Coercive treatment in psychiatry: a comprehensive review. Reflections on the Dresden WPA Thematic Conference, June 2007

Abstract

The WPA Thematic Conference Treatment in Psychiatry: A Comprehensive Review, 6 – 8 June 2007 in Dresden, Germany, may have been the first international scientific event dedicated to a critically important, highly sensitive, and hotly debated issue in psychiatry. The event was officially co-sponsored by the World Health Organization (WHO) and the German Research Association (DFG). The scientific program comprised 10 plenary lectures and 47 symposia/workshops. Participants came from 38 countries, and they evaluated the program as of outstanding quality. The Conference largely realized the aim to explore most of the clinical, legal, and ethical aspects of coercive treatment, to facilitate the presentation of the views of both users and professionals on the event theme, and to present recent research results and initiatives on mental health related human rights. It is particularly noteworthy that the Dresden Conference was the first event of its format that officially involved representatives from the most important international user organizations (ENUSP, WNUSP, Mind Freedom International). While traditionally critical users groups mount protests outside conference venues, this time most of them decided to come inside and engage in discussions with conference organizers and other professionals. This rendered the conference a landmark for WPA in its pursuing the dialogal basis of our profession [1]. Additionally, the Conference presented the exhibition in the Third Reich in Lower Saxony supported by the local Ministry of Social Affairs and Health. Cooperation also took place with the German Public Health Museum in Dresden and the exhibition Deadly Medicine from the United States Holocaust Memorial Museum. An opportunity was also provided to visit the Sonnenstein Memorial Center in Pirna concerning the extermination of mentally ill and disabled persons by the Nazis in the 1930s and 1940s. Radical protests from three critical organizations against the Conference took place elsewhere in Dresden, but did not interfere with the Conference proceedings. Human rights organizations, such as the Global Initiative on Psychiatry and the European Committee for the Prevention of Torture (CPT) of the Council of Europe, were officially represented at the conference. Having organized this conference, we would like to offer our community of colleagues and friends some concluding reflections: Organizing a conference on this theme is a real challenge. The event elicited resistance from various circles: from our psychiatric profession because it could damage our image vis-a-vis competing fields and taint recent successes in diagnostic and therapeutic methods; and from patients or users of psychiatric services in connection with their acute concerns on the infringement of human rights. The Conference, however, documented that these challenges and risks can be overturned and rendered positive departure points for the advancement of our field as well as of the community's health and human rights. Organizing a conference on this theme must involve all parties and disciplines interested in this theme. This is a difficult task, because interests of these parties and disciplines are often different from each other, and because communication among them still requires improvement, even in times of the trialogue involving patients, families and professionals. Improvements along these lines may lead in the future to more and fuller presentations from the involved groups than what was possible in Dresden. Organizing a conference on this theme must involve colleagues from all over the world, including developing countries. We were quite limited in this regard, mostly because of financial reasons. It will be crucial in the future to facilitate hearing and discussing the experiences and practices in low resource countries, which may be even more problematic that those in the developed world. There should be regular thematic conferences on coercive treatment and similar issues. This might clearly lower the threshold for open discussions in the field, and would define better standards and procedures on how to deal with this theme. Such events have additionally the potential to advance more broadly ethical and scientific clinical care. Complementing these reflections, the WPA Dresden Thematic Conference on Coercive Treatment in Psychiatry was externally rated as a major success, having received the 2007 Special Jury Prize for Congresses in Dresden. The experience was more than rewarding; it has opened new paths for the cultivation of our noble field through its emphasis on the totality of the person. We wish you a stimulating reading! Professor Juan E Mezzich President of the WPA and of the Conference Professor Thomas W Kallert Chairman of the Organizing Committee of the WPA Thematic Conference