Mapping and understanding exclusion

Abstract

On behalf of Mental Health Europe I would like to respond to the Lancet's Editorial (Jan 27, p 282)1The LancetInstitutional and coercive mental health treatment in Europe.Lancet. 2018; 391: 282Scopus (3) Google Scholar written about our Mapping and Understanding Exclusion report.2Turnpenny Á Petri G Finn A Beadle-Brown J Nyman M Mapping and understanding exclusion: institutional, coercive and community-based services and practices across Europe. Mental Health Europe, Brussels2017Google Scholar Although we welcome the coverage of our report, we were disappointed to see a reference to the need to uphold the status quo on coercive measures, which might lead to confusion regarding the conclusions of our report. The Lancet's Editorial stated that: “Involuntary treatment and detention are a necessary part of mental health care”.1The LancetInstitutional and coercive mental health treatment in Europe.Lancet. 2018; 391: 282Scopus (3) Google Scholar This statement is contrary to the core message in our report, which recommended that to reduce coercion in mental health services European states should adopt policies and practices that aim to immediately reduce coercion in mental health services and ultimately make such practices by exception only, in line with human rights standards. We agree with the fact that coercion being commonplace in mental health services is “shameful”.1The LancetInstitutional and coercive mental health treatment in Europe.Lancet. 2018; 391: 282Scopus (3) Google Scholar However, prioritising reform of mental health laws will not make a difference if we do not have a human rights-based approach. The UN Convention on the Rights of Persons with Disabilities3Division for Social Policy and Development DisabilityConvention on the rights of persons with disabilities.https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.htmlGoogle Scholar requires a shift away from the use of forced placement and treatment towards human rights-compliant mental health systems, which fully reflect the right to informed consent and legal capacity. Effective alternatives to coercive and institutional mental health services do exist, including Open Dialogue, Soteria Houses, advanced directives, and Zero vision initiatives, which aim to substantially reduce coercion. Human rights training, such as the WHO QualityRights initiative and the training implemented in psychiatric services in the region of Västra Götaland in Sweden, can reduce the use of coercion, seclusion, and restraint, and can empower practitioners and users to know their rights and obligations. These sorts of alternatives and training should be the mainstream in mental health services. Our report did show that some countries, including Germany, Finland, and Israel (which managed an impressive 60% reduction in seclusion and restraint), were working hard to reduce coercion through legislative and other reforms. However, other countries reported year-on-year increases in forced treatment and placement. Perhaps one of the most shocking findings from our research was that many countries do not collect or make data available on the use of coercion. Every incidence of involuntary placement and treatment, restraint, and seclusion, and reasons for their use should be properly documented and the information should be publicly released. Our report goes some way towards scaling the problem. However, if details were known on how coercive mental health systems are, would people still be advocating for the status quo? Experience shows that when a mental health system accepts coercion as normal practice, practitioners will continue to use it; and when a system is under stress, financial or otherwise, the amount of coercion will rise regardless of the rights of individuals. I am the President of Mental Health Europe. I declare no competing interests. Institutional and coercive mental health treatment in EuropeImages of people incarcerated, unkempt and kept in chains, mocked, and uncared for dominate the history of psychiatry, particularly from the middle ages to the early 20th century. Locked up for years, and forcibly sedated or sterilised, those with mental ill health were subject to inhumane conditions and removed from society, often under the supervision of doctors. What of now? How have things improved for those with mental illnesses? Full-Text PDF