Preventing and reducing 'coercion' in mental health services: an international scoping review of Englishlanguage studies. This article discusses initiatives aimed at preventing and reducing 'coercive practices' in mental health and community settings worldwide, including in hospitals in high-income countries, and in family homes and rural communities in low-and middle-income countries. The article provides a scoping review of the current state of English-language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals' rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non-Englishlanguage studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.
In recent years, the enumeration of the right to legal capacity in the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) has caused considerable controversy. The adoption of General Comment No. 1 by the UN Committee on the Rights of Persons with Disabilities ('CRPD Committee') in April 2014 sheds new light on major debates in the field, particularly regarding implementation measures to fulfil the obligation of States Parties to provide people with disabilities with 'support to exercise legal capacity' on an equal basis with others. This interpretive guidance builds upon the CRPD framework for achieving equal recognition before the law for people with disabilities. Yet commentators have criticised both the CRPD Committee's interpretation and the enumeration of Article 12 in the CRPD itself, as wanting in key respects. This article draws on the General Comment No. 1 to list and respond to major concerns raised about the obligation of States Parties to provide people with disabilities the support they may require in exercising their legal capacity. The list of concerns and counter-arguments are set against a broad range of implementation measures from domestic law and policy from around the world.
Respecting a person's choices about the mental health services they do or do not use is a mark of quality support, and is often pursued for moral reasons, as a rights imperative and to improve outcomes. Yet, providing information and assistance for people making decisions about the mental health services can be a complex process, and has been approached in various ways. Two prominent approaches to this end are 'shared decision-making' and 'supported decision-making'. This article considers each of these approaches, discussing points of similarity and difference and considering how the two might complement one another. By exploring the contribution that each approach can make, we conclude by proposing how future application of these approaches can account for the broader context of decisions, including support for ongoing decision-making; the multitude of service settings where decision-making occurs; and the diversity in supportive practices required to promote active involvement.
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