Abstract
Compulsory admissions to mental health rehabilitation wards are not uncommon. The aim of this paper is to reflect on current practice and discuss whether compulsory admission for psychiatric rehabilitation is justifiable and what impact involuntary rehabilitation has on a patient's recovery. Mental health legislation allows clinicians to treat people with acute psychiatric conditions that would otherwise remain untreated. However, admission for psychiatric rehabilitation usually does not warrant the use of mental health legislation. Based on my personal experience working with a rehabilitation team, we aim for a voluntary admission for our patients that can facilitate their journey to recovery and preserve their autonomy.
Although most of our patients have a chronic illness, which is resistant to treatment with residual psychotic symptoms and cognitive deficits, they are still capable of setting goals and making decisions about their future. Hence, maintaining personal control throughout the rehabilitation process rather than using traditional notions of their incapability of making decisions is the key approach in their recovery. During patients' voluntary rehabilitation admission we facilitate their choice, control and personal responsibilities. These are the fundamental factors in developing recovery-orientated practice [1]. We are often rightly concerned that these factors can be compromised when an individual with mental health issues is compelled to be admitted involuntarily onto a rehabilitation unit. Under such circumstances choices may be very limited initially at the time of compulsory admission and patients may regard this process coercive. But the therapeutic purpose of compulsion and treating people against their will is to gain the gradual handing back of choice and enable them to resume their responsibilities [2]. Hence consideration of a compulsory admission as a pathway to recovery is acceptable when a patient is unwell, at risk of self neglect, non-adherence to medication, substance abuse or behavioural problems, and lacks mental capacity. Under such circumstances clinicians have a duty of care to act in the best interest of the patient and consider compulsory admission. Irrespective of the legal status, an individual choice and collaboration is central to recovery. Evidence shows that enabling choice for patients and carers allows them to take more responsibility for the patient's care and to enjoy an open relationship with the treating team [3].
In conclusion, to assist people with mental health issues in engaging in the recovery process, they should be allowed to exercise their rights for the least restrictive option of staying in hospital. However, a balance must be struck between affirming the rights of individuals and their need for treatment while ensuring that decisions are made competently, safely and in the best interest of individuals. Even under the guide of professionals, the focus of rehabilitation services should reflect the preferences of patients and their carers.