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Reducing coercion in mental healthcare

Part of: Special Articles

Published online by Cambridge University Press:  09 July 2019

S. P. Sashidharan ,
Roberto Mezzina  and
Dainius Puras
S. P. Sashidharan*
Affiliation:
Institute of Health & Wellbeing, University of Glasgow, Scotland
Roberto Mezzina
Affiliation:
Dipartimento di Salute Mentale, WHO Collaborating Centre for Research and Training, ASUI Trieste, Italy
Dainius Puras
Affiliation:
Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Lithuania
*
Author for correspondence: S. P. Sashidharan, E-mail: s.p.sashidharan@gmail.com
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Abstract

Aims

To 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.

Methods

We 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.

Results

Coercion 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.

Conclusion

All forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.

Keywords

Community mental healthepidemiologyethicsforensic psychiatryhealth outcomes
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 28 , Issue 6 , December 2019 , pp. 605 - 612
Copyright
Copyright © Cambridge University Press 2019 

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