Reducing coercion in mental healthcare.

Area of Science:

• Mental Health Research
• Human Rights in Healthcare
• Psychiatric Practice

Background:

• Coercive practices are deeply integrated into mental healthcare systems globally.
• There is a significant lack of research and data on the extent and nature of coercion in mental health.
• Existing efforts to reduce coercion have limited evidence of generalizability or sustainability.

Purpose of the Study:

• To investigate the prevalence and characteristics of coercive practices in mental healthcare.
• To analyze the ethical and human rights implications of current coercive clinical practices.
• To propose recommendations for a more consensual mental healthcare approach.

Main Methods:

• Systematic literature search of major databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus) from 1980-2018.
• Inclusion of articles on mental health coercion and treatment, excluding specific populations (children, dementia patients).
• Review of relevant cited articles and personal files to supplement search findings.

Main Results:

• Coercion is pervasive in mental healthcare, with limited research and data hindering understanding.
• Few examples of effective, generalizable, or sustainable programs to reduce coercion were identified.
• Recommendations are made for fundamental cultural shifts in psychiatry to reduce coercion.

Conclusions:

• All coercive practices fundamentally conflict with human rights-based mental healthcare.
• Addressing coercion requires more than legislative changes; it demands a cultural transformation in psychiatry.
• Urgent global action is necessary to align mental healthcare with human rights principles.