Use of coercion and force is widespread in psychiatry

*Featured photo by Pete Linforth from Pixabay / This article is part of the series “Mental Health in crisis“

The still legally accepted possibility of using coercion and force in psychiatry is a very controversial issue. It is not only widespread but indicators and statistics from various European countries show it is increasing.

More and more people are being subjected to coercive psychiatric interventions. The phenomena that one would believe is only applied in extreme cases and to a very few exceptional and dangerous persons is in fact very common practice.

“Around the world, people with mental health conditions and psychosocial disabilities are frequently locked up in institutions where they are isolated from society and marginalized from their communities. Many are subjected to physical, sexual, and emotional abuse and neglect in hospitals and prisons, but also in the community. People are also deprived of the right to make decisions for themselves about their mental health care and treatment, where they want to live, and their personal and financial affairs,” Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO) noted in a United Nations meeting on human rights in mental health held in 2018.

And in the speech delivered on his behalf by Dr. Akselrod, Assistant DG WHO for Mental Health he added,

“Unfortunately, these violations of human rights are all too common. They do not occur only in low-income countries with few resources, they occur everywhere around the world. Rich countries can have mental health services which are inhuman, deliver poor quality care and which violate human rights. What is particularly shocking is that these violations occur in the very places where people should be receiving care and support. In this respect, some mental health services themselves have become agents for human rights violations.”

The implementation of human rights in psychiatry, and with that the phasing out any use of coercion – by law and actual practice – has become an important topic on the human rights agenda of the United Nations. But not only by the UN, in many European countries, by professionals working in the field of mental health and not the least by persons who have experienced the use and abuse of coercion in psychiatry.

Violence potentially amounting to torture

During the same United Nations meeting on mental health and human rights the UN High Commissioner on Human Rights, Mr. Zeid Al Hussein noted: “Psychiatric institutions, like all closed settings, generate exclusion and segregation, and being forced into one amounts to arbitrary deprivation of liberty. They are also, often, the locus of abusive and coercive practices, as well as violence potentially amounting to torture.“

The High Commission on Human Rights made it clear that: “Forced treatment – including forced medication and forced electro convulsive treatment, as well as forced institutionalisation and segregation – should no longer be practiced.”

He added that “Manifestly, the human rights of persons with psychosocial disabilities and those with mental health conditions are not being widely upheld around the world. This needs to change.”

The use of coercive measures (deprivation of liberty, forced medication, seclusion, and restraint and other types) are in fact very widespread and common in psychiatry. This may be because psychiatrists generally do not consider the patient’s viewpoints or respect their integrity. One may also argue that because the use of these uses of force is legally authorized they are used, because that is what has been done for centuries. The health care professionals in the psychiatric service are not educated and experienced in how to deal with people from a modern viewpoint of human rights.

And that traditional and widespread thinking appears to be the cause of an escalating use of force and abusive atmosphere in many mental health settings.

The rising trend is damaging for patients

Professors of psychiatry, Sashi P Sashidharan, and Benedetto Saraceno, former director of the World Health Organization’s (WHO) Department of Mental Health and Substance Abuse and currently the Secretary General of the Lisbon Institute for Global Mental Health, discussed the matter in an editorial published in the internationally respected British Medical Journal in 2017: “The rising trend is damaging for patients, unsupported by evidence, and must be reversed. Coercion in its various guises has always been central to psychiatry, a legacy of its institutional origins.”