Criticism of Coercion and Forced Treatment in Psychiatry

Is the rising trend of forced treatment and restricted freedoms damaging for individuals diagnosed with mental illness?


A recent editorial, published in BMJ, argues there is an increase in coercive measures in psychiatry that are damaging to individuals diagnosed with mental illness. The authors, led by Sashi Sashidharan, honorary professor at the Institute of Health and Wellbeing at the University of Glasgow in the UK, write:

“Collaborative and person centered care leading to recovery is an aspiration of most modern mental health services. This aspiration is entirely inconsistent with the increase in compulsion and involuntary care across much of psychiatry.”

Photo Credit: Wikipedia Commons

Coercive measures refer to involuntary hospitalizations, forced administration of medication, involuntary confinement in isolation, restraint, and the general restriction of freedoms. The authors state, “Coercion in its various guises has always been central to psychiatry, a legacy of its institutional origins.” They argue that since deinstitutionalization in the 1970s and 80s where “the focus shifted towards care rather than custody” there has been a resurgence of coercion in mental health treatment.

Evidence of this can be found in many places. In England, the number of involuntary psychiatric hospitalizations has increased by over a third in the past six years, with over half of all psychiatric hospitalizations now being involuntary. There has also been an expansion of “protected” housing (i.e., living in the community but with restricted freedoms), compulsory treatment in outpatient settings, and increases in inpatient psychiatric beds. In addition, prisons have become a common place to detain people with mental illness: three times as many people with mental health disorders are found in US jails and prisons versus hospitals, and 15-25% of the UK prison population reports symptoms of psychosis.

The authors note that there is no evidence suggesting coercive tactics improve mental health outcomes and discuss an increase in concerns around coercion in Psychiatry. This includes Prime Minister Theresa May’s commitment to replace the current mental health legislation, which discriminates against ethnic minority individuals, in order to reduce the number of detentions based on mental illness.

One of the main drivers of increased coercion argue the authors, is the emphasis on risk management: “Risk management has become a central tenet in the care of mentally ill people. Clinical practice seems no longer driven by the needs of the individual but by risk assessments, often of dubious validity.”

The authors describe laws that detain individuals perceived to be a risk to society in mental health ‘treatment’ facilities as “an ill conceived attempt to hide preventive detention behind the veneer of respectability provided by a mental health context. They argue, “Although society has the right to be protected, using healthcare facilities to detain people for punishment rather than treatment, is inconsistent with basic medical ethics.”

The focus on risk management inherently conflates mental illness with danger and the result is an increase in stigma and social exclusion for people with mental health challenges. Therefore, the authors call for a reduction, rather than an expansion, in coercive measures and increased collaboration between patients and doctors where individuals are involved in their own care.



Sashidharan, S. P., & Saraceno, B. (2017). Is psychiatry becoming more coercive? BMJ, 357, j2904. doi:10.1136/bmj.j2904 (Link)


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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Shannon Peters
MIA Research News Team: Shannon Peters is a doctoral student at the University of Massachusetts Boston and has a master’s degree in mental health counseling. She is particularly interested in exploring the impacts of medicalization and pathologizing the experiences of individuals who have been affected by trauma. She is engaged in research on the effects of institutional corruption and financial conflicts of interest on research and practice.


    • I wish I could hold up a sign and protest in the front of all of these buildings that hold people hostage and against their will, how dare they, and just who do they think they are, I really want to know. They are smug and arrogant and how, I wonder, do they even look at themselves in the mirror everyday without wanting to puke? How do they sleep at night knowing full well what they have done to people, they disgust me! It is a pseudoscience based upon fiction, that is all it is and it is all that is ever will be.

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  1. The medical community considers one a “risk of danger to oneself or others” if that person has medical proof of easily recognized iatrogenesis in their medical records, like a “bad fix” on a broken bone.

    The “mental health” industry is used to defame, poison, and torture people to proactively prevent legitimate, but non-existent, malpractice suits for dangerous and paranoid (I guess, according to their own made up disorders, that would make them “schizophrenic”) doctors.

