Thank all of you who signed our petition. On the Eighth anniversary of Kelly’s passing, I would like to share with you an article that I published with the World Psychiatric Association’s Working Group on Implementing Alternatives to Coercion. This article is now on the WPA web page describing a survey of people with lived experience of mental health conditions, their family and informal carers, and Psychiatrists, in a report: “Transforming Mental Health Care: Insights from the WPA Consultation on Implementing Alternatives to Coercion” (
https://www.wpanet.org/_files/ugd/6aba35_a221c6ea4a5f4015abd47c18ed33d190.pdf
)
Summary of the WPA report:
Here, ‘coercion’ describes a range of interventions, from involuntary treatment to forceful action and threats undertaken while providing treatment or addressing perceived harm a person poses to herself/himself or others due to a mental health condition. The WPA Position Statement and Call to Action: “Implementing Alternatives to Coercion: A Key Component of Improving Mental Health Care” was published in 2020 and updated in 2023. It stresses that implementing alternatives is crucial to improve quality of care and promote the human rights of people with mental disorders and psychosocial disabilities.
Yet there is a large variation in practices used in mental health services and countries are in different stages in development of understanding and introducing alternatives to coercion in clinical practice. In 2022-23 the WPA Working Groups on Partnership with Service Users and Family Carers, and Implementing Alternatives to Coercion co-designed and implemented two consultations with psychiatrists, people with lived experience of mental health conditions (PLEx), and their family members, and informal carers (FMIC) to gauge:
1. WPA member societies experience with and intention to pursue alternatives to coercion.
2. The experience and understanding of PLEx and FMIC (including participants responding on behalf of groups representing lived experience)
The final report on the consultation is now on the WPA website at the link above, and we repeat the highlights here:
In total 19 of member societies responded to the questionnaire sent to the WPA member societies (Eleven other societies had responded to an initial scan of activities in 2021). Eighty percent were actively working on alternatives to coercion with legislative change, public position papers, guidelines and working groups being the most common interventions. All considered that they will continue to work on or would soon take steps to support alternatives to coercion. Half the member societies thought that WPA should offer more training and professional guidelines.
This consultation was answered by 96 PLEx and 33 FMIC, representing 20 countries.
The responses from 133 PLEx produced a wealth of practical suggestions to improve implementation of alternatives to coercion. Over one quarter of PLEx respondents conveyed that their human rights were violated or compromised by coercion. Over half experienced trauma or re-traumatisation, and 44% reported a loss of trust in and reduced engagement with medical services, some even to the point of attempting suicide rather than submitting to a repeated hospitalisation.1
FMIC considered that the impacts on the life and recovery of their loved one as the result of the coercion were death (4 responses), negative impacts on health, social life, self esteem, self advocacy and their relationships with mental health service providers. No PLEx, and only 10% of FMIC responded that involuntary treatment was necessary to save the life or quality of life of their loved one.
Suggestions for what could have been done better ranged from better communication and respect, holistic engagement, enhanced care, compassion and understanding, peer-led support, greater family involvement, and better training for both families and health care workers.
Authors (of the summary): Martha Savage, Guadalupe Morales, Maria Rodrigues, Helen Herrman, John Allan, Guadalupe Morales, Silvana Galderisi