Compulsory Interventions in Psychiatry: an Overview on the Current Situation and Recommendations for Prevention and Adequate Use

State-of-the-art clinical psychiatry seeks to provide successful treatment of persons with mental illness in a comprehensive approach integrating biological, psychological, social and spiritual aspects. The focus on empowerment- and recovery-oriented strategies allows clinicians and people with mental illness to interact at the same level. However, illness symptoms sometimes prevent patients from fully understanding the potential benefits of treatment. Aggression, violence, and self-endangering behavior in psychiatric patients are often used as justification for more restrictive policies in mental health care. However, current studies have shown that restrictive settings do not necessarily prevent self-harm and suicide and do not reduce all sorts of violence and aggression. Locked doors lead to a worse climate on the wards, directly affecting the therapeutic milieu and the treatment alliances. In addition, patients who were mandated to psychiatric treatment might be more reluctant to receive treatment in the future. While studies have shown that mandated treatments do also impact positively the outcome of illness, this is often mediated by an increase in services rendered rather than the direct effects of coercion.

Compulsory interventions aiming at patient and staff safety, as well as mandatory treatment may be necessary to ensure treatment for those who do not want to be treated. The goal is to protect mentally ill persons from self-harm, suicide, and detrimental consequences of untreated illness, and to protect relatives, healthcare professionals, and the general public from preventable aggression and violence. This gives rise to serious ethical problems and clinical challenges.

The primary focus of this Research Topic is to provide an overview on the current situation in clinical psychiatry and in psychiatric research, to collect scientific evidence on the prevention and adequate use of compulsory interventions, its effects and consequences. The aim is to give recommendations for mental health care professionals on the prevention of aggression and violence, the use of coercive measures and possible treatment alternatives to reduce forced interventions. An additional target is to outline future research strategies to advance the field and to ultimately approach the goal of optimal and safe treatment of this vulnerable population. We encourage the submission of Original Research, Brief Research Reports, Systematic Reviews, narrative expert Reviews and Mini Reviews, Perspective and Opinion papers.