A review of the literature, published in Epidemiology and Psychiatric Sciences, examines the effectiveness of coercive practices in mental healthcare. The review indicates that coercive practices are not only ineffective, but unethical, anti-therapeutic, and violate human rights. The authors suggest steps that can be taken to reduce coercive practices in mental healthcare but ultimately arrive at the conclusion that a paradigm shift in the field of psychiatry is required for large-scale changes to be made.
“There is increasing recognition that we need to make mental healthcare more consensual and ensure that the human rights of people with mental health problems are always respected. However, little attention is given within current mental health policies and programs to reducing coercion in clinical practice despite our commitment to clinical safety,” write the authors, led by Dr. S.P. Sashidharan, a professor and researcher at the University of Glasgow.
Coercive practices are used internationally in mental healthcare, yet they remain under-researched. In addition, the available research suggests that they are detrimental to the health, wellbeing, and human rights of mental health clients. Coercive treatment broadly consists of involuntary and forcible treatment, which includes practices such as seclusion, physical restraint, and the forcible administration of medication. Such practices are not confined to mental healthcare but are also used in general healthcare, particularly in the treatment of the elderly, children, and individuals diagnosed with intellectual disabilities.
Despite the pervasive use of coercive practices in treatment, there remains a lack of systematic and reliable data on coercive practices both nationally and internationally. Yet, available research suggests that such practices elicit the opposite effect of what is intended. Although coercive practices are used in the service of keeping the client and others safe, research demonstrates that clients who are subjected to such treatment experience high levels of distress, even traumatization, as a result of such experiences. The authors note:
“. . . coercive practices are often associated with negative outcomes for patients with significantly adverse impacts on satisfaction and quality of life.”
While research identifying potential clinical remedies to coercive treatment is scarce, the research that is available suggests that clinical practices that involve loved ones of the client, client advocacy, and the use of advanced directives and joint care plans all contribute to the reduction of coercive practices in treatment.
In order for practices such as joint care plans, wherein the client and professionals collaborate in the process of treatment planning, to be utilized across psychiatric institutions, a major shift will need to occur regarding how treating professionals view their clients – not as dangerous or lacking the agency to engage in their own treatment, but instead as competent, capable, and worthy of dignity and respect.
Although coercive care is used across mental health and general healthcare settings, it is most prevalent in forensic psychiatry in high-income countries. In order to reduce coercive treatment as a whole, the authors suggest that forensic psychiatry itself needs to be completely restructured into treatment based on rehabilitation, as opposed to its current focus on public protection. Italy provides one example of how such a restructuring lends itself to positive outcomes – rather than indefinitely confining those with mental health issues and criminal histories, Italy has moved toward rehabilitating these individuals, which has resulted in the reduction in reliance on secure psychiatric beds.
Further, while legislative changes will likely not impact the use of coercive care in clinical practice, it can allow for increased protection of rights for those in treatment. Unfortunately, despite current mental health laws being described by the UN Convention of Rights of People with Disabilities (UNCRPD) as being, “fundamentally discriminatory and inconsistent with human rights principles,” there remains a lack of action by the field of psychiatry to make changes in mental health legislation.
There are organizations advocating for the upholding of human rights in mental healthcare. Dr. Sashidharan and his colleagues highlight the QualityRights initiative of the World Health Organization (WHO) as being an entity that promotes the maintenance of human rights across several countries through the use of assessment, training, and measures of treatment quality in mental health facilities.
The review of the literature outlined by the authors clearly indicates that coercive practices are harmful and detrimental to individuals, providing a strong argument to reduce the use of these practices in mental healthcare. Although a major overhaul of the field of psychiatry is required in order to significantly reduce these practices, changes in legislation and in the field of forensic psychiatry can pave the way for a shift in the psychiatric paradigm.
