The Use of Coercive Measures in Forensic Psychiatric Care Legal, Ethical and Practical Challenges Birgit Völlm Norbert Nedopil Editors 123 The Use of Coercive Measures in Forensic Psychiatric Care ThiS is a FM Blank Page Birgit Vollm€ • Norbert Nedopil Editors The Use of Coercive Measures in Forensic Psychiatric Care Legal, Ethical and Practical Challenges Editors Birgit Vollm€ Norbert Nedopil University of Nottingham Department of Forensic Psychiatry Nottingham Psychiatric Hospital of the University United Kingdom of Mu¨nchen Mu¨nchen Germany ISBN 978-3-319-26746-3 ISBN 978-3-319-26748-7 (eBook) DOI 10.1007/978-3-319-26748-7 Library of Congress Control Number: 2016934313 # Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland Contents 1 Introduction .......................................... 1 Birgit Vollm€ and Norbert Nedopil Part I The Context 2 International Human Rights and Institutional Forensic Psychiatry: The Core Issues ........................................ 9 Michael L. Perlin 3 Legal Aspects of the Use of Coercive Measures in Psychiatry ..... 31 Hans-Jorg€ Albrecht 4 Sociological Perspectives of Coercion in Psychiatry ............ 49 Hugh Middleton 5 Wise Restraints: Ethical Issues in the Coercion of Forensic Patients .............................................. 69 Gwen Adshead and Theresa Davies 6 An International Perspective on the Use of Coercive Measures ... 87 Tilman Steinert Part II Coercion in Different Settings 7 Coercive Measures in General Adult and Community Settings . 103 Peter Curtis, Bradley Hillier, Rachel Souster, and Faisil Sethi 8 Special Considerations in Forensic Psychiatry ................ 135 Norbert Nedopil 9 The Uses of Coercive Measures in Forensic Psychiatry: A Literature Review .............................................. 151 Ada Hui, Hugh Middleton, and Birgit Vollm€ 10 Coercion in Forensic Healthcare: A North American Perspective ........................................... 185 Johann Brink and Ilvy Goossens v vi Contents 11 The Use of Coercion in Prison Settings ...................... 209 Vicenc¸ Tort-Herrando, Ellen B.M.L. Van Lier, Aitor-Eneko Olive-Albitzur, Hans P.A.J. Hulsbos, and Alvaro Muro-Alvarez Part III The Experience of Coercion 12 Staff Attitudes Towards Seclusion and Restraint in Forensic Settings .............................................. 231 Tero Laiho, Anja Hottinen, Nina Lindberg, and Eila Sailas 13 Mental Health Workers’ Experiences of Using Coercive Measures: “You can’t tell people who don’t understand” ................ 241 Ada Hui 14 Patient Experience of Coercive Measures .................... 255 Pa¨ivi Soininen, Raija Kontio, Grigori Joffe, and Hanna Putkonen 15 Service User: Coercion Concern ........................... 271 Peter Andrew Staves Part IV Practical Challenges 16 Best Practices for Reducing the Use of Coercive Measures ....... 285 Jacqueline Ewington 17 Mechanical Restraint: Legal, Ethical and Clinical Issues ........ 315 Susan Elcock and Jessica Lewis Introduction 1 Birgit Vollm€ and Norbert Nedopil This book is dedicated to the use of coercive measures in one area of psychiatry— forensic psychiatry. Forensic psychiatry is a subspecialty of clinical psychiatry which operates at the interface between law and psychiatry. It is concerned with patients who have committed an, often serious, offence and are frequently detained in secure and mostly highly restrictive settings. The purpose of this detention is seen as twofold: care and treatment for the patient (for their own sake as well as in order to reduce future risk) and protection of the public from harm from the offender.This dual role can cause dilemmas for the practitioner who has conflicting obligations to the community, third parties, other healthcare professionals as well as the patient. Due to the nature of forensic psychiatry, both in terms of its clientele and the settings it operates in, the use of coercion seems to be therefore—rightly or wrongly—an integral part of its practice. It is thus surprising that—despite the plethora of academic writing about coercion in psychiatry in general—very little literature exists focusing specifically on forensic psychiatry—maybe a reflection of what Perlin (in the first chapter of this book) refers to as ‘an extra level of social isolation’ of this ‘most hidden’ patient group. What is coercion? According to the Oxford Dictionary of English, it is an ‘action or practice of persuading someone to do something by using force or threats’. Coercion usually occurs when one party has power over the other and does not necessarily have to involve obvious threats or use of force but can purely consist of B. Vollm€ (*) Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK Nottingham Healthcare NHS Foundation Trust, Nottingham, UK e-mail: [email protected] N. Nedopil Department of Forensic Psychiatry, Psychiatric Hospital of the University of Mu¨nchen, Mu¨nchen, Germany e-mail: [email protected] # Springer International Publishing Switzerland 2016 1 B. Vo¨llm, N. Nedopil (eds.), The Use of Coercive Measures in Forensic Psychiatric Care, DOI 10.1007/978-3-319-26748-7_1 2B.Vollm€ and N. Nedopil an implication that such force could be used. It is therefore important to distinguish between objective and subjective coercion, objective coercion being the actual use of coercive actions while subjective coercion describes the perception that such measures may be used. Objective and subjective coercion do not correlate well—some people may perceive actions which are not objectively coercive or intended to be coercive nevertheless as threats or compulsion while others may perceive objectively coer- cive measures in fact as helpful rather than coercive, making the delineation of the subject area even more challenging. In psychiatric settings, coercive measures may be used in three principle situations, though in practice they may not be clearly distinguished: (1) To restrict a patient’s freedoms on a medium to longer term basis to prevent harm towards self or others (e.g. offending), (2) to force a patient, who may or may not lack competency to accept treatment he or she refuses and (3) in the short-term manage- ment of a situation where there is a high likelihood of aggression or violence perpetrated by the patient. Though this book is primarily concerned with this kind of coercion, the concept of a ‘sliding scale’ of pressure to accept treatment, introduced by Szmukler and Appelbaum (2008), is a useful starting point in describing the various forms coercion may take in (forensic) psychiatric settings. The sliding scale includes: • Persuasion—the appeal to reason and/or emotions to accept the suggested course of action • Interpersonal leverage—where the patient–clinician relationship is used to put pressure on the patient, e.g. by pointing out the disappointment caused by the patient to his or her mental health worker if refusing the suggested course of action • Inducement—the use of positive rewards if the action suggested by the mental health professional is accepted • Threats—e.g. the threat to lose particular benefits such as the therapeutic rela- tionship itself or threats to use more aversive measures such as detention or physical force • Compulsory treatment finally is the situation where all choice is taken away from the patient and the treatment is delivered against his or her wishes In forensic psychiatry, coercion is mostly thought of in the short-term manage- ment of aggression or violence (see further below). There are, however, also long- term coercive measures applied, e.g. forcing the patient to accept depot medication in order to be transferred to a lower level of security or to be released into community treatment. Generally, accepted definitions of coercion hardly exist. While we would have preferred all authors using the same definitions for coercive methods within their chapters, it has soon become apparent that this aspiration was not achievable. This is an authors’ practice in different countries using different definitions and they write from their own experience within their countries. We have therefore decided to not edit out the overlap between chapters to allow the reader to appreciate the particular author’s viewpoint and definitions