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Mental Health and Human Rights in Secure Settings 

Mental Health and Human Rights in Secure Settings
Chapter:
Mental Health and Human Rights in Secure Settings
Author(s):

Danny H. Sullivan

and Paul E. Mullen

DOI:
10.1093/med/9780199213962.003.0018
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date: 23 October 2019

Danny Sullivan and Paul Mullen consider the rights of those doubly stigmatized as mentally disordered and criminal. Citizens committing serious criminal offences and mentally ill people unable to protect themselves or others both forfeit some civil rights. Offending and mental illness curtail rights in the name of justice and therapy. Deinstitutionalization, intended to end coercion and exclusion, preceded a trend towards compulsory hospital admissions and community treatment orders, thus perpetuating coercion in less forbidding places. Forensic psychiatry services and secure hospitals have grown substantially. Minimal standards for these services and for mentally ill offenders are sometimes deflected by populist media outrage. The authors consider the relationship between prisons and asylums (or hospitals), and for secure mental health institutions, and the tensions between therapeutic and custodial goals and cultures. Civil commitment necessitates diagnostic or dysfunction criteria, and/or incapacity to consent, treatment refusal, treatability, and other thresholds, such as harm to self or others, least restrictive environment, and parens patriae . The authors discuss capacity-based commitment, arguments against commitment, coercive cultures, and the situation of the mentally abnormal offender: the problems of (especially compulsory) treatment in prisons, transfer to hospitals, sexuality, and political dissent. The challenges for mental health professionals of providing care are scrutinized.

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