Supporting and implementing alternatives to coercion in mental health care
The use of coercion in mental healthcare has long been subject to controversy, and the call for viable alternatives is growing both within the profession and among people with lived experience of coercion in mental healthcare.
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Advocates for change aim to maximise therapeutic outcomes and promote the rights and recovery of people with mental health conditions and associated psychosocial disabilities. Research and guidance is now available to support the implementation of alternatives to coercion in low-income, middle-income and high-income countries. Service managers, clinicians, and people with lived experience and their families all can play a central role in leading change. With appropriate resources the services can, for example, pursue WHO QualityRights assessment and transformation processes and promote initiatives explicitly aimed at implementing alternatives to coercion.
An effective and long-lasting change can only take place in a recovery oriented system of care, in which respect for human rights and service user involvement are not only required, but realised through sound pathways to non-coercive care. This includes attention to all the important steps along the way – prevention, early intervention, and continuity beyond clinical settings to provide integrated and personalised care. Meaningful involvement by persons with lived experience of mental health problems and psychosocial disabilities and their families bring crucial insight and momentum irrespective of where the services are in their development.
Resources for implementing alternatives to coercion
The WPA is committed to supporting mental health professionals and their organisations to implement alternatives to coercion. To this end, the WPA has been working with the Royal Australian & New Zealand College of Psychiatrists, theJapanese Society of Psychiatry and Neurology and other partners to produce the following resources:
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WPA Position Paper and Call to Action:
Implementing Alternatives to Coercion: A Key Component of Improving Mental Health Care
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WPA Consultation on Implementing Alternatives to Coercion in Mental Healthcare (2020):
Summary of responses from Member Societies and the Service Users and Family Carers Advisory Group
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WPA Discussion paper: Review of evidence, policy and practice:
Implementing Alternatives to Coercion in Mental Health Care Discussion Paper from the WPA Taskforce
Index of tools and resources:
Implementing alternatives to coercion in mental health care: A growing list of tools and resources
Example from practice:
Campo Abierto Bogotá (Colombia) in English
Campo Abierto Bogotá (Colombia) in Spanish
Towards eliminating seclusion and restraint in Australia and New Zealand
The WPA will continue to update this list as it produces new tools and resources.
In addition, the WPA maintains an active partnership with the World Health Organization, which offers the QualityRights E-Training on Mental Health, Recovery and Inclusion. It is available in eleven languages and can be accessed free of charge.
Implementing Alternatives to Coercion in Mental Health Care Working Group
The WPA Working Group (WG) on Implementing Alternatives to Coercion in Mental Health Care has been tasked with the following:
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To identify topics related to improvement of the quality and safety of mental health services and implementation of sound alternatives to coercion, that are of interest for all stakeholders, and develop recommendations for WPA’s involvement in research, education and service development relevant to dealing with problems of quality and safety of mental health services.
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To identify member societies, institutions and individuals interested and willing to participate in WPA’s programs of research, service development and education related to the implementation of alternatives to coercion.
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To liaise with the other WPA Action Plan Working Groups on quality and safety of mental health services with a view to ensure that problems of respect for dignity and human rights of people with mental disorders, and related advocacy activities, are considered in the work of these groups and vice versa.
Members
Working Group Coordinators
John Allan
MBBS, FRANZCP, PhD, GAICD
MBBS, FRANZCP, PhD, GAICD
Associate Professor
President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) until May2021
Executive Director of Mental Health Alcohol and other Drugs Branch, Clinical Excellence Division in Queensland Health
School of Medicine University of Queensland
15 Butterfield St Herston, Brisbane 4030 Australia
Email: John.Allan@ranzcp.org
Read Professor Allan’s biography here
Silvana Galderisi
MD, PhD
Full Professor of Psychiatry
University of Campania Luigi Vanvitelli
Naples, Italy
Phone +39 081 5565155
Read Professor Galderisi’s biography here
Helen Herrman
MD, MBBS, BMedSc, FRANZCP, FFPH, FAFPHM
MD, MBBS, BMedSc, FRANZCP, FFPH, FAFPHM
Professor Emeritus of Psychiatry, Orygen and Centre for Youth Mental Health,
The University of Melbourne
Parkville, Victoria, Australia
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Read Professor Herrman’s biography here
Working Group Members
Michaela Amering
MD Univ. Prof. Dr.
Clinical Division of Social Psychiatry
Department of Psychiatry and Psychotherapy
Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
Phone +43 1 40400 35460
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Email: michaela.amering@meduniwien.ac.at
Read Professor Amering’s biography here
Neeraj Gill
MBBS; MD (Psychiatry); FRANZCP; DrPH
Professor, School of Medicine, Griffith University,
Gold Coast, Australia
Consultant Psychiatrist, Gold Coast Health, QLD, Australia
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Email: neerajgill@griffith.edu.au
Read Professor Gill’s biography here
Andreas Heinz
Prof. Dr. med. Dr. phil.
