Human Rights Expert: Why Everyone Should Care About Coercive Psychiatry

Efforts to improve mental health access and care are laudable.

Hospital
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The COVID-19 pandemic brought more awareness to mental health and less stigma associated with those who seek treatment. As the world attempted to navigate one mental health crisis, another has been happening under our noses for years. In 2021, the World Health Organization released a 296-page report which called for countries to prohibit "coercive practices such as forced admission and treatment, seclusion and restraint, as well as the administering of antipsychotic medication, electroconvulsive therapy (ECT) and psychosurgery without informed consent." These shifts show positive progress in the mental health sphere related to coercive psychiatry within short-term emergency commitment (STEC). With poor reporting on STEC still common, however, we must continue to make improvements to ensure that individual rights are not violated.

What Is STEC?

Short-term emergency commitment is the practice of having law enforcement or other authorized professionals involuntarily bring a person to a facility for mental health evaluation. It recognizes that mental health issues can make it difficult for individuals to accurately evaluate their safety or needs. STEC is intended to protect those in a mental health crisis from hurting themselves or others.

STEC goes by different names and is associated with a range of legislation based on region (e.g., the Baker Act in Florida), but every state has some form of mental health law that allows it. However, there is a concerning lack of reporting on STEC, making it difficult to provide oversight, evaluate the effectiveness and determine the number of people being taken into custody. Only 38 states have STEC data. Of those, only 25 have data sufficient for proper analyses. At the same time, cases of STEC are on the rise. Looking at the 22 states with continuous data, the average yearly detention rate increased by 13% between 2011 and 2018.

Even though data on STEC is cloudy, it's possible to make some broad extrapolations to get a sense of the potential scope of the practice. In 2018-2019, Florida saw 210,992 involuntary Baker Act exams. Assuming that other states are conducting exams at similar rates, this would result in millions of STECs having been initiated across the United States for that period.

How Are We Dealing With Mental Health?

Many mental health advocates are addressing the current mental health crisis by calling for increased mental health funding and better access to mental health treatment options. These options include initiatives within President Joe Biden's unity agenda, which recognized disparities in impacts by race and age. But, a look at Maine compared to Florida raises questions about whether more mental health spending works. Although Maine spends $375 per capita on mental health, the state's suicide rate per 100,000 still sits at 18.45, above the national average of 14.21. Comparatively, Florida has low mental health treatment access and the lowest funding, yet they have the 13th lowest suicide rate. If putting more money toward mental health access and treatment was the solution, the expectation would be that the suicide rate in Maine would be lower.

Maine's situation suggests that leaders take a broader view of the mental health crisis and not see money for treatment access as a cure. In their report, the WHO noted that the current stress still is on diagnosis, medication and symptom reduction — that is, it's primarily approached under a biological, reactive lens. Other social factors that can influence mental health, such as isolation, violence and poverty, often are overlooked or excluded.

What Do We Do?

Even as data on certain mental health areas such as STEC need verification and improvement, there's little question that people are suffering and need good mental health support. Even before the pandemic, there were signs of a troubling trend. Roughly one out of five adults (nearly 50 million Americans) experienced a mental illness, and the number of adults reporting an unmet treatment need sat at 24.7%. Schools, businesses and other organizations are attempting to find ways to ensure that people can be properly and compassionately evaluated and get the help they need.

Efforts to improve mental health access and care are laudable. Still, they likely will be most effective when placed parallel to initiatives that can shift the more considerable, interconnected social concerns the WHO noted. Safe, affordable housing is one of the most foundational elements. A place to live provides the stability necessary for other elements of recovery, such as being able to hold a job or get adequate rest. Additionally, insufficient nutrition, violence and a lack of access to valuable health care can affect mental health. Reducing these root concerns is no easy or quick task because each issue has its own spiderweb of ethical and economic disputes to tease apart. But this approach creates a person-centric solution while simultaneously reducing the reliance on the flawed biomedical model which relies on psychiatric drugs, while failing to address the individual and also encouraging citizens to take greater accountability for their roles in the mental health story. It sets the stage for advocates to try to provide other assistance before performing a STEC and admitting them to a mental health facility.

To Lead the World in Freedom, We Must Start With Mental Health.

Around the world, civil liberties are declining. People in the United States have long celebrated these freedoms and have woven them into the fabric of American culture. The right to have autonomy over one's mind and body is arguably the most basic freedom we enjoy, enabling all others. Although arguably proposed with good intention, STEC does more harm than good for autonomy. The current lack of oversight and data collection allows for abuses according to various biases and circumstances, creating a slippery slope of precedent that might allow future encroachments on other rights. To prevent additional degradation of mental health and other liberties, Americans must find a compassionate, statistically proven and more effective alternative to STEC that can serve as a model for the entire world.

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