Coercive Treatment in Psychiatry: Clinical, legal and ethical aspects


Coercion is one of the most fascinating and controversial subjects in psychiatry. It is a highly sensitive, and hotly debated topic in which clinical practice, ethics, the law and public policy converge. This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal problem of how to balance safety versus autonomy when dealing with psychiatric treatment. Coercive Treatment in Psychiatry is a much needed contribution to...

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Coercive Treatment in Psychiatry: Clinical, legal and ethical aspects

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Coercion is one of the most fascinating and controversial subjects in psychiatry. It is a highly sensitive, and hotly debated topic in which clinical practice, ethics, the law and public policy converge. This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal problem of how to balance safety versus autonomy when dealing with psychiatric treatment. Coercive Treatment in Psychiatry is a much needed contribution to the literature. The first three sections deal with the conceptual and clinical aspects of coercive treatment, the legal aspects and the ethical aspects of coercive treatment. In detail, these sections cover a broad spectrum of issues: coercion in institutions and in the community, coercive treatment and stigma, the definition of best practice standards for coercive treatment, de-escalation of risk situations, recent developments in mental health legislation, mental health care and patients' rights, cross-cultural perspectives on coercive treatment, historical injustice in psychiatry, and paternalism in mental health. The fourth section features users' views on coercive treatment: giving voice to an often-unheeded population. Finally, the book addresses the original topic of coercion and undue influence in decisions to participate in psychiatric research This book presents the first comprehensive review of the issue of coercion in psychiatry. With chapters written by the leading experts in the field, many of whom are renowned as clear thinkers and experienced clinicians, it may be seen as a starting point for international discussions and initiatives in this field aiming to minimize coercion.

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Editorial Reviews

Doody's Review Service
Reviewer: Steven T. Herron, MD (University of Arizona Health Sciences Center)
Description: This book addresses many of the coercive aspects of the treatment of psychiatric patients throughout the world, though mainly focusing on areas influenced by Western medicine, including Europe, the United States, New Zealand, Israel, and Egypt.
Purpose: As the editors' note, "The relevance of coercive treatment for psychiatry has been underestimated for a long period in the history of the discipline." However, recent developments have fueled an interest in understanding and learning how and why these procedures have been used, and this work compiles this information in one resource.
Audience: Though directed primarily at those in the mental healthcare field, such as psychiatrists, psychologists, psychiatric residents, and medical students, this book also could be useful to those interested in mental health law and the appreciation for the complex relationship between psychiatric treatment and civil liberties.
Features: Divided into five sections related to coercive treatment, each one addresses a different facet of these complex issues. Chapters end with a decent number of references, and some contain a "Conclusions" section which offers a brief summary of the chapter. There are a limited number of black-and-white graphs, pictures, tables, and diagrams.
Assessment: Though the other sections are interesting and useful, the chapters describing an individual's personal experience with coercion in their treatment are the most powerful part of this book. While it is clear that there has been a greater focus on monitoring and acknowledging the rights of psychiatric patients over the past 20 to 30 years, the nature of mental health issues often can create a difficult juxtaposition to navigate, especially when providers attempt to recognize the patient's individual rights and the rights of the society as a whole. The multicultural approach to this book is appealing and valuable and, despite its dull and bland appearance, it is well put together and worth reading.
From the Publisher
“Summing up then, this is a rich and valuable collection. It comes at a time when ideas about both coercion and treatment are being revised, and in addition to raising more practical and policy-related challenges, it demonstrates important philosophical issues requiring further attention.” (Metapsychology Online, 23 April 2013)
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Product Details

  • ISBN-13: 9780470660720
  • Publisher: Wiley
  • Publication date: 5/3/2011
  • Edition number: 1
  • Pages: 348
  • Product dimensions: 6.80 (w) x 9.90 (h) x 1.00 (d)

Meet the Author

Professor Kallert has been active in the field of mentalhealth services research for many years.  He was co-ordinatorof the EC-funded research project, European evaluation of coercionin psychiatry and harmonisation of best clinical practice(EUNOMIA). He has published 6 books, more than 35 chapters inbooks, and more than 125 articles in peer-reviewed journals. He hasreceived the Hermann-Simon-Prize for Social Psychiatry, and theHans-Heimann-Prize of the German Society of Psychiatry,Psychotherapy and Neurosciences.  He is an Honorary Member ofthe World Psychiatric Association.

