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Resolution 2291 (2019)
Ending coercion in mental health: the need for a human rights-based approach
1. In Europe, a growing number of
persons with mental health conditions or psychosocial disabilities
are subject to coercive measures such as involuntary placement and
treatment. Even in countries where so-called restrictive laws have
been introduced to reduce the recourse to such measures, the trend
is similar, indicating that in practice such laws do not seem to
produce the intended results.
2. The overall increase in the use of involuntary measures in
mental health settings mainly results from a culture of confinement
which focuses and relies on coercion to “control” and “treat” patients
who are considered potentially “dangerous” to themselves or others.
Indeed, the notion of risk of harm to oneself or others remains a
strong focus in justifications for involuntary measures across Council
of Europe member States, despite the lack of empirical evidence
regarding both the association between mental health conditions
and violence, and the effectiveness of coercive measures in preventing
self-harm or harm to others. Reliance on such coercive measures
not only leads to arbitrary deprivations of liberty but, being unjustified
differential treatment, it also violates the prohibition of discrimination.
3. Moreover, evidence from sociological research in the field
on persons with mental health conditions points to overwhelmingly
negative experiences of coercive measures, including pain, trauma
and fear. Involuntary “treatments” administered against the will
of patients, such as forced medication and forced electroshocks,
are perceived as particularly traumatic. They also raise major ethical
issues, as they can cause irreversible damage to health.
4. Coercion also has a deterrent effect on persons with mental
health conditions who avoid or delay contact with the health-care
system for fear of losing their dignity and autonomy, which ultimately
leads to negative health outcomes, including intense life-threatening
distress and crisis situations, which in turn lead to more coercion.
There is a need to break this vicious circle.
5. Mental health systems across Europe should be reformed to
adopt a human rights-based approach which is compatible with the
United Nations Convention on the Rights of Persons with Disabilities,
and is respectful of medical ethics and of the human rights of the
people concerned, including of their right to health care on the
basis of free and informed consent.
6. High success rates in preventing and reducing recourse to
coercive practices have been achieved through a number of approaches
within and outside Europe; positive examples include hospital-based strategies,
community-based responses, such as peer-led crisis or respite services,
and other initiatives, such as advance planning. These promising
practices are also highly effective in assisting persons with mental health
conditions during crisis situations, and should thus be placed at
the centre of mental health systems. Services which rely on coercion
should be considered unacceptable alternatives that must be abandoned.
7. In view of these elements, and convinced that greater awareness,
cross-stakeholder co-ordination and political commitment are crucial
in initiating and sustaining the much-needed change in mental health
policies, the Parliamentary Assembly urges the member States to
immediately start to transition to the abolition of coercive practices
in mental health settings. To this end, it calls on the member States
to:
7.1. develop, as a first step,
a road map to radically reduce recourse to coercive measures, with
the participation of all stakeholders, including in particular persons
with mental health conditions and service providers;
7.2. develop effective and accessible support services for
people experiencing crises and emotional distress, including safe
and supportive spaces to discuss suicide and self-harm;
7.3. develop, fund and provide resources for research on non-coercive
measures, including community-based responses such as peer-led crisis
or respite services, and other initiatives, such as advance planning;
7.4. dedicate adequate resources to prevention and early identification
of mental health conditions and early, non-coercive intervention,
especially in children and young people, without stigmatisation;
7.5. fight the stereotypes about persons with mental health
conditions, in particular the erroneous public narrative with regard
to violence and persons with mental health conditions, through effective awareness-raising
activities involving all relevant stakeholders, including service
providers, the media, the police and law-enforcement officers and
the general public, as well as persons with lived experience of
mental health conditions;
7.6. review the curricula of higher education institutions,
in particular those of schools of medicine, law and social work,
to ensure that they reflect the provisions of the United Nations
Convention on the Rights of Persons with Disabilities;
7.7. fight against the exclusion of persons with mental health
conditions by ensuring that they have access to appropriate social
protection, including housing and employment;
7.8. provide adequate social and financial support to families
of persons with mental health conditions to enable them to cope
with the stress and pressure of supporting their loved ones.