Treatment pressures and ‘coercion’

In this chapter, compulsion is presented in a broader context of ‘treatment pressures’. A hierarchy of pressures is presented, each increment moving in a more coercive direction. It comprises persuasion; interpersonal leverage; inducements; threats; and compulsion. The last has been dealt with in previous chapters. The distinction between inducements and threats turns on whether rejecting a conditional proposal—if you do X, I will do Y; if you don’t, I will do Z—results in the subject being ‘worse off’ or not according to a ‘moral baseline’. Threats involve proposals making the person worse off and represent ‘coercion’; inducements, where rejection does not make the person worse off, do not. However, in the context of mental health care, inducements can be problematic. While threats, often covert, are very common in mental health care, they are considered unethical. Perhaps, if regulated, they could have a place. Justifications, across the board, can follow a ‘capacity–will and preferences’ approach.