Dr. Mezzich was Chair of the World PsychiatricAssociation (WPA) Section on Classification and DiagnosticAssessment, and a member of the ICD-10 Mental Disorders Workgroupand the DSM-IV Task Force. He has authored over 200 scientificjournal articles and book chapters and 25 books and monographsprimarily on psychiatric diagnosis and epidemiology from clinical,philosophical, statistical, and cultural perspectives and morerecently on person-centered psychiatry and medicine. He hasreceived six Honorary Doctorates from universities in the Americasand Europe as well as the Simon Bolivar Award of the AmericanPsychiatric Association, the Medal for Extraordinary Merit of theMedical Council of Peru, and the Linneaus Medal of UppsalaUniversity in Sweden. He is President of the InternationalNetworkfor Person-centered Medicine.

Professor Monahan is well known internationally for hisnumerous publications and presentations in mental health law, forhis leadership of the MacArthur Research Network on Violence,Coercion and Competence and of the current MacArthur ResearchNetwork on Mandated Treatment in the Community, and for hisgenerous support and encouragement of scholars in coercion and inall areas of mental health law.

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Table of Contents

List of Contributors vii

Introduction xi
Thomas W. Kallert, Juan E. Mezzich and John Monahan

SECTION 1 Conceptual and clinical aspects of coercivetreatment 1

1. Person-centred psychiatry perspectives on coercion andcooperation 3
Juan E. Mezzich

2. Coercive treatment and stigma – is there a link3
Wolfgang Gaebel and Harald Zaske

3. Mandated psychiatric treatment in the community –forms, prevalence, outcomes and controversies 33
John Monahan

4. Is it possible to define a best practice standard forcoercive treatment in psychiatry? 49
Tilman Steinert and Peter Lepping

5. How to de-escalate a risk situation to avoid the use ofcoercion 57
Dirk Richter

SECTION 2 Legal aspects of coercive treatment 81

6. Psychiatry and the law – do the fields agree in theirviews on coercive treatment? 83
Julio Arboleda-Florez

7. Reducing discrimination in mental health law – the'fusion' of incapacity and mental health legislation 97
George Szmukler and John Dawson

8. Mental health care and patients' rights – are these twofields currently compatible? 121
Thomas W. Kallert

SECTION 3 Ethical aspects of coercive treatment 151

9. Cross-cultural perspectives on coercive treatment inpsychiatry 153
Ahmed Okasha and Tarek Okasha

10. Historical injustice in psychiatry with examples from NaziGermany and others – ethical lessons for the modern professional 161
Rael Strous

11. Paternalism in mental health – when boots are superiorto Pushkin 175
Tom Burns

SECTION 4 Users' views on coercive treatment 185

12. The moral imperative for dialogue with organizations ofsurvivors of coerced psychiatric human rights violations 187
David W. Oaks

13. Resisting variables – service user/survivorperspectives on researching coercion 213
Jasna Russo and Jan Wallcraft

14. Seventy years of coercion in psychiatric institutions,experienced and witnessed 235
Dorothea S. Buck-Zerchin

15. Coercion – point, perception, process 245
Dorothy M. Castille, Kristina H. Muenzenmaier and Bruce G.Link

SECTION 5 Coercion and undue influence in decisions toparticipate in psychiatric research 269

16. Ethical issues of participating in psychiatric research oncoercion 271
Lars Kjellin

17. Coercion and undue influence in decisions to participate inpsychiatric research 293
Paul S. Appelbaum, Charles W. Lidz and Robert Klitzman

Index 315

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