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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: [email protected]
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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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References

Akhter, SF, Molyneaux, E, Stuart, R, Johnson, S, Simpson, A and Oram, S (2019) Patients’ experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 5, e37, 1–10. doi:10.1192/bjo.2019.19.Google Scholar
Australian Institute of Health and Welfare (2019) Mental Health Services in Australia. Available at https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/restrictive-practices/seclusion.Google Scholar
Bak, J and Aggernæs, H (2012) Coercion within Danish psychiatry compared with 10 other European countries. Nordic Journal of Psychiatry 66, 297–302.Google Scholar
Barbui, C and Saraceno, B (2015) Closing forensic psychiatric hospitals in Italy: a new revolution begins? The British Journal of Psychiatry 206, 445–446.Google Scholar
Bhugra, D, Tasman, A, Pathare, S, Priebe, S, Smith, S, Torous, J, Arbuckle, MR, Langford, A, Alarcón, RD, Chiu, HFK and First, MB (2017) The WPA-lancet psychiatry commission on the future of psychiatry. The Lancet Psychiatry 4, 775–818.Google Scholar
Burns, T, Rugkåsa, J, Molodynski, A, Dawson, J, Yeeles, K, Vazquez-Montes, M, Voysey, M, Sinclair, J and Priebe, S (2013) Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. The Lancet 381, 1627–1633.Google Scholar
Care Quality Commission (2017) The state of care in mental health services 2014 to 2017. Care Quality Commission, Newcastle-upon-Tyne, Available at www.cqc.org.uk/sites/default/files/20170720_stateofmh_report.pdf.Google Scholar
Care Quality Commission (2018) Mental Health Act - the rise in the use of the MHA to detain people in England. Available at https://www.cqc.org.uk/sites/default/files/20180123_mhadetentions_report.pdf.Google Scholar
Chow, WS and Priebe, S (2016) How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990. BMJ Open 6, e010188.Google Scholar
Council of Europe: Parliamentary Assembly Recommendation n. 2091. Recommendation 2091 (2016) The case against a Council of Europe legal instrument on involuntary measures in psychiatry.Google Scholar
Davies, S, Clarke, M, Hollin, C and Duggan, C (2007) Long-term outcomes after discharge from medium secure care: a cause for concern. The British Journal of Psychiatry 191, 70–74.Google Scholar
De Ambrogi, M (2017) REMS, a new chapter in Italian psychiatry. The Lancet Psychiatry 4, 589–590.Google Scholar
de Jong, MH, Kamperman, AM, Oorschot, M, Priebe, S, Bramer, W, van de Sande, R, Van Gool, AR and Mulder, CL (2016) Interventions to reduce compulsory psychiatric admissions: a systematic review and meta-analysis. JAMA Psychiatry 73, 657–664.Google Scholar
Department of Health and Social Care (2018) Modernising the Mental Health Act. Increasing choice, reducing compulsion. Final report of the Independent Review of the Mental Health Act 1983. Available at https://www.gov.uk/government/publications/modernising-the-mental-health-act-final-report-from-the-independent-review.Google Scholar
de Stefano, A and Ducci, G (2008) Involuntary admission and compulsory treatment in Europe: an overview. International Journal of Mental Health 37, 10–21.Google Scholar
D'Lima, D, Crawford, MJ, Darzi, A and Archer, S (2017) Patient safety and quality of care in mental health: a world of its own? BJPsych Bulletin 41, 241–243.Google Scholar
Drew, N, Funk, M, Tang, S, Lamichhane, J, Chávez, E, Katontoka, S, Pathare, S, Lewis, O, Gostin, L and Saraceno, B (2011) Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. The Lancet 378, 1664–1675.Google Scholar
Duke, LH, Furtado, V, Guo, B and Völlm, BA (2018) Long-stay in forensic-psychiatric care in the UK. Social Psychiatry and Psychiatric Epidemiology 53, 313–321.Google Scholar
Fitzpatrick, R, Chambers, J, Burns, T, Doll, H, Fazel, S, Jenkinson, C, Kaur, A, Knapp, M, Sutton, L and Yiend, J (2010) A systematic review of outcome measures used in forensic mental health research with consensus panel. Health Technology Assessment 14(18). https://www.journalslibrary.nihr.ac.uk/hta/hta14180/#/full-reportGoogle Scholar
FRA–European Union Agency for Fundamental Rights (2012) Involuntary placement and involuntary treatment of persons with mental health problems. Luxembourg: Publications Office of the European Union; 2012. ISBN 978-92-9192-949-8. https://doi.org/10.2811/87077.Google Scholar
