Compulsion and psychiatry—the role of advance statements

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7458.122 (Published 15 July 2004) Cite this as: BMJ 2004;329:122
  1. Philip Thomas (p.thomas@bradford.ac.uk), consultant psychiatrist,
  2. Anne B Cahill, locum consultant psychiatrist
  1. Bradford Assertive Outreach Team, Centre for Citizenship and Community Mental Health, School of Health Studies, University of Bradford, Bradford BD7 0BB
  2. Bradford District Care Trust, Shipley BD18 3LD

    Liberation cannot be handed to the oppressed by the oppressor

    Most psychiatrists accept reluctantly that from time to time they need to force patients to have treatment against their wishes. The British government's proposed changes to the Mental Health Act will increase compulsion in three ways. They will remove the requirement that a patient's condition must be severe enough to warrant admission to hospital, thus enabling compulsory treatment in the community; they will re-incorporate people with personality disorder; and they will introduce wider definitions of mental disorder and of treatment. Users of mental health services have long been concerned about compulsion and have tried to combat it. Twenty years ago groups such as Survivors Speak Out pioneered the use of crisis cards as a way of resisting compulsion in mental health emergencies. More recently, partly in response to the proposed legislation but also as part of a growing critical debate within the profession, psychiatrists have turned to advance statements (or advance agreements if made consensually with a mental health professional), in the hope that these will reduce compulsion and facilitate a more collaborative engagement …

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