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SO436

The ethical limits of coercion in modern psychiatry

THE ETHICAL LIMITS OF COERCION IN MODERN PSYCHIATRY

Coercion is not a routine clinical tool but an exceptional intervention subject to the criteria of necessity, proportionality, and the least restrictive alternative, and the substantial cross-national variation in its use cannot be explained by differences in legislation.

The study aims to examine how coercion is used in psychiatry, what predicts it, and what reduces it. Coercion creates an ongoing tension between respect for autonomy, clinical benefit, and the duty to prevent harm; while involuntary admission and compulsory treatment are widely used, human rights frameworks increasingly challenge the traditional justifications for these practices. The study employed a structured review covering the period from 2015 to 2025; according to the abstract, PubMed and Scopus were searched, PRISMA criteria were followed, and approximately 40 studies were assessed for qualitative synthesis. The findings indicate that rates of involuntary hospital admission across 22 countries range from 14.5 to 282 per 100,000 people, representing an approximately 20-fold difference; involuntary admissions account for 3% to 22% of all psychiatric admission episodes, and this variability cannot be explained by differences in legislation. Factors associated with an increased likelihood of coercion include psychosis, previous involuntary admission, bipolar disorder, male sex, unemployment, and being unmarried, whereas depression is associated with a lower likelihood. Practices that reduce coercion include advance statements and crisis plans, while community treatment orders have shown no such effect. Necessity, proportionality, and the least restrictive alternative are central criteria in justifying coercion. The authors state that coercion is an exceptional intervention requiring stringent safeguards, that its use varies not only with legislation but also with service structure and social context, and that the ethical goal is not to implement coercion safely but to progressively render it unnecessary.

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