Legal Aspects of the Use of Coercive Measures in Psychiatry

Abstract

Coercion appears to be an integral component of psychiatry, particularly forensic psychiatry, and its use strongly influences the way the public sees this specialty. Coercion takes place when individuals are placed in hospital involuntarily and entails measures taken against their will during admission. The use of coercion is, however, increasingly scrutinised with a clear shift in perspectives from a medical- to a rights-based approach. A number of laws and declarations have been passed on a national and international level restricting the use of coercive measures. Particular aspects of psychiatric care and coercion have been met with particular concerns, e.g. electroconvulsive treatment and solitary confinement, and some forms of coercion may amount to inhumane and degrading treatment. The importance of thorough reporting of the use of coercive measures to allow for analysis and evaluation has been emphasised. The introduction of individual complaints procedures allowing patients to raise concerns about their treatment has further led to an improvement of conditions in psychiatric institutions. This chapter will outline the key hard and soft international and European law, including the UN Convention on the Rights of Persons with Disabilities and the European Convention on Human Rights, and their application to forensic psychiatry. Key cases brought before the European Court of Human Rights are reviewed.