Psychiatric practice with “high risk” adolescents and their families: working with coercion, medication and hospitalization

We work in the public mental health sector in Australia, across two different settings: a specialist adolescent in-patient hospital setting; and an assertive community based team that aims to provide local treatment to children and adolescents and their families. In both settings, adolescents can come to clinical attention with problems such as suicidal behaviours, aggression and psychosis. There is often also significant psychosocial adversity and family disruption. It can be challenging to know how to apply collaborative and dialogical principles to these contexts, where there are social and institutional pressures that can seem to push teams toward adopting more coercive practices.