The United Nations Convention on the Rights of the Child states that adolescents’ involvement in their own healthcare is a fundamental right. Collaboration in treatment is not only important for treatment outcomes, but also for young people’s social and emotional development. Growing in autonomy is a central part of adolescence that should be reflected in different aspects of their daily lives.
Collaborative treatment helps young people feel heard, understood, and considered as a person, not a ‘patient’. It builds trust between teenagers, mental health professionals, and parents. It encourages young people to stay in treatment and receive treatment again if it’s necessary.
On the other hand, involuntary treatment can dismantle this trust and may even be experienced as traumatic by a young person.
This doesn’t mean that involuntary treatment is never required and justified. If a teenager’s decisions put their safety at risk, it can sometimes be the only option. But involuntary treatment should always be considered a last resort, and we should take steps to find collaborative alternatives wherever possible.
This blog explores some of the harms caused by involuntary treatment, as well as the challenges that can arise when teenagers refuse help. It looks into ways that parents, clinicians, and mental health services can encourage teen self-engagement and collaborate towards wellness.
Why Should We Avoid Coercion and Involuntary Treatment?
When a young person is facing challenges in their mental health, parents often feel anxious and distressed. They may want to use all tools and resources available to help their child feel better, and professional treatment is the most important of all these tools. When a young person doesn’t want to accept treatment, it may be tempting to coerce them to participate in a program against their will.
This might seem like the quickest way for them to feel better.
However, there are several widely accepted problems with involuntary treatment that can harm a young person’s well-being and long-term recovery. Some of these include:
- Involuntary treatment or coerced treatment can be harmful, and even traumatic, for a young person. It can trigger feelings of shame and guilt that exacerbate mental health symptoms.
- Involuntary treatment is usually evaluated negatively by young people, clinicians, and relatives.
- It’s not clear how effective involuntary treatment is in the long term.
- Involuntary treatment can harm a teenager’s trust in medical staff and other people who were involved in the treatment process. It may affect their willingness to ask for help in the future or to build meaningful and trusting therapeutic relationships with mental health professionals. This can seriously impact their recovery, where trusted relationships with therapists are key to building self-worth, seeing new perspectives, and learning skills.
- A study found that ¾ of young people said that involuntary treatment impacted their trust in medical staff. Some were unwilling to share their thoughts and feelings even when they felt suicidal.
The reality of mental health disorders is that, sometimes, young people are not able to keep themselves safe. When young people are at risk of seriously harming themselves, coercion may be necessary. But this doesn’t mean involuntary treatment should simply be accepted as an outcome. As parents and clinicians, we should strive to reduce the need for coercion wherever possible, collaborating to develop treatment plans that young people trust and want to engage in.
Involuntary Treatment for Anorexia Nervosa
Some mental health disorders are more associated with a reluctance to receive treatment than others. This may have to do with the symptoms or consequences of a condition. For example, traits like low self-esteem, shame, or mistrust of others may be barriers to seeking help.
Young people with anorexia nervosa are often resistant to treatment. They may refuse to receive treatment, try to delay it, or leave treatment early. Specific features of the disorder, such as impaired cognitive decision-making processes caused by malnutrition, contribute to these decisions.
However, treating anorexia nervosa early, especially in the first three years of the disorder, is important. Early intervention is associated with significantly better outcomes, before co-occurring disorders develop which can complicate the treatment process. Almost all of the harm caused by anorexia nervosa can be reversed with early treatment.
This means that encouraging young people to participate in treatment is fundamental, while avoiding coercion wherever possible.
From a clinician’s perspective, managing compliance with treatment is often a key aspect of the recovery process of anorexia. It’s normal for young people with anorexia nervosa to change their approach towards receiving support, sometimes engaging in treatment and other times resisting it. This means that collaborating with young people to build and maintain trust, understand their needs, and adapt treatment plans to make them more accessible is an ongoing part of the treatment management.
Avoiding Coercion: Offering Engaging Treatment and Maintaining Trust
When we talk about collaborative treatment, we have to offer treatment options that young people want to engage in. This includes some more obvious steps, such as ensuring that treatment isn’t punitive, stigmatising, or judgmental. With respect to residential treatment, it might mean enabling young people to maintain contact with family members and friends, and creating treatment environments which are focused on providing enriching experiences as well as clinical care.