Sashidharan, S. P., Mezzina, R., & Puras, D. (2019). Reducing coercion in mental healthcare. Epidemiology and Psychiatric Sciences, 1-8. (Link)
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
“Coercive practices”, as they are called, have a different term for other contexts, and that different term is tyranny. If we’re going to criticize “coercive practices”, maybe we should be criticizing the entire system that has produced them, perfected them, excuses them, and apologizes for them. Antipsychiatry, as I see it, is pro-freedom, pro-democracy, and anti-tyranny. Why reform a system that should never have arisen in the first place when you can do away with it. More simply put, wrong is wrong, and “coercive practices” are not merely “dehumanizing”, they are wrong. Talk “reducing coercive practices” and you’ve already justified them. No, let’s not talk reform. Let’s abolish involuntary hospitalization and involuntary drugging. Tyranny is unjustified in all instances and under all circumstances. Limited tyranny has had its day, but let’s make sure that day is finally over by putting it to sleep once and for all.
“Let’s abolish involuntary hospitalization and involuntary drugging. Tyranny is unjustified in all instances and under all circumstances. Limited tyranny has had its day, but let’s make sure that day is finally over by putting it to sleep once and for all.” I absolutely agree.
Forced treatment is being utilized by criminal doctors to defraud both Medicaid and Medicare, and people’s private health insurance companies, out of likely millions or billions of dollars. This now FBI convicted, former force treating doctor of mine, defrauded my private health insurance company out of $30,000 for a bunch of medically unneeded “snowings,” in the hopes of making me unable to breathe, so he could hopefully do an unneeded tracheotomy on me, for profit, according to my medical records. And he was convicted of doing the same to many others, while defrauding Medicaid and Medicare out of a lot more money.
Kuchipudi’s psychiatric “snowing” partner in crime was never arrested, but should be. Her name is Humaira Saiyed, and she has a one star, based upon 11 reviews, for good reason. She’s a greed inspired, attempted murdering, criminal too.
Forced treatment is abused, due to the greed of unethical and criminal doctors, for nefarious reasons (covering up prior malpractice and medical evidence of the abuse of one’s child for the child abuse covering up religion that owned the hospital).
Forced treatment should be abolished. I’m one of the many “widows” mentioned in the Preface of this book, written by a justifiably appalled ELCA insider.
Both the religions and the medical community should get out of the child abuse covering business, which is the primary societal function of both the psychologists and psychiatrists, historically and today.
Our society should start arresting the pedophiles, and get rid of our child abuse covering up “professions,” who can’t even bill insurance companies for helping child abuse survivors.
When a society has a group of scientifically “invalid,” primarily child abuse covering up “professions.” It seems obvious to me, and an increasing number of people, that we have the wrong people in charge of our society.
Eliminating Mental Health Care and Prosecuting the Practitioners.
The whole thing is just about delegitimating abuse survivors!
So it is all coercive, its just being done via duplicity and deception.
This is why I say:
1. Eliminate Psychiatry and prosecute the practitioners in International Court.
2. Stop our government from being able to license or fund or promote Psychotherapy, Life Coaching, Recovery, or Religion.
Why “reduce” coercive practices, since they are seen as human rights violations? Why not eliminate them? In fact, why call them “coercive practices?” Why not entitle this “Eliminating human rights violations from any human services agency or practice?”
But we also do not want our government licensing or promoting psychotherapy, as it is a con, and survivors are being further taken advantage of when they end up confessing their anger to a psychotherapist.
As far as protecting the public we already have the penal system. This is understood to be punishment so it’s limited to an acceptable degree. But because psychiatry pretends to be medicine instead of a punitive system they get away with all kinds of BS the legal system never could.
Such as denial of due process. Cruel and unusual punishments. Extended, indefinite imprisonments based solely on the whim of the warden. And treating harmless eccentrics, those with TBI, and unhappy loners exactly the same way as violent criminals.
How about starting at the beginning and defining the promotion of “mental health” as a human rights violation?
The fact that people have to be coerced into receiving “care” should tell us all we need to know about the quality of that “care” and what people think of it.
The fact that coercive practices have been designed into the “care” system and codified into the law of the land reveals that it isn’t about “care” but rather about control.
Meanwhile, public support for coerced treatment is actually increasing, thanks largely to misleading and outright false media portrayals of a link between mental illness and gun violence.
How can the authors write that we need to “ensure that the human rights of people with mental health problems are always respected.”. Surely they would be aware that along with the status of “patient” comes a removal of human rights? They simply don’t have any, at all. This is why police will simply do absolutely nothing for a “patient” as they are fully aware that it would need to be approved by their doctor first. And when it is the doctor committing the offences against the “patient”? Sorry, not in the public interest.
