Coercion, involuntary treatment and quality of mental health care: is there any link?
OBJECTIVE
This paper summarizes major results and debates in the field of coercive or involuntary treatment of the mentally ill and how these relate to the quality of care, as published in literature during 2002 and 2003.


RESULTS
Studies focus on four major issues: involuntary hospital placement and treatment of mentally ill patients, compulsory outpatient treatment, attitudes towards or perceived coercion, and ethics of coercive measures in mental health care. Studies suggest a complex correlation between the involuntary placement of mentally ill patients, coercive measures, and outcomes. Outcome indicators for the quality of mental health care are not standardized, but vary with the point of view of the individual or collective assessor. None of the results question the necessity or the legality of involuntary treatments or conclude to refrain from employing coercive measures in mental health care if these cannot be avoided. Many results of research on attitudes towards involuntary treatments or perceived coercion suggest an acceptance of the application of coercive measures, even by the persons concerned, if the legal conditions are clearly defined. Research standards or study designs may benefit from some improvement. Study samples usually are small and only in rare cases has their selection been representative.


CONCLUSIONS
Research activities are remarkably few in number, especially considering the frequency of involuntary measures and the controversial perception or discussion of these measures among the persons concerned, professionals, or a wider public. Many basic research questions still remain to be adequately addressed, such as the long-term effects of involuntary treatment.
Salize
Hans Joachim
HJ
Central Institute of Mental Health, Mannheim, Germany. salize@zi-mannheim.de
Dressing
Harald
H