A review collecting adolescents’ persepectives on self-engagment in treatment identified several factors that were important to young people. These include:
- Being included in decision-making processes about their treatment
- Being recognised as experts in their own experience
- Being listened to and taken seriously
- Receiving clear and detailed information about their treatment
- Warm, welcoming, safe, and comfortable physical environments
- Daily structure and a choice of different activities
Building and Maintaining Trust
Building and maintaining trust between young people, parents, and clinicians is fundamental to collaborative treatment. Building trust involves a readiness to listen to and understand a young person’s experience. It requires understanding a teenager’s needs and responding to them. It means providing accurate information and realistic expectations, and following through on plans that are made.
Collaboration itself also helps to build and maintain trust. When young people have a say in their treatment, they know that their needs are heard and considered, and that they are valued and respected as individuals.
On the other hand, coercing teenagers into accepting treatment can dismantle this trust. Coercion doesn’t only mean involuntary treatment, which may involve a court order. It can involve strategies that push adolescents to make certain decisions, such as emotional manipulation or ‘punishments’ for not engaging in treatment. In the long term, these strategies make it less likely that teenagers will willingly participate in treatment.
Collaborating As Parents or Caregivers
Both mental health professionals and parents or caregivers play a role in collaborating towards wellness. Between professionals and adolescents, collaboration may centre around communication, sharing of information, and active involvement in treatment decision-making. Parents and carers can also support this process by listening to a young person, offering validation, and supporting them in making decisions.
But parents’ involvement often begins before a teenager even meets a mental health professional. Through open discussions and collaboration, parents can encourage young people to receive professional support in the first place, even when they may be reluctant to accept help. Or they might support them to stay in treatment or start treatment again at a later date.
If a teenager is reluctant to begin treatment, there are a few things parents might want to consider.
Focusing on their Priorities
Sometimes, teenagers with mental health disorders can find it hard to imagine feeling better. They may also think that their mental health symptoms are part of their identity and a part of who they are. This can make them resistant to receiving help.
If your teen is feeling this way, it can help to speak with them about their priorities and what they can gain from treatment. These might be things like having more energy to play football, or being more relaxed around friends. Focusing on their priorities can help teenagers develop a sense of agency in their experiences, actions, and decisions.
Involving the Family
Sometimes, teenagers can feel blamed or judged for their experiences when parents suggest they seek support. This might make them act defensively and refuse to accept help.
In these cases, it can help to participate in interventions for the whole family, such as family therapy, alongside individual support. Families can play a huge role in a teenager’s recovery, but often require support to understand the best ways to support a young person.
Family therapy helps families to restructure and develop skills that facilitate and nurture every family member’s mental health. This approach also prevents teenagers from feeling singled out or labelled as a ‘problem’.
Research has found that family-level engagement interventions make it more likely that young people will initially attend mental health services.
Exploring Different Alternatives
There is a range of treatment approaches available that can support teens with mental health disorders. Each treatment approach can be delivered by different therapists and clinicians, each with their own personality and characteristics. It’s normal for teenagers to work better with some therapists than others, and respond to some treatment approaches more than others.
It can help to speak with your teen about all the different options available and what might suit them best. If they don’t feel a good connection with one therapist, you can try another. If an approach doesn’t seem to be working in general, you can explore other treatment modalities. Before starting therapy, it can help to choose a few different therapists to try before deciding on one to continue.
Finally, it’s important not to give up. Even if your child says no at first, keep having open conversations where you listen to your teen and try to understand what they need. You might also want to seek advice from a mental health professional about what to do next.
The Wave Clinic: Making a Difference in the Lives of Young People
The Wave Clinic offers specialist mental health support for young people and families. Our residential programs combine exceptional clinical care with education, enriching experiences, and community building, supporting young people to develop life skills and lasting friendships as they recover from mental health concerns. We break away from traditional models of therapeutic boarding, focusing on building self-confidence, self-love, and a sense of belonging.
We also offer outpatient care with a diverse selection of evidence-based modalities. This includes parenting and family intensives that combine the lessons of several months of therapy into a few days or weeks.
If you’re interested in finding out more about our programs, get in touch today.
