Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World

Abstract

Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action ‘FOSTREN’ is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.

Factors and Processes Facilitating Recovery from Coercion in Mental Health Services—A Meta-Ethnography

“…When there is respect and dignity during coercion, patients have some kind of control, and the therapeutic alliance is kept, then the experience is less negative [ 19 , 86 , 87 ]. Wards that engage in more humane care, with a focus on respect, open communication, debriefing and empowering patients, are less coercive (e.g., Safewards and Sixcore strategies) [ 92 ]. This might be because there is less aggression within contexts that are less controlling and because caregivers who are emotionally closer to their patients see them more easily as unique human beings and use less coercion [ 93 ].…”

Something Happened with the Way We Work: Evaluating the Implementation of the Reducing Coercion in Norway (ReCoN) Intervention in Primary Mental Health Care

“…Below, we use excerpts from the data to illustrate and validate interpretations [28]. Unless otherwise specified, these are selected as they represent shared views and are only identified by municipality number [1][2][3][4][5], to protect anonymity.…”

“…The feasibility and penetration of the ReCoN intervention are highly relevant to national and international policy for reduced use of involuntary care [1,4,14] because it shows there may be potential to work towards this aim through collaborative, ongoing general support services [10] when people live at home. Should the pending RCT result of the intervention show positive outcomes, there will be a case for rethinking policy in his area, including the way in which responsibilities and resources are distributed.…”

“…Public policy in a number of countries seeks to reduce the use of involuntary psychiatric admissions [1,2]. Calls for such reduction come from international bodies, including the UN, WHO, and Council of Europe [2][3][4], and service user organisations [5].…”

No-Restraint Committed General Hospital Psychiatric Units (SPDCs) in Italy—A Descriptive Organizational Study

“…Despite some successes, significant research and application gaps remain [ 4 ]. The EU-COST Action ‘FOSTREN’ addresses these gaps, examining ways mental health services can eliminate coercive methods [ 5 ].…”