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Tijdschrift voor Psychiatrie 50 (2008) 3, 149 - 158

Review article

When is psychosis dangerous? Ethical, professional en juridical considerations concerning psychosis and coercion in Belgium

A. Verbrugghe, H. Nys, J. Vandenberghe

In Belgium a patient can only be compulsorily admitted to a psychiatric hospital if he is a danger to himself or others (law concerning coercion in Belgium, 26/06/1990).
aim To explore the relationship between psychosis and danger, and to analyse the various interpretations of the 'dangerousness' criterion in the context of psychotic disorders and the underlying ethical positions.
method We studied the literature by means of PubMed, Psycinfo, manuals and references and used the search terms: 'coercion', 'commitment of mentally ill', 'dangerous behaviour', and 'psychotic disorders'.
results The correlation between psychosis and danger is limited but is strengthened by comorbid substance abuse and non-compliance. The clinical assessment of danger does not have a firm scientific basis. The underlying ethical position determines when danger is regarded as being serious enough to justify coercion.
conclusion Danger is a problematical criterion for coercion. We propose a model that weighs up the likelihood of danger against the expected pros and contras of coercion and the extent to which the disorder can be treated. The fluid nature of the 'dangerousness' criterion and the principle of proportionality call for a more varied arsenal of coercive measures which are less drastic than compulsory admission.


keywords Coercion, commitment of mentally ill, dangerous behaviour, psychotic disorders