Intended for healthcare professionals


Is psychiatry becoming more coercive?

BMJ 2017; 357 doi: (Published 22 June 2017) Cite this as: BMJ 2017;357:j2904
  1. S P Sashidharan, honorary professor1,
  2. Benedetto Saraceno, professor2
  1. 1Institute of Health and Wellbeing, University of Glasgow, UK
  2. 2Institute of Global Mental Health, Lisbon, Portugal
  1. Correspondence to: S P Sashidharan s.p.sashidharan{at}

The rising trend is damaging for patients, unsupported by evidence, and must be reversed

Coercion in its various guises has always been central to psychiatry, a legacy of its institutional origins. In the 1970s and 80s use of coercion in psychiatry fell as old asylums were closed across much of western Europe and replaced with community based care. The focus shifted towards care rather than custody. Recent developments, however, indicate that this balance is shifting again in favour of coercive care, even within well resourced mental health systems. The term coercion has a broad definition in mental healthcare,1 but here we focus on the use of force or compulsion.

More and more people are being subjected to coercive psychiatric interventions. In England, the rate of involuntary psychiatric hospital admission has increased by more than a third in the past six years.1 In Scotland, the number of detentions has increased by 19% in the past five years.2 More than half of admissions to psychiatric hospitals in England are now involuntary, the highest rate recorded since the 1983 Mental Health …

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