Director and Chair, Professor (W3)
Department of Psychiatry and Psychotherapy
Charité – Universitätsmedizin Berlin, Charité Campus Mitte
Charitéplatz 1, 10117 Berlin, Germany
Phone: +49 (30) 450 517 001 andreas.heinz@charite.de
Read Professor Heinz’s biography here
Guadalupe Morales
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Bachelor Degree in Communication and Journalism
Director of Fundación Mundo Bipolar
Madrid, Spain
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Email: gm@mundobipolar.org
Read Guadalupe Morales’ biography here
Soumitra Pathare
MD DPM MRCPsych PhD
Director, Centre for Mental Health Law and Policy, Indian Law Society
Pune, India
Phone +91-9370666191
Email: spathare@cmhlp.org
Read Dr Pathare’s biography here
Maria Rodrigues
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BA (Psychology) Elmira College, New York, USA
PhD (Applied Ethics) The University of Melbourne, Australia
Lead Researcher, Community Works
Melbourne, Australia
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Email: maria@communityworks.com.au
Read Dr Rodrigues’ biography here
Martha Kane Savage
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PhD in Geophysics, FRSNZ, Fellow of the American Geophysical Union
Wellington, New Zealand
Phone +644635961
Email: martha.savage@vuw.ac.nz
Read Professor Savage’s biography here
Working Group Advisors
Paul S. Appelbaum
MD
Dollard Professor of Psychiatry, Medicine, & Law
Columbia University Vagelos College of Physicians & Surgeons
New York, NY, USA
Phone 646-774-8630
Email: Paul.Appelbaum@nyspi.columbia.edu
Read Professor Appelbaum’s biography here
Natalie Drew Bold
MA Human Rights
Technical Officer, Policy Law and Human Rights, Department of Mental Health and Substance Use, WHO
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Phone +41227913206
Email: drewn@who.int
Read Dr Drew Bold’s biography here
Michelle Funk
BSc (Hons),, MPsych, PhD
Unit Head, Policy, law and human rights, Department of Mental Health and Substance Abuse, World Health Organization
Switzerland
Phone +41-22 791 3855
Email: funkm@who.int
Read Dr Funk’s biography here
Shigenobu Kanba
MD, PhD
Professor Emeritus, Kyushu University
Nagano Prefecture, Japan
Email: kanba.shigenobu.921@m.kyushu-u.ac.jp
Read Professor Kanba’s biography here
Pratima Murthy
MD DPM FRCP (Glasgow)
Professor and Head, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS)
Bangalore, India
Phone +91-9844094482
Email: pratimamurthy@gmail.com
Read Professor Murthy’s biography here
George Szmukler
MB BS, DPM, MD, FRICPsych
Fellow King’s College
London, UK
Email: george.szmukler@kcl.ac.uk
Read Professor Szmukler’s biography here
Working Group Board and ECP Representative
Working Group Coordinators
Juliet Nakku
Butabika Hospital, P.O.Box 7017, Kampala Email : jnakku@yahoo.com
Working Group Coordinators
Amine Larnaout
Immeuble 1, appartement 7, cité Les Oliviers, Menzah 6, Ariana 2091; Tunisia
Email: larnaout.amin@gmail.com
Working Group members and advisors list can be downloaded here
Deliverables
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Symposium, workshop, forum other type of meeting
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Webinar(s)
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Position papers, reports, guidelines
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Digital/online, print version documents
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Articles in journals, books
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Products distributable through social media (eg short videos)
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Research protocols and studies
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Training programs
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Collaboration with other organisations working in this field
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This Discussion Paper from the WPA Taskforce outlines recent developments in practice, research and international human rights law concerning coercion in mental health settings with the aim of supporting psychiatrists and other mental health professionals in their work towards improving the quality and safety of mental health services and putting sound alternatives to coercion in place. Download the Discussion Paper HERE
Implementing Alternatives to Coercion: Examples from Practice
A set of three case studies designed to share experiences and promote understanding of existing efforts to generate change in settings operating under varying social, cultural, and economic conditions. It aims to encourage and support mental health professionals around the world to work with people with lived experience, service providers and other partners to put alternatives to coercion into practice. It should be noted that the WPA has neither implemented nor evaluated the work described in the case studies. Where available, links to full case studies are included below.
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Campo Abierto, Colombia – an example of a health facility implementing alternatives to coercion
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Quality Rights Gujarat, India – an example of implementing alternatives to coercion at the state level
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Towards eliminating coercion in Australia and New Zealand – an example of implementing alternatives to coercion at the national level