Ulysses Coercion Through Psychiatric Advanced Directives in Homeless People With Substance Use Disorder: A Qualitative Study of the Colombian Perspective

Abstract

Homeless substance users (HSUs) represent a public health challenge given their high social impact and the numerous barriers they have to overcome to receivemental health treatment. Recent public debate in Colombia is concerned with how to approach HSUs within the health system. The aim of this publication was to explore the possibility of implementing Psychiatric Advance Directives (PADs) in HSUs as an alternative to coercive treatment, to favor substance abuse treatment adherence and service retention in this population. For this purpose, the authors conducted 3 in-depth interviews of individuals who previously experienced homelessness and were voluntarily admitted to an inpatient substance abuse treatment ward at the moment of the interview. This research indicates that substance abuse in homeless individuals does not imply an impairment of their mental or legal capacity. Moreover, restraining HSUs during intense craving episodes within inpatient settings by implementation of PAD does not seem to be a viable option given the multiple risks and challenges it poses to mental health care providers. Finally, the use of any coercivemeasure towardHSUs, and this type of PADs in particular, could potentially be associated with violent episodes or human rights violations within mental health institutions.