Cited by 304Healthcare Decision-Making and RestraintsEthics and bioethics in healthcareEthics and Legal Issues in Pediatric Healthcare

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Treatment pressures, leverage, coercion, and compulsion in mental health care

Szmukler, George, Appelbaum, Paul S.·2008·Journal of Mental Health

DOI 10.1080/09638230802052203

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Abstract

Background: Questions concerning non-consensual treatment in mental health services have assumed an increased salience. In significant part, this has been due to changes in professional practice, as well as the perceived risks, associated with the movement of treatment from hospital to community.Aims: To define the main forms of pressure aimed at inducing reluctant patients to accept treatment and to examine frameworks for their justification.Method: Review of the literature on “coercion” focusing on morally relevant distinctions between its different forms.Findings: A hierarchy of treatment pressures can be defined based on distinctions having moral relevance. These range from persuasion, through interpersonal leverage, inducements (offers), threats, to the use of compulsion. Contemporary ideas about “coercion” suggest that the use of this term should be reserved for particular types of threat. The relationships to coercion of “unwelcome predictions”, “exploitation” and “deception” can be defined.Conclusions: As one ascends the hierarchy, the stronger must be the justification for intervention by the clinician. Two frameworks can prove helpful in decision-making, one based on a “capacity-best interests” approach, the other on an analysis of “paternalism”. Interventions for the protection of others rather than in the health interests of the patient may present special difficulties in their justification.

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Authors: Szmukler, G., & Appelbaum, P. S.
Affiliations: King's College London (GB)
Columbia University Irving Medical Center (US)
Corresponding author: Szmukler, George
ORCID: Szmukler, George
Appelbaum, Paul S.
Venue: Journal of Mental Health
Publisher: Informa UK Limited
Published: 2008-01
Volume: 17
Issue: 3
Pages: 233-244
ISSN: 0963-8237 (ISSN-L)
1360-0567
DOI: 10.1080/09638230802052203
OpenAlex: W2073765189
Cited by: 304
References: 43
Citations by year: 2026: 22 · 2025: 29 · 2024: 37 · 2023: 21 · 2022: 18 · 2021: 41 · 2020: 24 · 2019: 18 · 2018: 10 · 2017: 9 · 2016: 21 · 2015: 11 · 2014: 13 · 2013: 9 · 2012: 3
FWCI: 6.67
Type: journal article
Language: en
Open access: closed
Locations: Journal of Mental Health (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
Keywords: coercion in mental health care, treatment pressure, compulsive behavior, persuasion, threats, inducement, exploitation, deception, paternalism, best interests, capacity, community mental health services, involuntary treatment

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Treatment pressures, leverage, coercion, and compulsion in mental health care

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