Funk, M and Drew, N (2017) WHO qualityrights: transforming mental health services. The Lancet Psychiatry 4, 826–827.Google Scholar
Gaynes, BN, Brown, CL, Lux, LJ, Brownley, KA, Van Dorn, RA, Edlund, MJ, Coker-Schwimmer, E, Weber, RP, Sheitman, B, Zarzar, T and Viswanathan, M (2017) Preventing and de-escalating aggressive behavior among adult psychiatric patients: a systematic review of the evidence. Psychiatric Services 68, 819–831.Google Scholar
Gooding, P, McSherry, B, Roper, C and Grey, F (2018) Alternatives to Coercion in Mental Health Settings: A Literature Review. Melbourne: Melbourne Social Equity Institute, University of Melbourne.Google Scholar
Goulet, MH, Larue, C and Dumais, A (2017) Evaluation of seclusion and restraint reduction programs in mental health: a systematic review. Aggression and Violent Behavior 34, 139–146.Google Scholar
Guan, L, Liu, J, Wu, XM, Chen, D, Wang, X, Ma, N, Wang, Y, Good, B, Ma, H, Yu, X and Good, MJ (2015) Unlocking patients with mental disorders who were in restraints at home: a national follow-up study of China's new public mental health initiatives. PloS One 10, e0121425.Google Scholar
Henderson, C, Flood, C, Leese, M, Thornicroft, G, Sutherby, K and Szmukler, G (2004) Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMj 329, 136.Google Scholar
Human Rights Watch. ‘Chained Like Prisoners’ Abuses Against People with Psychosocial Disabilities in Somaliland (2015) Avialable at https://www.hrw.org/report/2015/10/25/chained-prisoners/abuses-against-people-psychosocial-disabilities-somaliland.Google Scholar
Human Rights Watch (2016) “Like Living in Hell”. Abuses against people with Psychosocial disabilities in Indonesia. Available at https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia.Google Scholar
Human Rights Watch (2017) “Like A Death Sentence”. Abuses against Persons with Mental Disabilities in Ghana. Available at https://www.hrw.org/report/2012/10/02/death-sentence/abuses-against-persons-mental-disabilities-ghana.Google Scholar
Jaeger, S, Pfiffner, C, Weiser, P, Längle, G, Croissant, D, Schepp, W, Kilian, R, Becker, T, Eschweiler, G and Steinert, T (2013) Long-term effects of involuntary hospitalization on medication adherence, treatment engagement and perception of coercion. Social Psychiatry and Psychiatric Epidemiology 48, 1787–1796.Google Scholar
Jansman-Hart, EM, Seto, MC, Crocker, AG, Nicholls, TL and Côté, G (2011) International trends in demand for forensic mental health services. International Journal of Forensic Mental Health 10, 326–336.Google Scholar
Johnson, S (2013) Can we reverse the rising tide of compulsory admissions? The Lancet 381, 1603–1604.Google Scholar
Kallert, TW, Glöckner, M and Schützwohl, M (2008) Involuntary vs. Voluntary hospital admission. European Archives of Psychiatry and Clinical Neuroscience 258, 195–209.Google Scholar
Katsakou, C and Priebe, S (2006) Outcomes of involuntary hospital admission–a review. Acta Psychiatrica Scandinavica 114, 232–241.Google Scholar
Kelly, BD, Emechebe, A, Anamdi, C, Duffy, R, Murphy, N and Rock, C (2015) Custody, care and country of origin: demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. International Journal of Law and Psychiatry 38, 1–7.Google Scholar
Luciano, M, Sampogna, G, Del Vecchio, V, Pingani, L, Palumbo, C, De Rosa, C, Catapano, F and Fiorillo, A (2014) Use of coercive measures in mental health practice and its impact on outcome: a critical review. Expert Review of Neurotherapeutics 14, 131–141.Google Scholar
McLaughlin, P, Giacco, D and Priebe, S (2016) Use of coercive measures during involuntary psychiatric admission and treatment outcomes: data from a prospective study across 10 European countries. PloS One 11, e0168720.Google Scholar
Mezzina, R (2014) Community mental health care in Trieste and beyond: An “Open Door–No Restraint” system of care for recovery and citizenship. The Journal of Nervous and Mental disease 202, 440–445.Google Scholar
Mezzina, R (2016) Creating mental health services without exclusion or restraint but with open doors Trieste, Italy. L'information Psychiatrique 92, 747–754.Google Scholar
Mezzina, R (2018) Forty years of the Law 180: the aspirations of a great reform, its successes and continuing need. Epidemiology and Psychiatric Sciences 27, 336–345.Google Scholar
Mezzina, R and Vidoni, D (1995) Beyond the mental hospital: crisis intervention and continuity of care in trieste. A four-year follow-up study in a community mental health centre. International Journal of Social Psychiatry 41, 1–20.Google Scholar
