CCHR Calls on Psychiatric Association Meeting to Denounce Coercive Practices
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LOS ANGELES - Californer -- The mental health industry watchdog, Citizens Commission on Human Rights (CCHR) International, has called on the American Psychiatric Association (APA) to issue a formal position statement condemning the use of coercive psychiatric practices, as its peer groups have already done. Since 2020, CCHR has put the APA on notice of the global concern about forced psychiatric institutionalization and treatment, which is rampant in the U.S. CCHR's demands coincide with the annual meeting of the APA being held in New York, May 4-8—a city criticized for its coercive approach to involuntary commitment, compulsory outpatient treatment, high restraint use and forced electroshock treatment.

In 2020, the World Psychiatric Association (WPA) issued a "Position Statement and Call to Action: Implementing Alternatives to Coercion: A Key Component of Improving Mental Health Care."  It stated its concern about "the extent to which coercive interventions violate" human rights. It recognized practices that constitute coercion including formal (involuntary) detention, treatment without consent, and seclusion and restraint use.[1]

Earlier this month, the European Congress of Psychiatry held a special seminar for its attendees on reducing coercive measures in psychiatry—something CCHR has several times asked the APA to do at its annual convention. Medscape reported on the European seminar, titled, "Coercion in psychiatry: Epidemiology and Prevention," which was addressed by Julian Beezhold, MD, a consultant in emergency psychiatry for Norfolk and Suffolk National Health Services (NHS) Foundation Trust in England. He emphasized the importance of the shift away from coercion because of its risks. Coercive practices ranged from physical restraints to social and emotional pressure.[2]

However, the APA formally endorses involuntary commitment as a "useful tool to promote recovery." Its position statement on the practice effectively sets out court-mandated treatment programs (often referred to as "assisted outpatient treatment," or AOT), that should occur for extended periods of time and "should last at least 180 days, with extensions possible after judicial review." That's nearly half a year of potentially forced, coercive treatment.

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CCHR directed the APA to the joint Guideline on Mental Health, Human Rights and Legislation that the World Health Organization (WHO) and United Nations Office of the High Commissioner for Human Rights (OHCHR) issued in October 2023. This condemns coercive practices defined to include, "involuntary hospitalization, involuntary medication, involuntary electroconvulsive therapy (ECT), seclusion, and physical, chemical and mechanical restraint."[3] These "violate the right to be protected from torture or cruel, inhumane and degrading treatment…."[4]

The U.S. is a signatory to both the UN Universal Declaration for Human Rights and international Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.  Yet, a study published in The American Journal of Psychiatry suggests that involuntary hospitalizations account for 54% of admissions to psychiatric inpatient setting.[5]

Jan Eastgate, President of CCHR International, says, "The fact that the APA chose New York to hold its congress says a lot about supporting, rather than working towards eliminating coercion." She pointed to the fact that in 2023, New York had the second-highest amount invested in mental health in the country at $4.95 billion, with California leading at $6.76 billion.[6] Yet "New York has among the highest rates of coercive psychiatric practices."

According to a Democrat & Chronicle report, patients at 13 hospitals in New York were being placed in restraints at rates above the national average. Mental health patients in New York spent a total of nearly 11,900 hours in restraints and 9,000 hours in seclusion while in psychiatric units in 2021, the latest federal data showed. Patients were handcuffed, hit with batons, drugged and left strapped to beds up to 12 hours without regular check-ups and water.[7]

In 1999, New York enacted Kendra's Law, named after Kendra Webdale, who was killed when a man with a history of 13 psychiatric hospital admissions pushed her into the path of an oncoming subway train. The law gives courts the authority to force people who have "a history of lack of compliance with treatment for mental illness" into "assisted outpatient treatment." Individuals who don't comply can be threatened with detainment by law enforcement or involuntary hospitalization.[8]

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Eastgate says, "The solution to Kendra's tragic death at the hands of someone who's treatment had failed him over and over was to force people to undergo psychiatric treatment that may have contributed to Goldstein's violence and ultimately indirectly lead to Kendra's death."

The WHO/UN guideline stresses there is "limited evidence to support the success of coercion to reduce the risk of self-harm, facilitate access to treatment, or protect the public."[9] It also condemns the forced use of electroconvulsive therapy (ECT), most commonly known as electroshock or shock therapy, as violating "the right to be protected from torture or cruel, inhumane and degrading treatment…." Yet electroshock can still be given to patients across the country without their consent.

Eastgate summarized: "While other associations have taken steps to denounce coercion, the APA's silence persists. Urgent action is needed to uphold fundamental human rights in the mental health system and to prohibit practices tantamount to torture."

About CCHR: CCHR was founded in 1969 by the Church of Scientology and the late Dr. Thomas Szasz, Professor of Psychiatry, State University of New York Upstate Medical University. It has helped achieve many laws that protect patients from abuse in the mental health system, including banning the use of ECT on minors.

Sources:

[1] www.wpanet.org/alternatives-to-coercion; www.wpanet.org/_files/ugd/e172f3_635a89af889c471683c29fcd981db0aa.pdf

[2] www.medscape.com/viewarticle/practice-changes-reduce-coercive-psychiatric-measures-2024a10006z0?form=fpf

[3] World Health Organization, OHCHR, "Guidance on Mental Health, Human Rights and Legislation," 9 Oct. 2023, p.  p. 13

[4] World Health Organization, OHCHR, "Guidance on Mental Health, Human Rights and Legislation," 9 Oct. 2023, p. 15

[5] www.cchrint.org/2023/09/18/who-guideline-condemns-coercive-psychiatric-practices/; ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030319

[6] rehabs.com/explore/mental-health-spending-by-state-across-the-us/

[7] www.democratandchronicle.com/story/news/2023/02/07/new-york-state-psychiatric-patients-spent-hours-restraints-see-where/69871002007/

[8] www.theguardian.com/society/2022/dec/23/involuntary-hospitalization-policy-new-york-city-eric-adams
[9] World Health Organization, OHCHR, "Guidance on Mental Health, Human Rights and Legislation," 9 Oct. 2023, p. 15