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Coercive Treatment in Psychiatry: Clinical, legal and ethical aspects

Thomas W. Kallert (Editor), Juan E. Mezzich (Editor), John Monahan (Editor)
ISBN: 978-0-470-66072-0
348 pages
April 2011
Coercive Treatment in Psychiatry: Clinical, legal and ethical aspects (0470660724) cover image


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.

Highly Commended in the Psychiatry section of the 2012 BMA Book Awards.

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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 coercive treatment 1

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

2. Coercive treatment and stigma – is there a link? 13
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 for coercive treatment in psychiatry? 49
Tilman Steinert and Peter Lepping

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

SECTION 2 Legal aspects of coercive treatment 81

6. Psychiatry and the law – do the fields agree in their views 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 two fields currently compatible? 121
Thomas W. Kallert

SECTION 3 Ethical aspects of coercive treatment 151

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

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

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

SECTION 4 Users' views on coercive treatment 185

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

13. Resisting variables – service user/survivor perspectives 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 to participate in psychiatric research 269

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

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

Index 315

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Author Information

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

Dr. Mezzich was Chair of the World Psychiatric Association (WPA) Section on Classification and Diagnostic Assessment, and a member of the ICD-10 Mental Disorders Workgroup and the DSM-IV Task Force. He has authored over 200 scientific journal articles and book chapters and 25 books and monographs primarily on psychiatric diagnosis and epidemiology from clinical, philosophical, statistical, and cultural perspectives and more recently on person-centered psychiatry and medicine. He has received six Honorary Doctorates from universities in the Americas and Europe as well as the Simon Bolivar Award of the American Psychiatric Association, the Medal for Extraordinary Merit of the Medical Council of Peru, and the Linneaus Medal of Uppsala University in Sweden. He is President of the InternationalNetwork for Person-centered Medicine.

Professor Monahan is well known internationally for his numerous publications and presentations in mental health law, for his leadership of the MacArthur Research Network on Violence, Coercion and Competence and of the current MacArthur Research Network on Mandated Treatment in the Community, and for his generous support and encouragement of scholars in coercion and in all areas of mental health law.

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“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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