An end to coercion: rights and decision-making in mental health care

Sugiura, Kanna; Mahomed, Faraaz; Saxena, Shekhar; Patel, Vikram

doi:10.2471/blt.19.234906

Cited by 97 publications

(53 citation statements)

References 24 publications

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“…Instead of coercion, scientific advisors have called for 'supported isolation', which includes providing appropriate accommodation, domestic assistance, and financial support (6,14). The latter is more in line with World Health Organization (WHO) recommendations to avoid coercion in public health (15,16) and to adopt instead a community engagement approach (17,18).…”

Section: Introductionsupporting

confidence: 53%

“…Instead of coercion, scientific advisors have called for ‘supported isolation’, which includes providing appropriate accommodation, domestic assistance, and financial support (6, 14). The latter is more in line with World Health Organization (WHO) recommendations to avoid coercion in public health (15, 16) and to adopt instead a community engagement approach (17, 18). Community engagement in public health refers to the involvement and participation of individuals, groups and structures in the decision-making, planning, design, governance and delivery of services (18, 19).…”

Section: Introductionmentioning

confidence: 57%

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What have we learned so far about COVID-19 volunteering in the UK? A rapid review of the literature

Mao

Fernandes‐Jesus

Ntontis

et al. 2020

Preprint

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BackgroundCommunity engagement and volunteering are essential for the public response to COVID-19. Since March 2020 a large number of people in the UK have been regularly doing unpaid activities to benefit others besides their close relatives. Although most mutual aid groups emerged from local neighbourhoods and communities, official public institutions also fostered community volunteering, namely through the community champions scheme. By considering a broad definition of COVID-19 volunteering, this article describes a systematic review of the literature focused on two broad questions: What have we learned so far from COVID-19 volunteering both at the UK national level and the more local community level? What have we learned from engagement with local communities and community champions during the COVID-19 period?MethodsA rapid review of the literature in peer-reviewed databases and grey literature was applied in our search, following the PRISMA principles. The search was conducted from 10 to 16 of October 2020, and sources were included on the basis of having been published between January and October 2020, focusing on COVID-19 and addressing community groups, volunteering groups, volunteers, or community champions in the UK.ResultsAfter initial screening, a total of 40 relevant sources were identified. From these, 28 were considered eligible. Findings suggest that food shopping and emotional support were the most common activities, but there were diverse models of organisation and coordination in COVID-19 volunteering. Additionally, community support groups seem to be adjusting their activities and scope of action to current needs and challenges. Volunteers were mostly women, middle-class, highly educated, and working-age people. Social networks and connections, local knowledge, and social trust were key dimensions associated with community organising and volunteering. Furthermore, despite the efforts of a few official public institutions and councils, there has been limited community engagement and collaboration with volunteering groups and other community-based organisations.ConclusionsWe identified important factors for fostering community engagement and COVID volunteering as well as gaps in the current literature. We suggest that future research should be directed towards deepening knowledge on sustaining community engagement, collaboration and community participation over time, during and beyond this pandemic.

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Section: Introductionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 57%

What have we learned so far about COVID-19 volunteering in the UK? A rapid review of the literature

Mao

Fernandes‐Jesus

Ntontis

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…4 In addition to the many benefits of community-based and primary care and support, such services may reduce the need for hospital admission. 11,76 Another prerequisite is the presence of legislative measures and policies aiming at operationalising a rights-based approach to decision-making. 3,11,77,78 For these reasons, results may hardly be applied to contexts where detention, chaining and violent treatment occur outside any legislative framework.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Coercive treatment conflicts with the principle of autonomy, a central guiding principle of the Convention on the Rights of Persons with Disabilities (CRPD), which aims to empower mental health patients in making their own decisions about treatment. 10,11 In addition to human rights considerations, empirical data suggest that coercive practices may be a traumatising experience leading to profound loss of trust in the therapeutic relationship and to physical health problems such as skin injuries, neurological problems, pulmonary disease, deep vein thrombosis and even death. 12,13 Coercion can also have long-term adverse consequences in terms of service avoidance, with reduced access to mental healthcare.…”

mentioning

confidence: 99%

Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence

et al. 2020

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Background Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services. Aims To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3. Method Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach. Results A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62–0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60–0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46–0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates. Conclusions Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.

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“…The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) is the most up-to-date international legal instrument speci cally tailored to stipulate the rights of persons with disabilities [22,23], and a major milestone in safeguarding the rights of people with mental disorders and psychosocial disabilities [3]. The Convention, and speci cally the Committee's General Comment Nº1 on Article 12 [24], sparked a global debate [14, 23, 25−28] and raised controversy and criticism when considering that all persons have legal capacity at all times, irrespective of mental status, and that substitute decision-making and involuntary hospitalization are indefensible [3,23,26,29].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Involuntary Psychiatric Hospitalization in Portugal

Silva

Antunes

Azeredo‐Lopes

et al. 2020

Preprint

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BackgroundIdentifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012.MethodsData from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors.ResultsMale gender [exp(β̂) = 1.31; 95%CI:1.06-1.62, p<0.05], having secondary and higher education [exp(β̂) = 1.45; 95%CI:1.05-2.01, p<0.05, and exp(β̂) = 1.89; 95%CI:1.38-2.60, p<0.001, respectively], a psychiatric diagnosis of psychosis [exp(β̂) = 2.02; 95%CI:1.59-2.59, p<0.001], and being admitted in 2007 and in 2012 [exp(β̂) = 1.61; 95%CI:1.21-2.16, p<0.01, and exp(β̂) = 1.73; 95%CI:1.31-2.32, p<0.001, respectively] were associated with an increment of involuntary hospitalizations. Being married/cohabitating [exp(β̂) = 0.74; 95%CI:0.56-0.99, p<0.05], having experienced a suicide attempt [exp(β̂) = 0.26; 95%CI:0.15-0.42, p<0.001], and belonging to the catchment area of three of the psychiatric units evaluated [exp(n) =0.65; 95%CI:0.49-0.86, p<0.01, exp(β̂) = 0.67; 95%CI:0.49-0.90, p<0.01, and exp(β̂) = 0.67; 95%CI:0.46-0.96, p<0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively] were associated with a decrease in involuntary hospitalizations.ConclusionsThe findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with sociodemographic, clinical, and contextual factors. This information may help to recognize high-risk patients, and to inform the development of better-targeted preventive interventions to reduce these hospitalizations.

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An end to coercion: rights and decision-making in mental health care

Cited by 97 publications

References 24 publications

What have we learned so far about COVID-19 volunteering in the UK? A rapid review of the literature

What have we learned so far about COVID-19 volunteering in the UK? A rapid review of the literature

Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence

Factors Associated With Involuntary Psychiatric Hospitalization in Portugal

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