Position Statement on Alternatives to Force and Coercion
Policy Lessons from Facing Mental Illness: MINDS ON THE EDGE
There are at least two perspectives on the issue of
forced treatment. Some believe that it can be lifesaving – and that position was
given a disproportionate percentage of attention in “Minds on the Edge.”
However, others believe that forced intervention is, by definition, traumatizing
and counterproductive. This perspective is often overlooked in the media, and
was not given adequate time for discussion and consideration in “Minds on the
The National Coalition of Mental Health
Consumer/Survivor Organizations (NCMHCSO) believes that the public needs to be
informed that forced treatment is intrinsically traumatic because it is
isolating and disempowering, whereas choice and self-determination facilitate
We should work to eliminate force and coercion,
and develop instead the compassionate, consumer- and family-driven system called
for in the 2003 report of the President’s New Freedom Commission on Mental
Research clearly shows that forcing patients to
take medication is not supported by clinical evidence.
Coercive interventions are routinely
traumatizing to the individuals they purport to help and make people fearful
of seeking treatment.
Involuntary interventions are a poor substitute
for building recovery-focused, culturally attuned, community-based mental
health and social support services.
There is an alternative to force and coercion:
the fostering of trusting and stable relationships while emphasizing choice in
A growing evidence base validates the efficacy
of “peer-directed services” – services directed by individuals who
themselves have psychiatric diagnoses.
Peer support workers can often help persons whom
traditional services cannot reach; they can also train non-consumers on how
to reach those experiencing extreme emotional distress or “psychosis.”
Person-centered crisis plans (also known as
psychiatric advance directives) can also avoid force. Such plans are written
documents in which individuals express their treatment preferences in the
event that they experience an emotional crisis. An individual can also
identify someone to act as a health care agent who can make sure his or her
wishes are respected.
The goal of treatment should be recovery of a
full role in society, not mere maintenance of “symptom-free” behavior.
In 2003, the President’s New Freedom Commission
on Mental Health, charged with reviewing the public mental health system in
the United States, reported “that the current system is unintentionally
focused on managing the disabilities associated with mental illness rather
than promoting recovery, ability to withstand stresses and life challenges.”
Congress should appropriate funding for peer-run crisis alternatives in every
state in the Nation.
Peer-run crisis respite centers are the most
recovery-oriented, cost-effective alternatives to psychiatric
These voluntary centers provide hope, trust,
person-centered treatment, and interpersonal connection from the outset.
Unlike involuntary hospitalization, which
disconnects and disempowers the individual, these centers start people with
psychiatric disabilities on their road to recovery at one-third to one-fifth
of the cost.
There are many different types of peer-run
alternatives to psychiatric hospitalization. Successful peer-run respites
are currently operating in New Hampshire, Maine, New York, West Virginia,
Ohio, and Georgia, and more are being created in New Mexico, Vermont,
Nebraska, Massachusetts and Arizona.
To learn more about mental health peer-operated
crisis alternatives, and to view a directory of crisis alternatives currently in
operation and learn about the growing evidence base to support these programs,
please visit http://www.power2u.org/peer-run-crisis-alternatives.html
NCMHCSO welcomes the opportunity to have a balanced public dialogue on the issue
of force and coercion in mental health treatment. The more the public becomes
aware that alternatives to force and coercion work, the more the public will
support policy changes leading to a recovery-oriented system.