More pressure, more release? When compulsory care fails: an autonomy-supportive treatment policy as an alternative to failed compulsory care in inpatient care for youth with anorexia nervosa

Abstract

Introduction: Anorexia nervosa (AN) in young people is, in its most severe form, a life-threatening problem for which compulsory care may be indicated. In The Netherlands, this compulsory care takes place in closed crisis departments for child and adolescent psychiatry. At the same time, the provision of compulsory care within the context of a closed ward has limitations and unintended adverse effects and is colored by ethical dilemmas. Because of the scenario described above, an alternative treatment policy, which can be embedded systemically within relationality and ethically within a care framework, is proposed and is aimed at promoting autonomy.Methods: This study consists of two parts, where in part one both policies are described and in part two qualitative interviews with two youths were held.Results: The results indicate that the youths’ experiences point to reflections on recovery, intrusiveness, traumatization, and resistance regarding the coercive elements within compulsory care. Finally, recommendations on how to professionalize compulsory care, if any, are given by youths with severe AN.Discussion: The practical and clinical relevance of our results are that an alternative to compulsory care is possible and feasible. The scientific implications are that treatment rationales and treatment policies in compulsory care for AN are dominantly rooted in positivistic, linear modes of thinking. In a mixed-methods perspective, we argue how positivistic and constructionist approaches can be integrated to improve the overall quality of care for youths with severe AN.