Location:
Hartford Room, The Commons Building, 2nd
Floor, The Institute of Living/Hartford Hospital
200 Retreat Avenue, Hartford, CT 06106
Abstract:
Managing the
boundary between consent and coercion is a central ethical issue for
psychiatry. The history of pre-enlightenment approaches to mental disorder was
rife with coercive practices. The moral treatment movement as it was manifested
in the early asylums changed perceptions of mental disorder and the role of
coercion while fostering notions of personal autonomy which were later codified
in the doctrine of informed consent.
Commitment practices and law became an early battleground in the struggle
against paternalism and coercion. The right to refuse treatment (medication)
became the next. Underlying both issues are several central questions: What
are the causes of non-compliance? What are appropriate responses? What are the
factors that lead patients to feel coerced? Involuntary outpatient commitment,
living wills for psychiatric treatments, the impact of stigma on perceptions of
coercion and choice and the recovery movement are some of the contemporary
issues which touch on these themes.
Learning Objectives
-
The
participants will be conversant with the history of coercive practices in
mental health services and the conflict between these practices and the value
of promoting autonomy.
-
The
participants will be conversant
with behaviors that lead to the perception of coercion, factors that lead to
non-compliance, and the issues that are shaping the discussion of consent,
autonomy and coercion presently and in the near future.
References:
Mandated Treatment in the Community
for People with Mental Disorders by John Monahan, Marvin Swartz, and Richard J.
Bonnie. Health Affairs, Vol. 22, No. 5, pp. 28-38, 2003.
Inclusion, Motivation and Good Faith:
The Morality of Coercion in Mental Hospital Admission by Bennett NS, Lidz CW,
Monahan J, et al. Behavioral Sciences and the Law, Vol. 11, pp. 295-306, 1993.
Bibliography prepared by
the IOL Medical Library. Call 545-7276 for information.
Books
Schopp RF. Competence,
Condemnation, and Commitment: An Integrated Theory of Mental Health Law.
American Psychological Association, 2001. WM 33 S373c.
Berg JW et al. Informed
Consent: Legal Theory and Clinical Practice, Second Edition. Oxford
University Press, 2001. WM 32.6 I435.
Articles
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Violence and leveraged community treatment for persons with mental disorders.
American Journal of Psychiatry. 163(8):1404-11, 2006 Aug.
<2> Bindman J et al.
Perceived coercion at admission to psychiatric hospital and engagement with
follow-up--a cohort study. Social Psychiatry & Psychiatric Epidemiology.
40(2):160-6, 2005 Feb. (ELECTRONIC FULL
TEXT)
<3> Monahan J et al.
Mandated treatment in the community for people with mental disorders. Health
Affairs. 22(5):28-38, 2003 Sep-Oct.
(ELECTRONIC FULL TEXT)
<4> Swartz MS et al. Does
fear of coercion keep people away from mental health treatment? Evidence from a
survey of persons with schizophrenia and mental health professionals.
Behavioral Sciences & the Law. 21(4):459-72, 2003.
(ELECTRONIC FULL TEXT)
<5> O'Brien AJ. Golding
CG. Coercion in mental healthcare: the principle of least coercive care.
Journal of Psychiatric & Mental Health Nursing. 10(2):167-73, 2003 Apr.
(ELECTRONIC FULL TEXT)
<6> Rain SD et al.
Perceived coercion at hospital admission and adherence to mental health
treatment after discharge. Psychiatric Services. 54(1):103-5, 2003 Jan.
<7> Monahan J et al.
Mandated community treatment: beyond outpatient commitment. Psychiatric
Services. 52(9):1198-205, 2001 Sep.
<8> Lidz CW et al.
Sources of coercive behaviours in psychiatric admissions. Acta Psychiatrica
Scandinavica. 101(1):73-9, 2000 Jan.
(ELECTRONIC FULL TEXT)
<9> Lidz CW et al.
Factual sources of psychiatric patients' perceptions of coercion in the hospital
admission process. American Journal of Psychiatry. 155(9):1254-60, 1998 Sep.
<10> Hoge SK et al.
Perceptions of coercion in the admission of voluntary and involuntary
psychiatric patients. International Journal of Law & Psychiatry. 20(2):167-81,
1997.
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