The need and feasibility of reducing coercion in mental health care is widely acknowledged. The discussion whether the goal is reducing or eliminating the use of coercive measures is a hot topic in professional and service user circles. Viewed in a human rights perspective one eventually would have to eliminate. The psychiatric community in a number of countries are now working to better understand, reduce and implement alternatives to coercion.
The United Nations Convention on the Rights of Persons with Disabilities as well as the guidance on community mental health services published by the World Health Organization (WHO) formulate clear goals for the future of psychiatry and psychosocial support. Innovative concepts of mental health care that focus on full participation, recovery-orientation and the prevention of coercion play an important role in achieving these goals.
At the recent 31st European Congress of Psychiatry that was held in Paris discussions were held on implementing and scientifically evaluating the effects of such models in mental health services. And the needs for these to be prioritized in national mental health planning and budgeting decisions.
In a presentation by Lieselotte Mahler, Medical Director and head of a Department of Psychiatry and Psychotherapy in Berlin and with the Charité University Hospital, Berlin it was noted that, “above all, coercive measures are an obvious encroachment into one’s personal rights.”
“They have negative consequences for all those affected, such as physical injury, worse outcome of the treatment, break in the therapeutic relationship, higher admission rates, higher risk of future coercive measures, psychological damage up to and including trauma,” she added.
Dr. Lieselotte Mahler pointed out that, “They are activities that run counter to the self-image of psychiatric professionals, mainly because they cannot be understood as therapeutic.”
The Chair of the discussion Prof. Michaela Amering from the Medical University of Vienna, Austria, commented on this stating that “I think many of us have experienced this feeling that this is not what we came in for – the psychiatric profession that we have – and that we have to be people who coercively treat other people.”
The past President of the European Psychiatric Association (EPA), Prof. Silvana Galderisi, who was the Co-Chair of the World Psychiatric Association’s (WPA) Taskforce and reference group on Minimizing Coercion in Mental Health Care presented data on implementing alternatives to coercion as a key component of improving mental health care. Prof. Galderisi, noted “Its really the least pleasant part of the job. This is sometimes really bringing quite a lot of pain to users, but also to us. So, it’s certainly a controversial practice.”
Prof. Silvana Galderisi clarified “coercive practices raise human rights concerns as it has been highlighted very, very well also in the other presentations, especially in the light of the Convention on the Rights of Persons with Disabilities (CRPD), which has a lot of good aspects, but really a lot of good aspects.”
“The CRPD asks Member States to view people with disabilities from the perspective of a bearer of human rights. How could it be different? I mean, this is something that when we read it, we say, but of course, I mean, what’s the point here? People with psychosocial disabilities or with a severe mental disorder – which is generally linked also to disability, not always, but many times – do they have less rights than other people? Of course not. They have the right to assert that. Their rights, will and preferences should always be respected,” Prof. Silvana Galderisi stressed.
The work of the WPA Taskforce and reference group on Minimizing Coercion in Mental Health Care and the various discussions and types of arguments were gone over. The final result of this work was a position statement of the World Psychiatric Association. Prof. Galderisi indicated “that in my view and in the view of all the members of the [WPA Taskforce] team, it’s an extremely important step. Having a position statement saying that coercion is overused in mental health systems. And this is one of the main drivers of the change, because I mean, if we recognize that coercion is overused, this is then an issue. So, certainly it is overused and our goal must be to come to more homogeneity and to have common grounds that recognize this.”
Prof. Vinay Lakra, the President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) stressed the need for supporting this WPA initiative. He said, “We funded this [WPA] project. Our board decided when John Allen was president and I was his president elect, we decided to fund this project because if there is one thing which differentiates us from the rest of the medicine, it is the use of coercion. We don’t see people holding placards, outside medicine conferences. You see people holding placards protesting outside psychiatric conferences.”
“And it’s almost always related to the fact that we use coercion in our service provision. So, I would encourage anyone who is related to the European Psychiatric Association (EPA) or to other EPA member societies here to do what they can do to support this project’s continuation, because I think that’s what is important,” Prof. Vinay Lakra added.