Mezzina, R, Rosen, A, Amering, M and Javed, A (2019) The practice of freedom: Human rights and the global mental health agenda. In Javed, A and Fountoulakis, KN (eds), Advances in Psychiatry. Cham: Springer, pp. 483–515.Google Scholar
Molodynski, A (2017) Coercion in mental healthcare: different perspectives, similar concerns and a united call for action. BJPsych International 14, 55–56.Google Scholar
National Mental Health Development Unit (2010) Pathways to unlocking secure mental healthcare. London: Sainsbury Centre for Mental Health. Available at https://www.centreformentalhealth.org.uk/Handlers/Download.ashx?IDMF=c651bae2-a910-4b3b-b788-136b66ec0966.Google Scholar
National Survivor User Network/MIND (2015) Restraint in Mental Health Services. What the Guidance Says. MIND, London. Available at https://www.mind.org.uk/media/3352178/restraintguidanceweb.pdf.Google Scholar
NHS Digital (2016) Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment. Uses of the Mental Health Act: Annual Statistics, 2015/16. Health and Social Care Information Centre. November 2016. Available at https://files.digital.nhs.uk/publicationimport/pub22xxx/pub22571/inp-det-m-h-a-1983-sup-com-eng-15-16-rep.pdf.Google Scholar
Newton-Howes, G and Mullen, R (2011) Coercion in psychiatric care: systematic review of correlates and themes. Psychiatric Services 62, 465–470.Google Scholar
Paksarian, D, Mojtabai, R, Kotov, R, Cullen, B, Nugent, KL and Bromet, EJ (2014) Perceived trauma during hospitalization and treatment participation among individuals with psychotic disorders. Psychiatric Services 65, 266–269.Google Scholar
Patel, V and Bhui, K (2018) Unchaining people with mental disorders: medication is not the solution. The British Journal of Psychiatry 212, 6–8.Google Scholar
Priebe, S, Frottier, P, Gaddini, A, Kilian, R, Lauber, C, Martínez-Leal, R, Munk-Jørgensen, P, Walsh, D, Wiersma, D and Wright, D (2008) Mental health care institutions in nine European countries, 2002 to 2006. Psychiatric Services 59, 570–573.Google Scholar
Pūras, D (2017) Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN General Assembly A/HRC/35/21. March 2017. Available at http://undocs.org/A/HRC/35/21.Google Scholar
Puteh, I, Marthoenis, M and Minas, H (2011) Aceh Free Pasung: Releasing the mentally ill from physical restraint. International Journal of Mental Health Systems 5, 10.Google Scholar
Raboch, J, Kališová, L, Nawka, A, Kitzlerová, E, Onchev, G, Karastergiou, A, Magliano, L, Dembinskas, A, Kiejna, A, Torres-Gonzales, F and Kjellin, L (2010) Use of coercive measures during involuntary hospitalization: findings from ten European countries. Psychiatric Services 61, 1012–1017.Google Scholar
Rains, LS, Zenina, T, Dias, MC, Jones, R, Jeffreys, S, Branthane-Foster, S, Lloyd-Evans, B and Johnson, S (2019) Variations in patterns of involuntary hospitalisation and legal frameworks: an international comparative study. Lancet Psychiatry (published online April 3, 2019). Available at http://dx.doi.org/10.106/S2215-0366(19)30090-2.Google Scholar
Regione Piemonte (2017) Commissione parlamentare per la tutela e la promozione dei diritti umani - audizione nell’ambito dell’indagine conoscitiva sui livelli e i meccanismi di tutela dei diritti umani, vigenti in Italia e nella realtà internazionale, sulla contenzione meccanica. Regione Piemonte, 6 dicembre 2017. http://www.quotidianosanita.it/allegati/allegato2867110.pdf.Google Scholar
Rose, D, Perry, E, Rae, S and Good, N (2017) Service user perspectives on coercion and restraint in mental health. BJPsych International 14, 59–61.Google Scholar
Rosen, A, O'Halloran, P and Mezzina, R (2012) International trends in community mental health services. In McQuistion, HL, Sowers, WE, Ranz, JM and Feldman, JM (eds), Handbook of Community Psychiatry. New York, NY: Springer, pp. 389–404.Google Scholar
Rutherford, M (2010) Blurring the Boundaries. London: Sainsbury Centre for Mental Health.Google Scholar
Sailas, EE and Fenton, M (2000) Seclusion and restraint for people with serious mental illnesses. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD001163. doi: 10.1002/14651858.CD001163.Google Scholar
Sailas, E and Wahlbeck, K (2005) Restraint and seclusion in psychiatric inpatient wards. Current Opinion in Psychiatry 18, 555–559.Google Scholar
