Coercive measures in psychiatry: consensus and controversy in Swiss professional discourse

Introduction Coercive measures, such as involuntary admission, treatment without consent and mechanical restraint, are among the most ethically contentious practices in psychiatry. In Switzerland, several influential position papers and guidelines articulating different professional, ethical and policy perspectives on the use and prevention of coercion have been published in recent years. Objective This review aims to provide a comparative analysis of five key Swiss documents addressing coercive measures in psychiatry, focusing on their formal characteristics, thematic priorities and underlying normative assumptions. Methods A narrative review was conducted aiming to synthesize ethical, legal and clinical perspectives on coercive measures in psychiatry, with particular focus on Swiss position papers emphasizing legal and ethical frameworks. The review included documents discussing involuntary admission, forced medication, seclusion, and restraint, as well as broader ethical analyses of coercion. Five documents published between 2014 and 2025 by various professional and stakeholder organizations were analyzed in terms of their formal structure, key recommendations and framing of coercion. Results A broad consensus exists across all documents regarding the ethical problem of coercion, the importance of prevention and the prioritization of voluntary treatment. However, significant differences emerged with respect to normative goals (reduction vs. abolition of coercion), attribution of responsibility (procedural safeguards vs. relational practice vs. systemic reform), interpretation of clinical risk and security logics, and framing of coercion as exceptional necessity, professional failure or systemic symptom. Conclusions The current Swiss debate among professionals on coercive measures is characterized less by empirical disagreement than by different normative and discursive rationalities. Future developments may benefit from integrating procedural and legal safeguards with preventive, relational, outcome-oriented and systemic approaches aimed at reducing coercion.