The additional protocol will have to be approved by the Committee of Ministers of the Council of Europe. If it will happen, individual countries will be able to choose to ratify it and be included in the discipline of protocol. But there are also proposals for alternatives.
“Sign and ratify this protocol means endorse involuntary treatment, which is a huge step backwards – Marie Fallon-Kund of Mental Health Europe said – We think that involuntary treatment must not be regulated, it must be abolished”.
Marie, tell us about the study on alternatives your organization has performed about involuntary treatment.
“Our organization, Mental Health Europe, has also been involved in the opposition to this protocol from the beginning. Our work at Mental Health Europe is guided by the conventions of the rights of persons with disabilities. This protocol drives us backwards with the rights of people with psycho-social disabilities. One of our current projects is to work on a report exploring promising practices for the reduction of coercion. What we did was to send a request to our 73 national level member organizations about who are service providers, users or former users of mental health services, health professionals and organizations as family organizations and representative organizations of users”.
Which was your work with these organizations?
“We asked them if they knew alternatives in their countries, promising practices to reduce and to prevent the use of coercion. Through this consultation, we got some examples which we are compiling now. This will result in a report of approximately 15 pages, a report which is accessible to the broad audience and shows that it is possible to reduce or end coercion in mental health services. We have set a database for these practices, very local level initiatives that contribute to reduction and end of coercion. Some initiatives are also more preventive, to avoid that a person comes to a situation where coercion could be needed”.
Also the University of Melbourne made a report about alternatives. Are your proposals connected with those of Melbourne?
“Some are connected, not all. I have seen that report, but the Melbourne report is focused on examples that have been published in scientific articles and have been scientifically evaluated. That was the main focus of the Melbourne report, it was by academic researchers”.
Where is your approach different?
“For us the examples mainly come from our members, that are people who have experience or work in mental health services at national level. We didn’t take a scientific approach on our report, for us the idea was to ask examples from and for a non-academic audience. That is the main difference. What we compiled comes from a consultation among our members and not through scientific publications”.
Can you give an example?
“In Sweden there is a project which came from the Human Rights Committee of the region of Gotaland, in the psychiatric wards of hospitals to deal with persons who are experiencing psychosis. The training in the Sahlgrenska Hospital was developed by human rights defenders in collaboration with users, staff members and hospital managers for everyone wants to get a human rights approach to mental health. The result of the training is: that the use of both physical and mechanical restraints has been dramatically reduced; that there were fewer forced injections; that the staff is more satisfied with their work; that users as well are more satisfied with the services. This work is spreading to all the region of Gotaland to other psychiatric wards to eliminate coercion in the psychiatric care. A 2017-2020 action plan was adopted with a zero vision to coercion as a core objective for the 2020”.
What are the general conclusions after the job you have done for the report?
“What I can tell from the examples we assessed on the past weeks is that we need different elements to be able to obtain the reduction in view of elimination of coercion. It means that we need a multidisciplinary approach, and a lot of people working together in multiple disciplines. We need training, a lot of awareness raising, and initiatives aimed also to change the physical environment to make it more positive, if you want, for users”.
Have you studied proposals out of psychiatric wards?
“I made an example which involved hospitals, but community space practices are equally important. For example implementing community-based services allow to prevent coercion, because if we have sanitary services available in the community it allows to have less need of coercion”.