries F . Variables Associated With the Subjective Experience of Coercive Measures in Psychiatric Inpatients: A Systematic Review. Can J Psychiatry. 2017; 63(2):129-144. PMC: 5788134. DOI: 10.1177/0706743717738491. View

15.

Meynen G, Swaab D . Why medication in involuntary treatment may be less effective: the placebo/nocebo effect. Med Hypotheses. 2011; 77(6):993-5. DOI: 10.1016/j.mehy.2011.08.029. View

16.

Kotov R, Krueger R, Watson D, Achenbach T, Althoff R, Bagby R . The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017; 126(4):454-477. DOI: 10.1037/abn0000258. View

17.

Appelbaum P . Protecting the Rights of Persons With Disabilities: An International Convention and Its Problems. Psychiatr Serv. 2016; 67(4):366-8. DOI: 10.1176/appi.ps.201600050. View

18.

Cuthbert B . The RDoC framework: facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry. 2014; 13(1):28-35. PMC: 3918011. DOI: 10.1002/wps.20087. View

19.

Nikolaidis K, Weinmann S, Doring S, Fischer L, Kleinschmidt M, Pfeiffer J . [Inpatient Equivalent Home Treatment (IEHT) compared to inpatient psychiatric treatment: 12-month follow-up results of a retrospectively matched cohort study using propensity score]. Psychiatr Prax. 2023; 51(2):92-98. DOI: 10.1055/a-2177-6113. View

20.

Caspi A, Houts R, Belsky D, Goldman-Mellor S, Harrington H, Israel S . The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders?. Clin Psychol Sci. 2014; 2(2):119-137. PMC: 4209412. DOI: 10.1177/2167702613497473. View