    One of the satanic doctors who illegally held me in a hospital against my will, by illegally forging my signature on voluntary admission papers, has now been convicted of medically unnecessarily having lots and lots of patients shipped long distances to himself, “snowing” these patients, so he could perform unneeded tracheotomies on them for profit.

    “Power tends to corrupt, and absolute power corrupts absolutely.” The right to force treat patients needs to be taken away, it is being abused for nefarious and medical greed inspired reasons.

    Not to mention, it is insane to give doctors a right to force poison people with drugs known to create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, and the positive symptoms of “schizophrenia,” via neuroleptic or antidepressant induced anticholinergic toxidrome.

    The neuroleptic/antipsychotic drugs create both the negative and positive symptoms of “schizophrenia,” they do not cure the made up disorder called “schizophrenia.”

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  2. RISK
    It’s the WELL people on SSRIs (for unsuitable reasons) that present the RISK to Society.
    Evidence of this can be seen in the MEDIA again and again.

    “Severely Mentally Ill” People might get very irritable but outside of Risky Drug treatment, I would believe present very little Risk. Whenever anything does happen it can usually be traced to starting, stopping, or changing medication – usually ending in self harm or suicide.

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    • So true, Fiachra, changing medications is very dangerous, which is why it is not recommended. Which leads one to wonder why today’s hospitals believe the following willy nilly forced treatments would be considered “appropriate medical care,” as is believed by the ELCA Advocate Good Samaritan Hospital in Downers Grove, IL today.

      Day 1
      Force treatment with Etomidate, Benztropine, Haloperidol, Lorazapam (Avitan), Ziprasidome (Geodon), more Geodon, Tylenol, Mi-Acid II, Milk of Magnesia, Alum-mag hydro-simeth oral suspension

      Day 2
      Force treated with Benztropine, Depakote, Haloperidol, Lorazapam (Avitan), Divalproex ER (Depokote ER), Quetiapine (Seroquel), more Seroquel, maybe more Geodon, Milk of Magnesia

      Day 3
      Force treated with Benztropine, Depakote, Lorazapam (Avitan), Divalproex ER (Depokote ER), Quetiapine (Seroquel), more Seroquel, Geodon, Milk of Magnesia

      Day 4
      Force treated with Benztropine, Depakote, Haloperidol, Lorazapam (Avitan), Nicotine, Seroquel, Geodon, Milk of Magnesia

      Day 5
      Force treated with Depakote, Lorazepam, Divalproex ER (Depokote ER), Quetiapine (Seroquel), more Seroquel, Milk of Magnesia

      Day 6
      Force treated with Depakote, Lorazepam, Quetiapine (Seroquel), Nicotine, more Seroquel, Geodon, Milk of Magnesia

      Massive numbers of willy nilly, mostly “major-major” drug interaction warning filled drug cocktails, up until the day that my medical records say, “No longer Needing [Nurse] Review.” And on this day I was even given a drug that is “no longer available in the US.”

      Day 10
      Forced treated with Depakote, Haloperidol, Lorazepam (Avitan), Quetiapine (Seroquel), Darvocet A500 (acetaminophen-isometh-dicloral 325-100-65) (“no longer available in the US), Nicotine, Seroquel, Midrin, Milk of Magnesia

      Is this really “appropriate medical care” in the US today? Or is this a “snowing” to try to make a person stop breathing, so the doctors could do an unneeded tracheotomy for profit, just like Kuchipudi was eventually arrested for doing to many of his other patients? He did admit me with a non-existent “chronic airway obstruction,” too.

      His psychiatric “snowing” partner in crime, Humaira Saiyed, has yet to be arrested. We need to start arresting more of the criminal doctors, especially the scientifically invalid psychiatrists. The IL Department of Professional Regulations is not doing it’s job, and is morally responsible for six additional years of patient deaths by V.R. Kuchipudi, from the time I reported these criminal doctors, to his eventual arrest.

