IT'S TIME TO END FORCED TREATMENT | Behavioral Healthcare Executive Skip to content Skip to navigation


December 1, 2006
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People will experience true recovery when treatment isn't forced upon them

The concept of recovery has been around long enough now that most of us have had a chance to consider it and agree (in some cases, grudgingly) that it's a real probability. As we've shifted our perspective toward recovery, and moved our expectations beyond the mere hope for stabilization and maintenance, we've challenged ourselves to reexamine policies, procedures, and our own personal beliefs about the limitations we've placed on the human spirit to heal.

Once we've come face-to-face with this challenge, we each move to new ground in one of two ways—embracing or resisting. For some of us, the embracers, this has been a moment of validation that confirms what we've suspected all along. We embrace the opportunity to open new doors for our organizations, employees, and the people we serve. We are rewarded by seeing amazing outcomes and results that we previously thought impossible.

For others, the resisters, this shift has been difficult. They have had trouble letting go of what they assumed was absolute truth. They have resisted change by reciting numerous past experiences they have had with people who showed little evidence of recovering. As polarized as these two parties seem to be, there is one issue that continues to unite them, regardless of party affiliation (embracers or resisters): forced or involuntary treatment (people held against their will in hospital or short-term crisis settings, medicated against their will, physically restrained, court ordered to attend treatment, etc.).

No matter how much some of us embrace the concept of recovery, we hang on, knuckles white, joints aching, to this last remnant of our disbelief, which represents the doubts and fears that got us into this unfortunate position to begin with. Beyond doubts and fears, the glue that seems to hold these attitudes together is the simple matter of convenience and the seductive, but misleading, concept of efficiency.

First, we doubt our own ability to solve problems in ways that promote, instead of interfere with, a person's recovery. Along with this, we doubt the person's ability to learn and grow. Our fears about our own lack of skill paralyze us, and we begin to be afraid of the people we are trying to serve. We try to relieve our doubts and fears by quickly moving into “efficiency mode” and bringing an end to our discomfort by forcing an outcome, usually by means of involuntary treatment, that we think is best for us and for the person being served.

Trouble is, while forcing an outcome provides immediate relief for us, it creates a more intense level of pain and trauma for the person being served. So let's take the concept of efficiency off the table right now, because involuntary treatment is anything but efficient, as it only causes more problems that a person has to try and recover from.

There appears to be little training and supervision that teach, demonstrate, and reinforce the use of expert help in lieu of forced or involuntary treatment. Instead, staff often are misguidedly trained to think that they can and must control people and that is, in fact, their jobs' “bottom line.”

Not long ago, a children and adolescents residential program asked Dr. Ashcraft for consultation. As she was waiting for a door to be unlocked, she overheard a staff member immodestly say to another, “I got to do my first takedown today.” This conversation did not illustrate a relationship that promotes recovery, but rather one that illustrates the perversion of power in lieu of an authentic healing relationship.

Consider some recent reflections by Dr. Anthony:

Force has become the easy alternative to expert helping…. [T]he conditions that generate forced treatment are easily trumped by our seeming indifference to the massive use of force in the mental health culture…. The point is that we need to redouble our efforts to practice alternatives to forced treatment…. Let us commit to figuring out how to stop our mindless use of force. Let us use our best minds…to find ways to extricate our field from being society's purveyor of force.1

We all need to rise to this challenge regardless of our status as embracers or resisters. We have talked to people who have experienced expert helping rather than force in situations in which force might otherwise have been applied. They have provided the following stories on how we can rise to a more skilled level of treatment, using professional skills and authentic relationships to promote recovery.

Here's what Ed had to say:

I was taken to the hospital by the police, and it was a very unfriendly ride. By the time I got there, I was feeling like a wild animal. I didn't want to be restrained again because that would prove that I was a wild animal.

Once they medicated me, I still felt like a wild animal, but a sleepy one. That night when I got in bed, my agitation outstripped my drowsiness, and I was ready to tear the place apart. The thought of being locked up overnight was more than I could take.

Then a nurse came in and just talked to me—not like I was a patient, but a human being. I started to feel more like a person. Then he asked if I'd like him to tuck me in. This is what my mom always did for me. I told him I'd really like that, so he pulled my blanket up and tucked in the edges. I was so moved by this that I quietly cried myself to sleep, but not as an animal—as a boy.

And here's what Courtney told us: