An end to coercion: rights and decision-making in mental health care.

Kanna Sugiura,Shekhar Saxena,Faraaz Mahomed,Vikram Patel

doi:10.2471/blt.19.234906

Abstract

The United Nations Convention on the Rights of Persons with Disabilities requires a paradigm shift from a medical model of disability to a social model that emphasizes overcoming the barriers to equality created by attitudes, laws, government policies and the social, economic and political environment. The approach adopted by the social model recognizes that people with psychosocial disabilities have the same right to take decisions and make choices as other people, particularly regarding treatment, and have the right to equal recognition before the law. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. Although recent mental health laws in some countries have attempted to realize a rights-based approach to decision-making by reducing coercion, implementing the Convention on the Rights of Persons with Disabilities can be challenging because it requires continuous refinement and the development of alternatives to coercion. This article reviews the impact historical trends and current mental health frameworks have had on the rights affected by the practice of involuntary treatment and describes some legal and organizational initiatives that have been undertaken to promote noncoercive services and supported decision-making. The evidence and examples presented could provide the foundation for developing a context-appropriate approach to implementing supported decision-making in mental health care.

Highlights

In December 2018, an independent review of the 1983 Mental Health Act of the United Kingdom of Great Britain and Northern Ireland concluded that reforms were needed to reduce coercion in mental health care and to support mental health service users in making their own decisions about treatment
Mijatović recognized the relationship between coercive care, isolation from the community and the stigmatization of people living with psychosocial disabilities
Adopting a rights-based approach to decision-making in mental health care primarily involves: (i) aligning mental health laws more closely with the Convention on the Rights of Persons with Disabilities; (ii) fostering the participation of mental health service users in policy and decision-making; and (iii) establishing community-based strategies for supported decision-making. These practices have been adopted in a range of economic and cultural contexts, and have been applied to mental health conditions of all degrees of severity

Summary

Introduction

In December 2018, an independent review of the 1983 Mental Health Act of the United Kingdom of Great Britain and Northern Ireland concluded that reforms were needed to reduce coercion in mental health care and to support mental health service users in making their own decisions about treatment. This approach can incorporate supported decision-making that respects the rights of people with psychosocial disabilities and has been shown to have the added benefit of reducing stigmatization.[34] there is evidence that community-based care and support can be applied in different ways in countries as varied as Finland, India and Mexico,[35,36,37] which demonstrates that a lack of resources should not be considered an impediment to realizing the Convention’s vision This approach has been found to be viable for people with acute episodes of mental health conditions as well as for less severe cases.[38] Box 2 describes the varied ways supported decision-making has been implemented around the world, which we identified by carrying out a scoping exercise and engaging with key informants. Most of these methods have been empirically validated, others require additional research to establish their efficacy

Conclusion

Findings

46. A new profession is born