Seclusion, restraint and coercion: abuse 'far too common' in mental health services across the world

·3-min read
Therapy concept illustration
Therapy concept illustration

Severe human rights abuses and coercive practices are still far too common in mental health services in all countries, the World Health Organization has warned.

In a damning new report, the WHO has called for “considerable” changes in countries of all income levels, citing widespread use of forced admission and treatment; manual, physical and chemical restraint; physical, verbal, psychological and sexual abuse; and unsanitary living conditions. Globally, the majority of mental health care continues to be provided in psychiatric hospitals, the report found.

Dr Michelle Funk, from the department of mental health and substance use at the WHO, told the Telegraph that physical, sexual and emotional abuse are widely reported.

“Even in high-income countries, the unnecessary seclusion or restraint of people with mental health conditions or who are experiencing a mental health crisis still occurs,” she said. “These practices have detrimental effects on people’s mental health and can also lead to physical harm.”

Dr Funk added that the pandemic has “brought to light the damaging effects of institutions”, and the “the marginalisation” of mental health sufferers. In January, the WHO warned a “parallel pandemic” of poor mental health was unfolding in Europe, with half of young people reporting depression and anxiety.

The report throws into the spotlight how most countries overlook causes of distress – violence, discrimination, poverty, job insecurity, poor housing and lack of health services – and instead over-prescribe drugs, often the only form of treatment.

“Too often treatment focuses on diagnosis and symptom reduction instead of taking a broader, holistic approach which includes talking therapies and peer support as well as links to education, income generation, housing and social protection systems where these are needed,” Dr Funk said.

Governments around the world currently spend less than two per cent of their health budgets on mental health, according to the WHO’s latest estimates.

While allocating financial resources to mental health is necessary, it alone won’t help. The report found that many existing policies and laws are part of the problem, with the majority of expenditure allocated to psychiatric hospitals.

The WHO is calling for community-based mental health care, which focuses on recovery and supports day-to-day living. This could include helping find access to accommodation, education or employment services.

Cost comparisons indicate that such services can be provided at the same or lower cost than “mainstream” mental health services. In some cases, these also have better outcomes, the report found.

Successful examples cited include Link House in Bristol, a crisis centre for women over 18, where residents are encouraged to follow a routine and learn skills related to self-care, cooking, time management and employment.

Similarly, Soteria in Switzerland – which supports people experiencing psychosis or schizophrenia – offers a home-life environment. The centre has been found to be “as effective as traditional hospital-based treatment”, but with much lower levels of medication.

In Norway, an open-door service invites individuals to acknowledge and accept frightening thoughts and feelings, and manage them with more functional coping strategies. It found participants displayed fewer symptoms and significantly improved their level of functioning afterwards.

Dr Funk concluded: “Now is the time to increase investment in mental health and ensure that this funding goes towards comprehensive mental health services that are person-centred and respect people’s human rights.”

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