1. Workstream I — Well-being, security and coercion in general psychiatry

    In situations where people with mental disorders pose a substantial risk to themselves or others, they can, under certain legal conditions, be hospitalized and treated against their natural will in Germany and many other countries. When deciding whether to use coercive measures, various values are weighed against each other: the patient’s right to self-determination, their well-being, and the safety of the patient and third parties. In our project, we work with a broad definition of coercion, which also includes so-called informal coercion or psychological pressure. This involves using various communicative means, such as persuasion, interpersonal leverage, offers or threats, in an attempt to obtain the consent of those affected.

    This raises important conceptual and ethical as well as empirical questions, which are examined in more detail in various work packages in this project area:

    - In line with the methodological approach of the SALUS project, we start ‘bottom up’ by investigating the attitudes of different stakeholders towards coercion. The attitudes of people with mental disorders, their relatives, psychiatric professionals and the general population will be determined through both qualitative and quantitative methods.

    - Despite the central role of well-being in the justification of coercive measures, professionals and those people affected often have different perspectives on what is meant by the term ‘well-being’. In one subproject, we develop a concept of well-being that considers both subjective and objective aspects.

    - Risk assessment procedures have been developed to support psychiatric professionals in balancing self-determination and safety. We examine, inter alia, the justifiability of such safety-related considerations.

    - The concept and norms of coercion will be further analysed. Although basic philosophical approaches have proven fruitful in the analysis, psychiatry-specific requirements are often not adequately addressed in these approaches.