Coercion in community mental health nursing – The ethical dilemmas

Coercion is a defining feature of public mental health services in Australia. Much of the research and recent policy directives aiming to reduce coercive interventions have been focused on inpatient mental health settings, particularly regarding restrictive practices such as seclusion and restraint. Implementation of the Safewards Model of Care is an example of a successful initiative to reduce such restrictive practices. However, increasing numbers of Australians are subject to coercive interventions in community mental health settings delivered through community treatment orders. This is despite conflicting evidence of the effectiveness of community treatment orders and concerns about the potential for harm. As in hospital settings, coercion in community mental health care holds risks of traumatisation and re-traumatisation. Forced treatment appears contradictory to the key principles of empowerment and self-efficacy in personal recovery. Moreover, some may consider forced treatment as a breach of human rights. The experience of coercion may cause people with mental illness to avoid seeking care at times of mental health crisis which risks relapse and further trauma. Coercion can also compromise the therapeutic relationship which is core to the work of meaningful mental health nursing. The tension between providing best practice care that avoids coercive practices, and ensuring the conditions of community treatment orders are met creates potential for ethical dilemmas for mental health nurses. This presentation will examine the increasing prevalence of coercion and involuntary treatment in community mental health services and explore the ethical issues that mental health nurses need to consider in these settings. By being mindful of and accounting for the potential for harm arising from coercive practices we are better able to manage the associated ethical dilemmas and focus on the provision of person-centred, trauma-informed, and recovery-oriented nursing care.