Human rights of psychiatrically disturbed persons in the tropical Pacific

The management of acutely disturbed patients in smaller Pacific island communities presents many clinical challenges as well as ethical and human rights questions. The aggressive, excited, sexually inappropriate, and possibly violent disturbed person frequently will need physical restraint and possible seclusion in a secure environment. In practical terms, on many Pacific islands the only physically secure room is a jail cell. This environment will protect others and possibly protect the out-of-control person from themselves. After protection, the next requirements are adequate information about the person and clinically informed individuals who can make a diagnosis and commence treatment in the jail environment. Adequately trained people who can diagnose and suggest initial treatment are few and widely dispersed in Pacific island communities. Two representative case vignettes from the author's experience as a World Health Organization short-term consultant in Tonga and the Commonwealth of the Northern Mariana islands illustrate the tension between a disturbed person's right to adequate treatment and the right of a citizen/patient to be free of coercion.