"They Had to Catch Me Like an Animal": Exploring Experiences of Involuntary Care for People with Psychosocial Conditions in South Africa.

Abstract

Protecting the rights of people with psychosocial conditions is an important and controversial global aim, particularly in light of multiple calls for reduced coercion catalyzed by General Comment 1 of the United Nations Committee on the Rights of Persons with Disabilities, which stipulates the replacement of substituted care with supported care. Responding to this and other global calls for reduced coercion is complex globally but can entail particular challenges in developing countries, where resource shortages and environmental barriers are sometimes a significant factor in how people with mental conditions experience involuntary care and encounter limitations to their autonomy. To better understand these complexities, our study explored experiences of involuntary care among people with psychosocial conditions in South Africa. Participants described varying degrees of coercion within involuntary care and found that different approaches from professionals when they were in crisis significantly impacted their illness experience, including their ability to make decisions and feel dignified. Participants' reports include variable feelings and embodied experiences of coercion in different forms and degrees, ambivalence about compliance and resistance while being treated against their will, and gray areas between conventional separations of autonomy and paternalism. On the whole, our analysis troubles binaries about the use or disuse of involuntary care and illustrates the complexity of participants' experiences and views of coercive intervention, which could hold multiple possibilities for both care and autonomy.