Psychiatric services are there for your mental wellbeing, but the Care Quality Commission’s (CQC) annual report into the working of the Mental Health Act has revealed some concerning practices. Last year, there was a 5% increase in involuntary detentions in hospital, and a 10% increase in the use of community treatment orders (CTOs). These are orders that force psychiatric patients currently well and living at home to comply with their treatment, or else they’ll be compulsorily readmitted to hospital. So the question appears to be; is there too much coercion in our mental health services?
It is almost certain that the figures do not reveal the full extent to which coercion is routine in some services. The CQC even notes that a lot of voluntary patients only remain locked in wards because they fear being sectioned if they demand to be allowed home. Roughly one third of patients living at home are subject to informal threats or “leverage”, such as they won’t be allowed to see their children, or receive their benefits, if they do not follow medical advice.
Though coercion should be avoided if at all possible, many mental health professionals, especially psychiatrists, see it as an essential tool. In medical ethics, the respect for the right to make choices is a widely recognised principle, and the denial of this autonomy could be distressing or traumatic for mental health patients. The reason why many people’s wellness is affected by psychiatric problems in the first place is because they have already experienced physical and sexual abuse, bullying and other kinds of victimisation, and so coercion by services could add to this burden of adversity, and damage the relationship between the patient and their doctor, making them more reluctant to seek help in future.
Those who support coercion believe it is in the best interest of the patient, based on the assumptions that patients are irrational in rejecting psychiatric care, that psychiatric treatments are always beneficial, and that patients who are compelled to receive treatment do better in the long-run. However, studies have revealed the dubiousness of each of these assumptions, as many patients reject drugs due to their inefficacy and side effects, and there’s little evidence that they reduce future hospitalisation. Sometimes, coercion is difficult to avoid, but if it is a necessary evil, then it is still an evil and mental health services need to find ways of resorting to it less.
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