So how can you respect something that doesn’t exist? Meh, anyway I need to go feed my Unicorn. Human rights and mental patients waaaahahahaha Were heading in the other direction in my country. Euthanasia Bill here we come. Want to talk about the coercive practices that might come into play there? Nope, need to keep the public out of that debate altogether. They just wouldn’t understand.
Not that we haven’t been shown police beating and pepper spraying a man whilst asking “Do you like that?” Before delivering him to his doctor. Perhaps next time he will be a little more cooperative and attend his appointments with his master.
All a government program admin has to do is suggest that your think reflects a psychological problem, the you are delegitimated. You will end up having to disclose your affairs to a psychotherapist. This is a brazen method of denying you your rights.
True Pacific Dawn.
I have an email here that serves as a classic example of a dog whistle slandering that comes directly from the desk of our Minister for Health. He notes on my file that I have not sought any ‘assistance’ from mental health services. I did reply and explain that in order to ‘treat’ me they would first need to recognise that I was a victim of torture, and that calling it “referral” and “detention” might be the preferred narrative, but it was also a false narrative. The facts show kidnapping and torture.
When a Government is authorising the distribution of fraudulent documents to conceal torture though, it’s hardly surprising that the Minister finds himself badly informed. Its a wonder he gets through his days having expensive lunches with sports stars at an unknown cost to the taxpayer.
I also asked if it was as a result of his psychologist sister being good friends (and work colleague) with the ‘spiker’ had anything to do with the covering up of these offences.
Haven’t heard back though. Guess once he has slandered people with fraudulent documents no need to respond to any questions.
Bit busy getting his Euthanasia Bill through. Cover ups will be easy once that is achieved. Because we all know how ‘consensual’ medical treatment is where psychiatry is involved. Take the Voluntary out of Voluntary Assisted Dying and what have you got? Another one of the Ministers word games, Because ‘coercion’ is a method available to our public officers. In fact, consider that the use of coercion is available for use on ‘partners’ as a result of HCA decision 47 (2010). So appoint partner as ‘carer’ and coerce as required. It would all appear lawful from that point on.
Rage against the Machine 🙂
I am not sure I would want me to be “humanized”. That to me is an insult and I might rather be stripped and flogged, than to receive something psychiatry and law was forced into.
How dare they speak of humanizing humans. My words are, here is my middle finger to your humanization of me.
This is all just chatter to divert. It makes the public think there is some nice treatment for the ‘afflicted’.
The problem is NOT the treatment, the problem lies in much deeper.
It lies within a public that is caught in a new religion.
Works every time….we need to believe in something and for many, religion lost it’s oomph when creating shaming and erecting new opposing churches lost it’s appeal.
Nothing keeps society as pumped up as division. Makes the world feel alive.
The very term “humanizing mental healthcare” shows that mental “health” is dehumanizing to begin with.
America finally has a state church just like Sweden, England and others. The Church of Psychiatry.
Join their membership and you’ll never be able to leave.
Perhaps it is the people doing the “treatment” that need to be “humanized!”
True Steve. They are afraid to be vulnerable.
They sincerely believe that people are trying to manipulate them away from ‘the truth’.
When I was last in the CIU of the local hospital, after I’d been held overnight and it was getting towards noon the following day, I felt sick, hungry, worried about my cat who was home alone and I had no one to call to go and feed/reassure him (such is the life of a person who’s been diagnosed and in the system for 15 years…friends and family give up, if they were there in the first place), listening to the cries of the other patients who were also being ignored in their cells, I started yelling. A nurse came in with a needle in her hand and 4 male security guards trailing her. They surrounded the bed as the nurse told me to lie on my stomach. She pushed my gown out of the way and shot me in the butt. I’m a 53 year old woman. All else aside (the forced drug, the tacit threat represented by the guards, I could go on), the nurse could have put the needle in my arm and the drug would have entered my system just as quickly. The point was to humiliate me as much as possible. As others have said, there’s no way to insert humanity into a system that’s innately dehumanizing. This nurse wasn’t some outlier or rogue actor. She was just doing her job.