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Monday, March 24, 2014

Workshop on Coercion

What could be called the 2nd Indo-European symposium on coercion, started today morning at 9 in the first floor of Platinum Jubilee Auditorium, JK Grounds, Mysore.

Checkout their website here: mysorecoercion.com

First, Prof. Tom Palmstierna talked about various forms of coercion used in Europe. Belts, net beds, clothes, so on. The interesting thing is, these practices are not the same in different regions. Some countries practise seclusion, some countries practise restraint, and mental health workers in different regions consider their own methods as good, and others' method as terrible.

He went on to point out cochrane reviews which said that there is no evidence to show that coercion is useful. By which he only meant that coercion per se is not helpful. And this point was clarified in questions, when Dr S said that coercion or physical restraint is the first step to treatment.

Although it was argued that coercion and restraint are not the same, Prof Palmstierna said that coercion is a spectrum which goes from restraint to strong advice.

The discussion about CTOs will happen later.

The second session - about the definition of coercion in the Indian setting, was made into a discussion session because Dr Murali Krishna was unable to reach.

The crowd was asked about different forms of coercive practices followed in India. It was said that people are tied up, that it is mostly the family that does it rather than the doctor, that religious leaders and institutions have a role in how psychiatric patients are managed. That sometimes there is nobody to coerce the large population of India - people who walk on streets, talking to imaginary friends. Chain cannot be used after Erwadi incidence. There are physical, mechanical, covert medication, etc. Covert is common. Seclusion is not so used. Coercion is a necessary evil, it needs to have a law. Different opinions will always exist.
Family's concern, patient's concern. Autonomy of patient vs freedom of society. Coercion is not a punishment. Role of BOV in MHA 1987 is not explained. Non-Indian citizens have to be considered. Is coercion always in the best interest of patients? Mental Health Care Review Board has only a role in supervision.
Shouldn't we be bothered about treatment more rather than the right of the patient?

We should try to achieve general good clinical practice. There should be no difference in hospital or community. Legislation will delegate the powers to execution.

Mysore Declaration on Coercion
 Last year, in the Indo-European symposium, a small step towards setting up guidelines about coercion was made.
In India, covert medication, etc is common place. But we do not have data about the use of coercive measures and other forms of leverage. This makes international comparison difficult.
There is a need for recognizing the rights of the mentally ill.
Disproportionate, unsafe or prolonged coercion or violence against persons with mental illness is a violation of human rights.
There are barriers like lack of awareness about the treatment and outcomes expected, the assumption that mental illness is always accompanied by mental incapacity, lack of provision for advanced planning in the event of future incapacity and compulsory admissions; lack of resources, lack of training.

Long term goals would be to involve patients in decisions made about them. To develop strategic plans, benchmarking, regular analysis of data, regional and national and international comparisons and transparency.

And so on