Community psychiatric treatment under legal mandates: The international experience

During the last 30 years, new ways of legally mandating psychiatric treatment for patients living in the community have emerged. Changes to law and practice have occurred in various jurisdictions and cultures. The simultaneous introduction in a range of settings of new approaches to mandating community treatment suggests that there may be shared causes for these changes. This chapter reviews the experience of mandated community treatment in the United States, Australia, and the United Kingdom. For each of these countries, we examine the measures and prevalence of their use, the evidence for their effectiveness, and the most likely explanation of any differences between the results in their jurisdiction and experience elsewhere.

Patient experiences and perceptions of coercion: universal meaning, individual experiences?

This chapter presents a synthesis of major research themes and findings on patients’ subjective experiences and perceptions of coercion in community psychiatry. Covering the 20-year period from 1994 to 2014, it reviews studies of both formal (legislative) and informal (non-legislative) coercion, including patients’ experiences of mandated community treatment or community treatment orders (CTOs), assertive community treatment (ACT), and leverage. It begins by presenting four concepts that characterize patients’ perceptions: interventions, obligations, threats, and safety. It then reviews the contradictory evidence surrounding patients’ experiences of coercion, including patient comparisons of hospital and community coercion and the implications of coercion for self-determination, ‘normality’, care and services, and for wellness. It concludes by identifying gaps in the literature and recommending future research.