Alternatives to coercion in mental health care

Both the World Health Organisation (WHO) and the World Psychiatric Association (WPA) urge countries to take action to promote non-coercive practices in mental health (see recent article). WHO together with the United Nations Office of the High Commissioner for Human Rights (OHCHR) has issued a guidance and practice document on Mental health, human rights and legislation (see previous post). The WHO QualityRights initiative (see eg. previous post) has developed a range of tools and resources to transform mental health services. A discussion paper from a WPA Taskforce on ‘Implementing alternatives to coercion in mental health care’ led to a WPA Position Statement. 

As I’ve said before, mental health legislation needs to become compliant with the United Nations Convention on the Rights of People with Disabilities (CRPD) (see eg. previous post). There are different interpretations of CRPD about whether deprivation of liberty under mental health legislation can ever be lawful (see article). This divide has been known as the ‘Geneva impasse’, as it is reflected within the United Nations human rights system. Personally, I have always thought that CRPD can allow for involuntary treatment as a last resort, for the shortest possible time, subject to safeguards and monitoring by a competent review system. The trouble is that current legislation, and even the present proposals for change by the UK government, do not go far enough (see previous post).

Despite the considerable resistance to change (eg. eg. see previous post), system and service changes to reduce coercion in mental health services are required. There has actually been a reinstitutionalisation of mental health services over recent years and this needs to be reversed to build on the dehospitalisation that led to the closure of the asylums some years ago now (see eg. another previous post).