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Compulsion and freedom 

Compulsion and freedom
Chapter:
Compulsion and freedom
Author(s):

Tom Burns

, and Mike Firn

DOI:
10.1093/med/9780198754237.003.0008
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date: 19 August 2019

Outreach is particularly needed for patients with limited insight into their need for treatment. This chapter examines the concept of insight and the practices used to support it and to ensure treatment despite its limitations. Balancing individual liberty and recovery against the need for effective treatment is a constant challenge for outreach workers. Internationally, levels of compulsion are increasing. Compulsion has expanded beyond the hospital into the community despite the absence of evidence that such community treatment orders (CTOs) have any significant benefits for patients. Different forms of informal coercion, including leverage, are described along with practices to protect the therapeutic relationship when compulsion has to be used. The power imbalance in the therapeutic relationship is explored and the risks for unwitting abuse noted.

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