“The Ethics of Coercion in Mental Healthcare: The Role of Structural Racism” by Faissner and Braun (2024)
- rajaduttamd
- Jul 28, 2025
- 1 min read
🧠 The Ethics of Coercion in Mental Healthcare: Structural Racism in Focus
Core Thesis: Traditional ethical frameworks used to justify coercion in mental healthcare overlook the impact of structural racism, potentially leading to unjust applications of force.
Case Illustration: A fictional scenario of David, a young Black man with psychosis, is used to highlight how bias and systemic racism can influence perceptions of dangerousness and decisions to use coercion.
Standard Ethical Justifications for Coercion:
Must be effective in preventing harm.
Must be the least restrictive option.
Must be proportionate to the potential risk.
Key Critique – Proportionality at Risk:
Overestimation of Danger: Racial and gender stereotypes may inflate perceptions of threat from Black service users.
Underestimation of Harm: The psychological trauma caused by coercive measures is often downplayed in racialised individuals, especially those with prior experiences of discrimination.
Proposal – A Safeguard Question:
“Considering the service user’s intersectional identity, is it possible that danger was overestimated or harm underestimated?”
If yes, the proportionality assessment should be reconsidered.
Second Critique – Ethical Blind Spots in Context:
Even if coercion meets ethical criteria, it can still compound prior injustices (e.g., racist treatment leading to anger which triggers restraint).
The use of coercion in such cases engages with and worsens pre-existing discrimination—an act of compounding injustice.
Moral Dilemma for Providers:
Conflict between duty to prevent harm and duty not to compound injustice.
Authors argue the duty to avoid compounding structural racism is as morally weighty as harm prevention.
Conclusion & Call to Action:
Ethical evaluations of coercion must be expanded beyond immediate clinical interactions to include social and structural factors.
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