Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Acknowledgements
- Section 1 Introduction and concepts
- Section 2 The evidence
- Section 3 Current practice
- 6 Crisis resolution teams: rationale and core model
- 7 The crisis resolution team within the community service system
- 8 Assessment of crises
- 9 Assessment and management of risk
- 10 Symptom management
- 11 Practical psychosocial interventions
- 12 Working with families and social networks
- 13 Strategies for promoting engagement and treatment adherence
- 14 Mixed blessings: service user experience of crisis teams
- 15 Early discharge and joint working between crisis teams and hospital services
- 16 Working with repeat users of crisis resolution services
- 17 Responding to diversity in home treatment
- 18 Coercion and compulsion in crisis resolution teams
- Section 4 Variations and enhancements
- Section 5 Developing a local service
- Index
- References
18 - Coercion and compulsion in crisis resolution teams
from Section 3 - Current practice
Published online by Cambridge University Press: 13 August 2009
- Frontmatter
- Contents
- List of contributors
- Foreword
- Acknowledgements
- Section 1 Introduction and concepts
- Section 2 The evidence
- Section 3 Current practice
- 6 Crisis resolution teams: rationale and core model
- 7 The crisis resolution team within the community service system
- 8 Assessment of crises
- 9 Assessment and management of risk
- 10 Symptom management
- 11 Practical psychosocial interventions
- 12 Working with families and social networks
- 13 Strategies for promoting engagement and treatment adherence
- 14 Mixed blessings: service user experience of crisis teams
- 15 Early discharge and joint working between crisis teams and hospital services
- 16 Working with repeat users of crisis resolution services
- 17 Responding to diversity in home treatment
- 18 Coercion and compulsion in crisis resolution teams
- Section 4 Variations and enhancements
- Section 5 Developing a local service
- Index
- References
Summary
One of the aims of crisis resolution is to offer treatment in a less coercive manner than inpatient care, which always imposes the constraints of institutional living on patients, whether or not they are also subject to legal compulsion, physical restraint or forcible injections. While many people do indeed recognise and value the freedom to be treated in their own environment, treatment at home may also be applied coercively, and crisis resolution teams (CRTs) use a range of ‘treatment pressures’ in the course of their work, including, but not confined to, the use of legal compulsion. In some cases, the degree of intrusion into the patient's home environment and social network may be so great that they may find hospital treatment preferable. This chapter describes a simple hierarchical model of treatment pressures and illustrates how these may be applied in practice by CRTs, and the dilemmas that arise. The use of legal powers to compel acceptance of treatment in the community and some of the practical difficulties of using coercive powers in a community setting are also discussed.
Defining coercion
Szmukler and Applebaum (2001) have conceptualised a hierarchy of ‘treatment pressures’ (Figure 18.1). Only the highest levels of the hierarchy (threats and force) are conventionally recognised as coercive, but the lower levels of treatment pressure, commonly used in practice, raise some of the same ethical dilemmas as the higher ones, and all can be regarded as forms of coercion.
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- Information
- Crisis Resolution and Home Treatment in Mental Health , pp. 223 - 232Publisher: Cambridge University PressPrint publication year: 2008