The ethics of mandated inpatient mental healthcare: the consumer perspective

Background: Although mandated inpatient mental healthcare is initiated on a therapeutic premise, consumers’ autonomy, safety and recovery are often compromised. Mandated inpatient mental healthcare is ethically complex and the therapeutic basis of inpatient mental healthcare must be clearly established. Research aim: The aim of this study is to understand the perspectives of consumers in relation to the ethical merits and demerits of mandated inpatient mental healthcare. Research design: This study was a qualitative descriptive study, involving semi-structured interviews with 12 consumers. The data were analysed using reflexive thematic analysis, whereby significant themes were constructed and reported with supporting quotes. Participants and research context: Participants were adults who had experienced involuntary inpatient mental healthcare. Participants were recruited from social media special interest groups. Ethical considerations: Free and fully informed consent was sought from all participants. This study was approved by a university human research ethics committee. Findings: Mandated inpatient mental healthcare was regarded as ethical to the extent that it ensured safety in circumstances that could not be managed without mandated intervention. However, the perceived ethical merit of mandated care was challenged by recurring violence and unwanted sexual interactions, as reported by the participants of this study. Furthermore, mandated inpatient mental healthcare involved the routine and unnecessary suspension of participants’ autonomy, without regard for their preferences or individual needs. Conclusions: Mandated inpatient mental healthcare is ethical to the extent that it is necessary for ensuring therapeutic outcomes. However, the hazardous environment and incursions to autonomy described by participants compromise perceived ethical integrity. This study demonstrates the necessity of a clear therapeutic basis for all aspects of mandated inpatient mental healthcare, and that greater consideration for consumer safety and autonomy is needed.