Involuntary Treatment Meeting Summary

Introduction

Involuntary interventions and coercion are among the most controversial practices engaged in by mental health practitioners. They evoke passionate advocacy and deep rifts in the closely-held beliefs of people who share a common desire to improve the quality of life of individuals with mental illnesses. The use of involuntary interventions has long been accepted by many as an unfortunate but necessary part of mental health care. However, others have fervently opposed their use.

In order to initiate a dialogue at the national level about involuntary interventions, the Center for Mental Health Services (CMHS) convened a series of three roundtable discussions in the early 1990's. These meetings broke new ground in directly addressing the issues and concerns of consumer/survivor/ex-patients who had been directly affected by involuntary interventions, as well as family members, psychiatrists, attorneys, and policymakers. A comprehensive report of the meetings is available from the Center for Psychiatric Rehabilitation at Boston University.

Most of the issues discussed then are still relevant half a decade later. New developments have also added to the complexity and urgency of the issues. For instance, managed care has become a significant force of change in private and public mental health care systems, and new questions have emerged about its impact on the use of involuntary interventions. Spending on community-based services nationwide recently surpassed institutional spending. Consumer-directed services have achieved greater importance in local mental health systems and may offer more accessible alternatives to hospitalization. Interest is growing in mediation and advance directives as tools to prevent the need for involuntary interventions. And there is still much to be learned about such basic issues as the frequency, duration, and type of involuntary interventions and coercive practices presently occurring across the country.

An important part of the mission of CMHS is fostering the independence and protecting the legal rights of people with mental illnesses. By definition, involuntary interventions and coercive practices interfere with the enjoyment of freedom and liberty by people with mental illnesses and CMHS has an interest in reducing the need for these practices in the delivery of mental health care nationwide.

To that end, CMHS convened a meeting in December 1997 of consumers, family members, psychiatrists, administrators, researchers, attorneys, and representatives of national mental health organizations. The purpose of the meeting was to elicit the diverse opinions and beliefs of a wide range of individuals and groups for CMHS's information, not to reach consensus or chart a course of action for CMHS. No attempt was made to assemble a group that would be representative of the views held by the public or even by critical stakeholders in the mental health field; rather, individuals were invited to articulate what they had learned about involuntary interventions and coercion through personal experience, clinical or legal practice, research, or advocacy. CMHS sought to obtain as many different views on the subject of involuntary intervention and coercion as possible, especially unconventional or less popularly-held beliefs.

The meeting objectives were described as follows by Bernard Arons, MD, Director of CMHS, in his opening remarks to the group:

to specify current issues, concerns, and questions about involuntary interventions and coercion;
to identify effective practices in reducing coercion and involuntary interventions and methods for disseminating effective practices; and
to generate recommendations for CMHS regarding knowledge dissemination, training, services demonstration, and research in this area.

This document is an executive summary of the December 1997 meeting. Its purpose is to capture the main points of the group's contributions toward these objectives without judgment or evaluation. It does not catalog every opinion or idea expressed at the two-day meeting.

This summary should be read with the understanding that no single statement represents the opinions of every meeting participant. No recommendation listed here should be construed to represent a consensus among those in attendance. An idea or proposal may have been expressed by only one person at the meeting, or reiterated by several. A minority of statements was presented as the findings of rigorous research studies, but most were opinions, theories, or proposals. The summary is organized around the three objectives of the meeting, with key points listed under each objective.

Attached is a complete list of participants.

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