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Coercive Treatment in Psychiatry: A Human Rights Issue? 

Coercive Treatment in Psychiatry: A Human Rights Issue?
Chapter:
Coercive Treatment in Psychiatry: A Human Rights Issue?
Author(s):

Thomas Wilhelm Kallert

DOI:
10.1093/med/9780199213962.003.0021
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date: 16 October 2019

Reviewing coercive psychiatry, Thomas Kallert notes inconsistencies in mental health legislation in European countries, the greater effectiveness of the European Convention of Human Rights regarding unwanted treatment than access to treatment, and inequities in individual access to the European Court of Human Rights depending on the degree of democracy in the applicant’s country and access to legal assistance. Some psychiatrists and psychiatric bodies have advanced proposals to address legal discrimination against those with severe and persistent mental illness. Clinically, patients report various coercions (restrictions on movement, forced medication, patronizing communication, property confiscated, not knowing one’s legal status), and sometimes involuntary commitment and treatment are not distinguished. Reducing coercion requires leadership and policy to reduce and regulate seclusion and restraint, incident management systems and data reporting, staff training, independent patient advocates, emergency response teams, reducing unit sizes, improving patient-staff ratios, using second generation antipsychosis medications, and increasing non-pharmacological treatments. Re-institutionalization may promote complacency about standards. Stakeholders differ about the CRPD’s implications, but the ability of mental health systems and laws to reduce coercion requires re-examination, as also coercion in non-psychiatric residential settings, non-Western countries, and totalitarian regimes. There is a need for further discussions between all parties whatever their positions.

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