Transforming Mental Health Care

Insights from the WPA Consultation on Implementing Alternatives to Coercion

In 2024, Kindred worked in collaboration with the World Psychiatric Association (WPA) and Community Works to complete a global consultation on addressing coercion in mental health care settings.

Parallel online consultations were held with:

  • WPA Member Societies on behalf of the psychiatrists they represent
  • People with lived experience of mental health conditions (PLEx),
  • Family members and informal caregivers (FMIC) of PLEx,
  • Organisations representing PLEx and FMIC.

Through a collaborative effort, this consultation has sparked conversations amongst psychiatrists while prioritising the voices of people with mental health conditions and recognising them as rights-holders whose needs and interests are central to quality of care.

People with lived experience of mental health conditions (PLEx), family members and informal carers (FMIC) were central to all stages of designing and delivering this consultation. Analysis of consultation responses from PLEx and FMIC was led by Guadalupe Morales (PLEx) and Martha Savage (FMIC) supported by professional social researchers at Kindred (two of whom are also FMIC) and experienced psychiatrists.

The resulting consultation report compiles insights gathered from all participant groups above. The report reflects both overlaps and differences in perspectives, while concentrating on points of convergence across viewpoints expressed by the diverse range of participants. In doing so, it encapsulates a distinct perspective on implementing alternatives to coercion in mental health care and illuminates the disadvantage, discrimination and other harmful consequences of coercive practices in psychiatric settings around the world.

Key recommendations stemming from this consultation are:

Foster rights-based communication and compassionate care

Respectful and transparent communication with individuals and their families is essential to quality mental health support, alongside the broader need to treat individuals with dignity and compassion. Empathetic care is a critical factor in motivating individuals to seek help voluntarily and engage willingly in treatment and care. Informed consent across all aspects care is an important way of ensuring that respect for autonomy and rights remains central to mental health systems. Strong partnerships between psychiatrists, people with lived experience and family & informal carers is one way of achieving this. National legislation, service provider policies and de-stigmatisation of mental health conditions in the media are also important conduits for change.

Enhance training and education

Better training for psychiatrists and mental health workers is vital to implementing alternatives to coercion. All consultation groups called for better education on respectful treatment, trauma-informed care, examples of successful alternatives to coercion, and more comprehensive sharing of information with people with lived experience of mental health conditions and their families. Family support, self-care, effective communication, and greater awareness about the substantial risks of coercion were identified as key needs. Testimonies from people with lived experience and family members demonstrated these risks including traumatization, erosion of trust in health professionals, avoidance of treatment, lasting physical injuries and death.

Review protocols to ensure that coercion is not used as a default approach

Existing protocols surrounding mental health need comprehensive review, with emphasis on shifting away from coercion as the default approach. Prioritizing voluntary treatment over coercion is a common goal across all stakeholder groups consulted.

Promote collaboration and peer support

Consultation participants called for peer support programs and collaboration among psychiatrists, community professionals, and families. They stressed the value of diverse perspectives in designing, implementing and evaluating treatment and care. The importance of listening to people with lived experience and engaging peer support workers to strengthen support networks is central, involving family and carers when desired by the person with the person being treated.

Promote delivery of trauma-informed care

Addressing trauma and preventing re-traumatization in the course of mental health treatment is called for by people and organisations across all consultation groups.

Diversify understanding of mental health treatment and care

Individuals and organisations across all consultation groups acknowledged diverse perspectives and worldviews on the causes and treatment of mental health conditions. Respondents demonstrated interest in complexifying delivery of treatment and care beyond conventional medical models and overreliance on pharmacueticals and hospitalisation. This indicates the importance of expanding research to better understand what works when it comes to delivering high quality treatment and care free from coercion in a variety of different settings and situations.

Read the report