Coercion in Mental Health Practice: An Overview

Abstract

Coercion in psychiatric practice remains a controversial topic. Coercive practices take different forms that include the use of physical or psychological force or pressure directly to patients or through proxies in the process of delivering mental health care. While coercion may have socioanthropological origins, its current perpetuation in different forms around the world reflects historical, developmental, sociocultural, and health system contexts and realities. Most high-income countries have evolved strong institutions, legislations, and well-resourced health systems to address coercion. However, many low- and middle-income countries are still constrained by health system inadequacies at both macro and micro levels that put pressure on families, communities, and service providers that lead to the continued use of coercion in the care of persons with mental ill health. In this regard, pragmatic approaches to addressing coercion in these settings will include greater investment in the expansion of evidence-based mental health services, and the earmarking of resources not only to develop relevant policies and legislation but to implement them. Furthermore, training is required for healthcare workers in the use of alternatives to coercion and for service users and civil society organizations to serve as society’s watchdog against the use of coercion. More research is needed on how best to improve the services provided by traditional and faith healers where the use of coercive practices tends to be more common.