Salize, HJ and Dressing, H (2004) Epidemiology of involuntary placement of mentally ill people across the European Union. The British Journal of Psychiatry 184, 163–168.Google Scholar
Salize, HJ, Lepping, P and Dressing, H (2005) How harmonized are we? Forensic mental health legislation and service provision in the European Union. Criminal Behaviour and Mental Health 15, 143–147.Google Scholar
Shaw, J, Davies, J and Morey, H (2001) An assessment of the security, dependency and treatment needs of all patients in secure services in a UK health region. The Journal of Forensic Psychiatry 12, 610–637.Google Scholar
Starace, F, Baccari, F and Mungai, F (2018) Salute Mentale Italia. La Mappa della Disuguaglianze. SIEP – Quaderni di Epidemiologia Psichiatrica. N.2/2018 http://siep.it/wp-content/uploads/2018/07/La-Salute-Mentale-in-Italia-SIEP-02-2018.pdf.Google Scholar
Swartz, MS, Swanson, JW and Hannon, MJ (2003) Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals. Behavioral Sciences and the Law 21, 459–472.Google Scholar
Szmukler, G (2015) Compulsion and “coercion” in mental health care. World Psychiatry 14, 259.Google Scholar
Szmukler, G and Appelbaum, PS (2008) Treatment pressures, leverage, coercion, and compulsion in mental health care. Journal of Mental Health 17, 233–244.Google Scholar
Szmukler, G and Kelly, BD (2016) We should replace conventional mental health law with capacity-based law. The British Journal of Psychiatry 209, 449–453.Google Scholar
Szmukler, G, Daw, R and Callard, F (2014) Mental health law and the UN convention on the rights of persons with disabilities. InternationalJjournal of Law and Psychiatry 37, 245–252.Google Scholar
Thornicroft, G and Henderson, C (2016) Joint decision making and reduced need for compulsory psychiatric admission. JAMA Psychiatry 73, 647–648.Google Scholar
Thornicroft, G and Slade, M (2014) New trends in assessing the outcomes of mental health interventions. World Psychiatry 13, 118–124.Google Scholar
Thornicroft, G, Alem, A, Dos Santos, RA, Barley, E, Drake, RE, Gregorio, G, Hanlon, C, Ito, H, Latimer, E, Law, A and Mari, J (2010) WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 9, 67–77.Google Scholar
Thornicroft, G, Farrelly, S, Szmukler, G, Birchwood, M, Waheed, W, Flach, C, Barrett, B, Byford, S, Henderson, C, Sutherby, K and Lester, H (2013) Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. The Lancet 381, 1634–1641.Google Scholar
Tingleff, EB, Bradley, SK, Gildberg, FA, Munksgaard, G and Hounsgaard, L (2017) “Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion. Journal of Psychiatric and Mental Health Nursing 24, 681–698.Google Scholar
Turnpenny, A, Petri, G, Finn, A, Beadle-Brown, J and Nyman, M (2018) Mapping and understanding exclusion: institutional, coercive and community-based services and practices across Europe. Mental Health Europe & University of Kent, December 2017.Google Scholar
Weich, S, McBride, O, Twigg, L, Keown, P, Cyhlarova, E, Crepaz-Keay, D, Parsons, H, Scott, J and Bhui, K (2014) Variation in compulsory psychiatric inpatient admission in England: a cross-sectional, multilevel analysis. Health Services and Delivery Research 2, 90. Available at https://doi.org/10.3310/hsdr02490Google Scholar
World Health Organization (2005) Resource Book on Mental Health, Human Rights and Legislation. WHO, Geneva. Available at https://ec.europa.eu/health/sites/health/files/mental_health/docs/who_resource_book_en.pdf.Google Scholar
World Health Organization (2010) A situation analysis of mental health in Somalia. Available at http://applications.emro.who.int/dsaf/EMROPUB_2010_EN_736.pdf.Google Scholar
World Health Organization (2013) The European Mental Health Action Plan 2013 −2020. WHO, Copenhagen. Available at http://www.euro.who.int/en/publications/abstracts/european-mental-health-action-plan-20132020-the.Google Scholar
World Health Organization (2014) Mental Health Legislation worldwide: WHO Mental Health Atlas. https://www.Mindbank.Info/Item/5648.Google Scholar
World Health Organization (2018) Mental health, human rights and standards of care [cited 2018 Jul 25]. Available at http://www.euro.who.int/en/publications/abstracts/mental-health,-human-rights-and-standards-of-care-2018.Google Scholar
Wright, S (2003) Control and restraint techniques in the management of violence in inpatient psychiatry: a critical review. Medicine, Science and the Law 43, 31–38.Google Scholar
Zinkler, M and Priebe, S (2002) Detention of the mentally ill in Europe–a review. Acta Psychiatrica Scandinavica 106, 3–8.Google Scholar