      Giving doctors the power to force treat people turns doctors into unrepentant murderers and attempted murderers. A one world monetary system is a really bad idea too, especially given the staggeringly fiscally irresponsible behavior, and “luciferian” sins, of today’s “too big to fail” globalist bankers. “Power tends to corrupt, and absolute power corrupts absolutely,” in all professions. The medical and banking professions are NOT exempt from this common sense reality.

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    I would say that there’s an overall Medical policy of suppressing Akathisia related Suicidal Reaction and Unpredictable Behaviour.

    My Historical Irish Records from Galway Ireland suppressed Akathisia induced suicide attempts, putting me at risk. But my Present Day UK Records at Newton Medical Centre in Central London also suppress Akathisia induced Suicidal Reaction.

    My attempts at rectifying my Safety situation through apropriate Regulatory means have also been seriously obstructed.

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    • Someone Else,

      I think there’s more or less a tolerance within the Western Medical System, towards the killing of the “Mentally Ill”.

      The Psychiatric Holocaust DID genuinely happen:- between 1935 and 1945, and 150, 000 people, might have been killed. But this is happening all the time:- Everywhere Else,

      I have named my Doctors Surgery:- Newton Medical, Central London, in the UK (above). These doctors are, I would imagine, following orders.

      The Research Doctors that treated me in Southern Ireland were injecting lots of people and covering up lots of deaths, while promoting the drugs as safe and economical for the Larger Markets.

      All the other Research Universities everywhere else promoting these drugs, were covering up the deaths as well (in return for money).

      But, Manufacturers of Long Acting Injection Drugs ” Modecate” and “Depixol”, DO acknowledge that these drugs are Extremely Unpredictable and Dangerous and Deadly.

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      • Long Acting Injections like Modecate and Depixol are Forced Treatment instruments that can in my experience induce Acute Akathisia and Suicidal Reaction.

        These drugs also disable people; and cause permanent neurological damage in the majority of people that consume them.

        For me coming off these drugs meant an end to taxpayer funded disability and an end to suicidal hospitalizations.

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  4. For me, being carted off and locked up when I had done nothing wrong, had threatened no-one, and had not threatened or attempted self harm was THE most traumatic event in my life. I was in a sensitive and stressed state and the act of locking me up in a mental hospital plunged me into my first (and only) psychotic episode at age 50. It took me years to get off their “medication” (ie highly destructive and addictive and totally revolting mind-altering drugs) and to be able to function in society and form friendships etc again.

    Thirteen years down the track and I still have significant issues with trust, particularly of people in positions of respect or trust, because I know how easily I can have all my rights and freedoms removed on their whim.

    In my journals at the time I didn’t write of doctors or people trying to help me, I wrote of my “gaolers” (jailers to the US readers) and “tormentors”. Because they had kidnapped, imprisoned and drugged me, plunging me into such a terrifying altered state, how else would I have seen them?

    …and yet they seemed to think I should be thankful…and had trouble understanding why I would be fearful and uncooperative.

    I still don’t think it was me who was suffering anosognosia!

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  5. Anyone out there interested in talking on this topic I’m having a radio show this evening starting at 6:30 going for ONE HOUR ONLY. Topic: Leadership and the Psychiatric Survivor Movement: Where do we go from here?

    Here is the blurb:

    Call in to speak with the host

    (323) 443-7210

    This is a ONE HOUR call-in show. Who shall lead us now that the Movement has gotten so large? Who is best qualified? Why is it important not to rely on “providers” to take up these roles any longer? Who shall speak out as authority? Who shall be the decision-makers? Where shall the hub of our leadership be located? These and other questions will be explored tonight.

    Feel free to call in!


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    • Hi, I wish I could have called in to your radio show! How cool is that! I applaud you in unsurfacing the veil of the pseudoscience of sychiatry, it’s not even a word as far as I’m concerned, not deserving of being a word because it’s not a science.

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