(June 5, 2012) If an individual with severe mental illness becomes psychotic and dangerous, “how can one honor the principles of recovery-oriented practice to achieve recovery goals without use of involuntary interventions?”
Psychiatrist Jeffrey L. Geller, MD, MPH, recently explored this question in a Psychiatric Services “Open Forum” and concluded that “(r)ather than focusing on the elimination of every aspect of coercion and involuntary treatment in psychiatry, we might do better to focus on how to use involuntary interventions in the context of a recovery-oriented process to achieve recovery goals.”
Geller says “the notion that we can eliminate all coercive interventions by using our current array of psychopharmacologic agents, psychotherapies, and rehabilitation” is “without precedent.”
“The gyrations that staff would have to go through to achieve zero coercion would be considerably less patient centered, less safe, and less honest than the level of care they can provide through the judicious use of effectively monitored coercive interventions,” according to the author, who is affiliated with the Department of Psychiatry, University of Massachusetts Medical School, and a member of the Treatment Advocacy Center board.
Geller draws parallels between other “coercive measures” society takes to prevent and treat other dangerous behaviors and discusses the importance of using a patient-centered model of care that acknowledges when coercion is used.
For a thoughtful and thought-provoking examination of court-ordered treatment as part of the recovery model, see “Patient-centered, recovery-oriented psychiatric care and treatment are not always voluntary ” (May 2012).