8 - Compulsion and locked doors

Summary

Controversy continues to rage over the use of legal compulsion in the treatment of people suffering from mental illness. The current focus of conflict is over the use of compulsory treatment orders in the community, which already exist in some countries. There has been a long-standing governmental aspiration to introduce them in the UK, and this is likely to happen in the near future. We do not propose to explore the controversy here. Suffice to say that the debate within the mental health community regarding compulsion in general centres on the tension between two positions: What is the point of symptom relief if the price is loss of personal freedom? and What is the point of personal freedom if the consequence is severe mental illness and distress?

The limited use of compulsion is a feature of mental health care in all developed countries, and most mental health professionals recognise that it is sometimes necessary and appropriate. However, few of us are comfortable with the use of compulsion. This unease tends to worsen the longer you practise, as the certainties of youth dissolve into the ambiguities of experience. Few psychiatrists can escape the salutary experience of recommending that a patient should be detained, only to find that other authorised professionals disagree and that the subsequent treatment plan works well, whilst avoiding compulsion. We have written elsewhere about the experience of being detained (Poole & Higgo, 2006).