Mental Health Europe: President’s letter to the Lancet

Outgoing President of Mental Health Europe and Penumbra Chief Executive Nigel Henderson has written to the Lancet about a report they published earlier this year.

On behalf of Mental Health Europe I would like to respond to the Lancet’s Editorial (Jan 27, p 282) written about our Mapping and Understanding Exclusion report. Although we welcome the coverage of our report, we were disappointed to see a reference to the need to uphold the status quo on coercive measures, which might lead to confusion regarding the conclusions of our report. The Lancet’s Editorial stated that: “Involuntary treatment and detention are a necessary part of mental health care”. This statement is contrary to the core message in our report, which recommended that to reduce coercion in mental health services European states should adopt policies and practices that aim to immediately reduce coercion in mental health services and ultimately make such practices by exception only, in line with human rights standards.

We agree with the fact that coercion being commonplace in mental health services is “shameful”. However, prioritising reform of mental health laws will not make a difference if we do not have a human rights-based approach. The UN Convention on the Rights of Persons with Disabilities requires a shift away from the use of forced placement and treatment towards human rights-compliant mental health systems, which fully reflect the right to informed consent and legal capacity.

Effective alternatives to coercive and institutional mental health services do exist, including Open Dialogue, Soteria Houses, advanced directives, and Zero vision initiatives, which aim to substantially reduce coercion. Human rights training, such as the WHO and the training implemented in psychiatric services in the region of in Sweden, can reduce the use of coercion, seclusion, and restraint, and can empower practitioners and users to know their rights and obligations. These sorts of alternatives and training should be the mainstream in mental health services.

Our report did show that some countries, including Germany, Finland, and Israel (which managed an impressive 60% reduction in seclusion and restraint), were working hard to reduce coercion through legislative and other reforms. However, other countries reported year-on-year increases in forced treatment and placement. Perhaps one of the most shocking findings from our research was that many countries do not collect or make data available on the use of coercion. Every incidence of involuntary placement and treatment, restraint, and seclusion, and reasons for their use should be properly documented and the information should be publicly released. Our report goes some way towards scaling the problem. However, if details were known on how coercive mental health systems are, would people still be advocating for the status quo?

Experience shows that when a mental health system accepts coercion as normal practice, practitioners will continue to use it; and when a system is under stress, financial or otherwise, the amount of coercion will rise regardless of the rights of individuals.

You can read the letter on the lancet website here.

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