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APHA Scientific Session and Event Listing

Recorded presentation

Glenn Currier, MD, MPH¹, John F. Crilly, PhD, MPH, MSW¹, and Virginia Aldige-Hiday, PhD². (1) Psychiatry, University of Rochester, 300 Crittenden Boulevard, Box PSYCH, Rochester, NY 14642, 585-275-0611, glenn_currier@urmc.rochester.edu, (2) Sociology and Anthropology, North Carolina State University, Dept. of Sociology, Raleigh, NC 27695

Psychiatric emergency departments and acute inpatient units are treatment settings which require a range of assertive therapeutic intervention options. The level of a client's unwillingness to engage in treatment when there is risk to safety of self or others can influence the use of assertive or coercive interventions to achieve both safety and at least minimal engagement in treatment. Such interventions may include emergency administration of medications for acute agitation or involuntary hospitalization. Although these interventions are clinically necessary under defined conditions and have beneficial effects, they contain coercive elements and have developed pejorative connotations in the literature. The boundaries which separate coercion and assertive treatment interventions become strained in the complex environment of today's emergency and acute inpatient services. Providers operate under the pressure of competing demands to use certain types of potentially coercive actions with patients under mandatory outpatient treatment orders, court-ordered mental health treatment, or probation conditions requiring treatment compliance. This presentation will focus on the complex issues around necessary assertive treatment in this difficult treatment setting, particularly those occurring at the intersection of the criminal justice and mental health systems. Discussion will be aided by the important context of the Expert Consensus Guidelines on the Treatment of Behavioral Emergencies as a means to better describe the differences between coercive actions and necessary assertive treatment.

Learning Objectives:

• This session will provide the attendee with a discussion around the differences between coercion and the necessary and beneficial therapeutic interventions for difficult to reach consumers.

Keywords: Mental Health Care, Emergency Department/Room

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation