“Coercion Is Not Care”: The Movement to End Force in Mental Health

“Coercion Is Not Care”: The Movement to End Force in Mental Health

A powerful international movement, often encapsulated by the rallying cry “Coercion Is Not Care,” is fundamentally challenging one of the oldest and most damaging practices in the mental health system: the use of force. This movement, driven by human rights advocates, individuals with lived experience, and progressive clinicians, demands that mental health services transition from relying on restrictive measures to adopting interventions grounded in consent, trust, and human dignity.

The Trauma of Coercion

Coercive practices, such as involuntary hospitalization, forced medication, mechanical restraints, and seclusion, are unfortunately still common in mental healthcare globally. While often justified by providers as necessary for safety or in the patient’s best interest (paternalism), these interventions are increasingly recognized as ethically problematic because they directly violate an individual’s autonomy.

Crucially, coercion is a subjective experience; it is defined by how the recipient perceives the provider’s actions. For many, these practices are experienced as dehumanizing, punitive, and deeply traumatic. The concern is that high levels of perceived coercion drive individuals, whose connection to the system is often fragile, out of services, deterring them from seeking help in the future.

From Moral Dilemma to International Mandate

The use of coercion has been a serious dilemma in mental health services since at least the 18th century. However, there is now a strong international momentum to move away from these practices.

This commitment is evidenced by the Council of Europe, which recently adopted a resolution calling for national governments “to immediately start to transition to the abolition of coercive methods in mental health settings“. This shift represents a zero-tolerance policy for unacceptable practices by healthcare providers.

The core ethical argument is the need for a prima facie ban on coercion in mental healthcare, asserting that the presupposition of limited autonomy due to mental illness cannot automatically justify the use of force. Instead, the Principle of Least Coercive Care must be adopted, meaning any intervention must be proven to be the least restrictive means available to avert potential harm.

Alternatives: Building Care on Trust and Collaboration

The “Coercion Is Not Care” movement is not simply about what to stop doing; it is intensely focused on what to start doing. The alternatives prioritize recovery-oriented care, human rights, and trauma-informed support.

Proven alternatives to coercion include:

Advance Planning: Tools like Joint Crisis Plans or advance directives allow a person to make decisions about their treatment preferences and support needs before a crisis, maximizing their control and respect for their will when they may be distressed.
Open Dialogue: This community-based approach emphasizes support in a person’s home and community and focuses on transparency, empathy, and an equal hearing of all voices to avoid hospitalization and coercion.
Peer-Led Initiatives: Crisis respite houses and peer support programs, run by individuals with lived experience, significantly reduce hospital admissions and emergency service usage by providing non-clinical, empathetic support and social connection.
Supported Decision-Making: This shifts the professional role from making decisions for the individual to strengthening the individual’s right to self-determination and capacity to make their own choices.

The message is clear: an effective and long-lasting change requires a recovery-oriented system of care where respect for human rights and service user involvement are not just requirements, but are actively realized through sound pathways to non-coercive care.