Reducing coercion in mental healthcare

Abstract

AimsTo examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making mental healthcare less coercive and more consensual.MethodsWe identified references through searches of MEDLINE, EMBASE, PsycINFO and CINAHL Plus. Search was limited to articles published from January 1980 to May 2018. Searches were carried out using the terms mental health (admission or detain* or detention or coercion) and treatment (forcible or involuntary or seclusion or restraint). Articles published during this period were further identified through searches in the authors' personal files and Google Scholar. Articles resulting from searches and relevant references cited in those articles were reviewed. Articles and reviews of non-psychiatric population, children under 16 years, and those pertaining exclusively to people with dementia were excluded.ResultsCoercion in its various guises is embedded in mental healthcare. There is very little research in this area and the absence of systematic and routinely collected data is a major barrier to research as well as understanding the nature of coercion and attempts to address this problem. Examples of good practice in this area are limited and there is hardly any evidence pertaining to the generalisability or sustainability of individual programmes. Based on the review, we make specific recommendations to reduce coercive care. Our contention is that this will require more than legislative tinkering and will necessitate a fundamental change in the culture of psychiatry. In particular, we must ensure that clinical practice never compromises people's human rights. It is ethically, clinically and legally necessary to address the problem of coercion and make mental healthcare more consensual.ConclusionAll forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.

Experiences of Individuals Who Were Physically Restrained in the Emergency Department

“…9 This is compounded by the fact that agitated patients may often experience coercion, defined as actions performed on a patient that cause loss of self-determination, ranging from involuntary detention or seclusion to use of forcible treatment with restraints. 10 A recent observational study 11 found that 61% of agitated patients felt coerced by police or prehospital staff before ED arrival. Experiences of coercion may limit the ability of ED clinical staff to engage in a dialogue and create a therapeutic bond.…”

Professionals’ perspectives on factors within primary mental health services that can affect pathways to involuntary psychiatric admissions

“…Involuntary admission of adults to psychiatric hospitals has obvious implications for people's autonomy and liberty, is ethically and professionally controversial and expensive for services and the wider society [1]. The use of involuntary admissions can also be traumatic for both the person in question and their relatives [1].…”

Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

“…Committee As there is little research on coercion in mental health care [30] and supporting data about how to make mental health care more consensual, the present survey was undertaken.…”