Recent clinical practice guidelines on schizophrenia remain largely silent on the role of coercion in psychiatric care

Recent Australian and New Zealand clinical practice guidelines for schizophrenia demonstrate important methodological advances, including use of the Grading of Recommendations, Assessment, Development, and Evaluations framework and early involvement of people with lived experience. However, these guidelines remain largely silent on the role of coercion in psychiatric care, despite its prevalence and potential for harm. People diagnosed with schizophrenia experience disproportionately high rates of compulsory interventions—including community treatment orders, involuntary admission, seclusion, and restraint—many of which lack robust evidence of effectiveness. Community treatment orders, the most common form of coercion, show wide and unexplained variation in use across jurisdictions and are disproportionately applied to First Nations people, culturally and linguistically diverse populations, and individuals from socioeconomically disadvantaged areas. Evidence of effectiveness is limited, particularly in more robust controlled designs that have used matching, randomisation, or multivariate analyses to adjust for confounding, while adverse outcomes such as coercion, disempowerment, and disengagement remain under-researched. Similar concerns apply to involuntary admission and other restrictive practices, where evidence of therapeutic benefit is mixed and harms—including trauma and fear—are well documented. Despite this, the latest clinical practice guidelines devote minimal attention to these issues, with potential harms mentioned only briefly and without substantive guidance on minimising coercion. Future iterations of schizophrenia clinical practice guidelines would be strengthened by explicit appraisal of the evidence on coercive practices, systematic consideration of their harms, and incorporation of lived-experience perspectives on the use of coercion, thereby better supporting clinicians and policymakers in delivering care that balances effectiveness, safety, equity, and respect for autonomy.