This report provides a compendium of good practices to promote voluntary measures in mental health care and support. It draws from practices submitted to the DH-BIO Secretariat by delegations representing the 47 Member States of the Council of Europe (COE) as well as civil society stakeholders. The compendium fulfils the aim set out in the DH-BIO Strategic Action Plan on Human Rights and Technologies in Biomedicine 2020-2025 to:

assist member States [by developing] a compendium of good practices to promote voluntary measures in mental healthcare, both at a preventive level and in situations of crisis, by focusing on examples in member States.

 

The practices may directly aim to reduce, prevent, or even eliminate coercive practices in mental health settings, and others will indirectly result in similar outcomes by advancing the general aim to promote voluntary mental health care and support.

The compendium is not meant as an exhaustive list of leading practices in COE Member States. Instead, it is meant as an initial step toward compiling practices aimed at promoting voluntary mental healthcare and support, and reducing and preventing coercion in mental health settings. More generally, the materials promote compliance with the Convention on the Rights of Persons with Disabilities (CRPD), notwithstanding debates about coercion in mental healthcare which will be noted in Part 1(B) of the report.

Atrás Weddinger Modell – Germany

The Weddinger Modell, developed in 2010 in Berlin, is a model of psychiatric care for acute settings that focuses on recovery, participation, supported decision-making and the prevention of coercive measures on psychiatric wards (Submission 29). There is some evidence that the model decreases an individual’s likelihood of being subject to coercive measures and reduces their average length of hospitalisation; it also reportedly enhances ward atmosphere. The Weddinger Model is a cost-neutral initiative that re-orients care away from traditional professional hierarchies in which treatment is ‘done to’ the relevant person. Instead, treatment decisions are made in active discussion with the person along with informal supporters whom the person wishes to involve. One key aim is to increase the transparency and accountability to the individual about the services they receive. The model aims to support the individual with assistance that is tailored to her or his circumstances.

A study by Czernin and colleagues (2020) compared two groups of service users, one treated according to the Weddinger Modell (intervention group; n=122) and the other one conventionally (control group; n=235). The results showed a significant reduction of the maximum frequency of restraint events as well as the duration of seclusion incidents in the group of patients treated according to the Weddinger Modell. The authors concluded that the implementation of the Weddinger Modell and similar treatment concepts in inpatient psychiatric setting can help reduce coercion (Czernin et al., 2020).

Further information on the Weddinger Modell is also available in a report by Mahler et al (2014).

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