From The Journal: “We are all potential users of mental health services. The question is how would we like to be treated if we found ourselves in this situation?
Under current Irish mental health legislation, people experiencing severe mental distress are at high risk of being denied the right to make decisions about their treatment, deprived of their liberty, and having their human rights violated.
This is at odds with the United Nations, World Health Oganization and international best practices. The real tragedy is that people are still having their human rights violated and not getting the support they want in the Irish mental health system.
At the moment, members of the Oireachtas are working through proposed changes to the Mental Health Act after the Government approved the draft heads of a Bill of amendments to the legislation.
Human rights approach
The UN Convention on the Rights of Persons with Disabilities requires us to move to a human rights-based approach in line with WHO guidance. This is an obligation, not a choice. The World Psychiatric Association has recently made important steps in this direction and issued a position statement entitled ‘Implementing alternatives to coercion. A key component to improving mental healthcare’:
‘Mental health is the only area of healthcare where people can still be treated without their consent outside of emergency situations even though research shows that people are at no greater risk than the general population and have similar levels of decision-making capacity’.
While only 16% of people being admitted for mental health treatment in Ireland in 2020 are detained under the legislation, the threat of coercion permeates the whole system and affects everyone who is admitted on a voluntary or involuntary basis due to regrading powers in the legislation.
Coercion includes any intervention or treatment given against a person’s will or without their informed consent and can be actual or implied . . . The fear that non-compliance with mental health treatment may lead to detention in hospital or forced treatment under the legislation is described as ‘a coercive shadow’. Many people are not seeking help when they need it for this reason. Any treatment decision made under the threat of coercion is not free and informed consent.
Coercion has a profound impact on the person and should not be viewed as necessary to treat people . . . It is not necessary to violate human rights to respect them.
Involuntary detention and treatment are not necessary if we have a system of support and alternatives in place to allow people to access treatment in accordance with their wishes in these situations. Our new Assisted Decision-Making (Capacity) Act (due to commence this summer) is moving towards a system of supported decision-making for this very reason. Our new mental health policy, Sharing the Vision, also states that coercion should only be used in emergency circumstances.
Fear of system
There is no evidence that current approaches are working or giving people any choice. Readmission rates of 61% in the mental health system suggest we need to consider funding alternatives. Coercion is extremely stigmatising and traumatising for the person and can lead to a breakdown of trust, leading to further isolation.”
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