Abolish Coercive Mental Health Laws in Favor of Peaceful Support

The Issue

Help should be effective and respectful, not traumatizing. As a result of commitment laws, innocent people are often subjected to awful experiences, a lack of helpful services, and an almost total removal of their human rights. The United Nations and World Health Organization have repeatedly called for a replacement of coercive measures in psychiatry. Our nation needs a plan to implement these changes and respect human rights.

There are a number of legislation changes policymakers can make to promote autonomy and recovery while reducing hospitalization and suicide rates:

1. Supported decision-making: Patients and potential patients should be collaborated with to find consensual solutions that respect their human rights. It's common in legislation for there to be requirements that forcing treatment will help the patient and there is no less invasive alternative, but these things are taken for granted in hearings. There is a lack of quality evidence for the use of force in psychiatry, including forced admission, restraints, strip searches, and forced drugging. Meanwhile, there is a lot of evidence these policies harm people. There are always less invasive alternatives, and a collaborative decision-making process is the bare minimum expected in other areas of medicine. The same should be true in mental healthcare. 
2. Adherence to advance directives: Psychiatrists should be barred from deviating from advance directives, including based on a history of mental disorder. These directives already require potential patients to be of "sound mind" and have 1-2 witnesses when these are created, so their wishes should be respected. Additionally, providing advance directive forms should be compulsory for all people entered into the mental healthcare system. Therapists and doctors should offer to take an active role in crisis planning from the outset of care.
3. Rights for self-harming patients: When a patient is self-harming, the immediate threat should be removed (e.g. take the implement away), and the patient should be spoken to about the steps moving forward. Voluntary deescalation training should be mandated for all workers. No further coercion should be permitted after the immediate threat is addressed (unless otherwise specified by an advance directive), and a supported decision-making process should ensue. Any footage should be kept available to prevent abuse, overreaction, or misleading patient records from biasing courts.
4. Rights for violent patients: While rare, a few patients diagnosed with SMI can become agitated and violent towards others. For the safety of other patients and staff, these patients should be kept in a separate ward from peaceful ones. If they choose staying in a ward over jail, they should not be detained longer than they would be in jail. Voluntary deescalation training should be mandated for all staff to avoid coercive measures. However, if coercive measures are used, any advance directive specifications should be respected (e.g. desire for injection over restraints, or vice versa). Like with self-harming patients, any available footage should be mandated to appear in trial to demonstrate the behavior of both patient and staff during the issue and in the aftermath. This way, potential for abuse, overreaction, or misleading records biasing courts is minimized.

50

The Issue

Help should be effective and respectful, not traumatizing. As a result of commitment laws, innocent people are often subjected to awful experiences, a lack of helpful services, and an almost total removal of their human rights. The United Nations and World Health Organization have repeatedly called for a replacement of coercive measures in psychiatry. Our nation needs a plan to implement these changes and respect human rights.

There are a number of legislation changes policymakers can make to promote autonomy and recovery while reducing hospitalization and suicide rates:

1. Supported decision-making: Patients and potential patients should be collaborated with to find consensual solutions that respect their human rights. It's common in legislation for there to be requirements that forcing treatment will help the patient and there is no less invasive alternative, but these things are taken for granted in hearings. There is a lack of quality evidence for the use of force in psychiatry, including forced admission, restraints, strip searches, and forced drugging. Meanwhile, there is a lot of evidence these policies harm people. There are always less invasive alternatives, and a collaborative decision-making process is the bare minimum expected in other areas of medicine. The same should be true in mental healthcare. 
2. Adherence to advance directives: Psychiatrists should be barred from deviating from advance directives, including based on a history of mental disorder. These directives already require potential patients to be of "sound mind" and have 1-2 witnesses when these are created, so their wishes should be respected. Additionally, providing advance directive forms should be compulsory for all people entered into the mental healthcare system. Therapists and doctors should offer to take an active role in crisis planning from the outset of care.
3. Rights for self-harming patients: When a patient is self-harming, the immediate threat should be removed (e.g. take the implement away), and the patient should be spoken to about the steps moving forward. Voluntary deescalation training should be mandated for all workers. No further coercion should be permitted after the immediate threat is addressed (unless otherwise specified by an advance directive), and a supported decision-making process should ensue. Any footage should be kept available to prevent abuse, overreaction, or misleading patient records from biasing courts.
4. Rights for violent patients: While rare, a few patients diagnosed with SMI can become agitated and violent towards others. For the safety of other patients and staff, these patients should be kept in a separate ward from peaceful ones. If they choose staying in a ward over jail, they should not be detained longer than they would be in jail. Voluntary deescalation training should be mandated for all staff to avoid coercive measures. However, if coercive measures are used, any advance directive specifications should be respected (e.g. desire for injection over restraints, or vice versa). Like with self-harming patients, any available footage should be mandated to appear in trial to demonstrate the behavior of both patient and staff during the issue and in the aftermath. This way, potential for abuse, overreaction, or misleading records biasing courts is minimized.

The Decision Makers

Joseph R. Biden
Former President of the United States
U.S. Senate
2 Members
Rand Paul
U.S. Senate - Kentucky
Bernie Sanders
Former U.S. Senator

Supporter Voices

Petition updates