People with mental illnesses have the right to choose the care they receive. Forced treatment–including forced hospitalization, forced medication, restraint and seclusion, and stripping–is only appropriate in the rare circumstance when there is a serious and immediate safety threat. In general, circumstances that give rise to the use of force are not spontaneous and do not occur in isolation. Usually, there were multiple opportunities for earlier interventions that could have prevented the need for force. For this reason–and to counteract coercion that is too often routine in mental health systems–it is important to regard the use of forced treatment as reflecting a failure in service and to reform systems accordingly.
The Bazelon Center has a long history of opposing forced treatment. Not only is forced treatment a serious rights violation, it is counterproductive. Fear of being deprived of autonomy discourages people from seeking care. Coercion undermines therapeutic relationships and long-term treatment. The reliance on forced treatment may confirm false stereotypes about people with mental illnesses being inherently dangerous. Moreover, the experience of forced treatment is traumatic and humiliating, often exacerbating a person’s mental health condition.
Often, it is difficult to engage people in treatment. But service systems have developed effective techniques for doing so. Peer services, outreach, mobile outreach [such as assertive community treatment (ACT)], and supportive housing (Housing First) have proven success. All too often, systems turn to force and coercion because they lack such services.
The Bazelon Center advocates for self-determination in treatment decisions and works for service systems that avoid force and coercion. Such systems listen carefully to consumers and offer the type of services and support that consumers prefer. Such systems do not simply respond to crises but develop plans in partnership with the individuals they serve to avert crises. When treatment plans are imposed, it is not surprising that consumers may depart from the plan. Shared responsibility promotes “buy-in” and better treatment outcomes. In the long run, the best way to secure “treatment compliance” is to respect consumer choice.