Compulsion and freedom in community mental healthcare

In recent decades, there have been changes in the nature and delivery of mental healthcare, with the majority of patients now being cared for in the community. New legislation, currently being enacted in England and Wales, will give clinicians the power to compel patients to comply with community treatment. These changes in law and service delivery have led to debate about the extent to which treatment pressures should be used to limit patients' freedom in the community. This contribution outlines recent changes in mental health services and describes how different pressures are used in clinical practice to impose treatment in the community. It summarizes current legislation allowing for compulsory community treatment, provides an overview of new amendments to mental health laws in England and Wales, and explores why balancing compulsion and freedom in the community is such a contested issue. © 2007 Elsevier Ltd. All rights reserved