Reduce or eliminate coercion in mental health services?

As I mentioned in a previous post, the Office of the High Commissioner for Human Rights (OHCHR) has called for inputs to the draft Guidance on Mental Health, Human Rights and Legislation published by World Health Organisation (WHO) and OHCHR. The publication aims to be a resource for countries, when considering legislative measures to support the transformation of mental health systems in line with international human rights law. Mental health should be a global health priority and the rights of people with mental health problems need to be protected (see previous post). 

Because it authorises coercion, mental health legislation can condone discrimination and the violation of basic human rights. As I’ve mentioned before (see eg. previous post), the Convention on the Rights of Persons with Disabilities (CRPD), adopted in 2006, calls for a significant paradigm shift within the mental health field. Coercion needs to be reduced in mental health services through making legislation compliant with CRPD (see previous post). There is also limited evidence for the effectiveness of coercion. Non-coercive practices may actually produce better outcomes.

Rates of involuntary hospitalisation and treatment continue to increase around the globe, particularly in high-income countries. This reflects a misguided reinstitutionalisation of services after the earlier rundown of the traditional asylums in the West (see previous post and my eletter). The UK government’s intention to reduce detentions and address racial disparities in its draft Mental Health bill is therefore welcome (see another previous post). However, pre-legislative scrutiny of the draft bill needs to consider whether the proposed changes go far enough (see yet another previous post).

The Committee on the Rights of Persons with Disabilities argues that CRPD precludes all forms of involuntary commitment to mental health facilities, including on the basis of dangerousness or need of care. Certainly mental illness or learning disability in themselves are not a reason for detention. It is the additional risk and need for hospital care that in my view may justify detention (although any separate risk criterion may well be superfluous - see eg. previous post). I do think that extension of the powers of coercion to community treatment orders (CTOs) has been a mistake. My position is that the aim of MHA reform should be to respect and secure the rights of people with mental and intellectual disabilities to progressively reduce compulsion in any necessary hospital treatment, with a view to evaluating whether coercion can be completely eliminated (see previous post).

I do not think the Committee is prepared to compromise on this issue but it does concern me that its intransigence may well be preventing pragmatic progress in reforming the Mental Health Act. Essentially the Committee want to abolish mental health law, whereas I want mental health legislation to become CRPD compliant, despite the resistance to doing so from mainstream psychiatry (see previous post).