The article by de Jong et al1 in this issue of JAMA Psychiatry raises fundamental questions about the practice of psychiatry. In essence, the review finds that advance statements can reduce the occurrence of compulsory admissions by approximately one-quarter, while community treatment orders, medication compliance enhancement, and integrated treatment measures were ineffective in reducing compulsory admissions. Why is this issue important? Writing in On Liberty, John Stuart Mill differentiated between liberty as the freedom to act and liberty as the absence of coercion. Yet, it is clear that in most countries of the world (whether codified and regulated by law or not) measures to treat people with mental illness on a basis of compulsory admissions are used and are sometimes commonly used. Within the psychiatric profession, there has been an uneasy elision between the duty to care for patients and the responsibility to act for society, on whose behalf physicians often use compulsory admissions (eg, to protect the public from risk by people who are mentally unwell). Various wording has been used to try to reconcile these separate and often contradictory roles, such as the provision of the “least restrictive alternative” form of treatment by the physician.
Thornicroft G, Henderson C. Joint Decision Making and Reduced Need for Compulsory Psychiatric Admission. JAMA Psychiatry. 2016;73(7):647-648. doi:10.1001/jamapsychiatry.2016.0571