Compulsory treatment in psychiatry.
OBJECTIVE
Compulsory treatment is a common, yet controversial, practice in psychiatry. This paper reviews recent studies on the use of compulsory measures in hospital, the community and special populations.


RESULTS
Researchers continue to examine the rates and patterns of involuntary hospitalization. However, they have extended their investigations to care in the community, acknowledging it as the primary locus of treatment for most patients. Research shows that the implementation of community mental health legislation presents complex clinical and practical issues that require further investigation. Recognition that compulsory treatment is an objective event which is subjectively experienced by patients, families and clinicians has led to research investigating stakeholder views. The therapeutic relationship has been found to be an important modifier of the experience of compulsory treatment. Recent studies have also focused on specific coercive practices, such as forced medication and seclusion, and the use of these in patient subgroups, including those with eating disorders and adolescents. The debate about whether compulsory treatment is ethical continues in the literature.


CONCLUSIONS
Compulsory treatment in psychiatry remains an ethically and clinically contentious issue. As ethical concerns are generally countered by the argument that compulsory measures can lead to beneficial clinical outcomes, further empirical investigation in this area is required.
Sheehan
Kathleen A
KA
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. katie.sheehan@gmail.com
D000293:Adolescent; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D003156:Community Mental Health Services / Q000941:ethics* / Q000379:methods; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D011570:Psychiatry / Q000941:ethics* / Q000379:methods