Compendium report : Good practices to promote Voluntary Measures in Mental Health Services
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.
‘Patient-led action plan’ to appeal compulsory treatment orders – The Netherlands
This practice functions as a form of appeal process available to a person who is subject to an involuntary psychiatric intervention (Submission 30). However, it is a process that places the onus on the individual herself or himself to propose an alternative care arrangement and gives discretion...
‘Improved cooperation between psychiatry and home care - reducing the number of compulsory admissions’ – Sweden
This small-scale initiative in the Eksjö municipality of Sweden, successfully reduced rates of involuntary psychiatric interventions through a program that focused on improving the interactions between individuals in mental health crises, nurses providing home based care, and inpatient and...
Trieste Model – ‘Open Door—No Restraint System of Care for Recovery and Citizenship’ – Italy
The Trieste Model is described as an ‘open door... no restraint system of care for recovery and citizenship' in the city of Trieste, Italy (Mezzina, 2014, p.440). Trieste is a city of approximately 236,000 people in the north-eastern region, Friuli Venezia Giulia. In the mid-late 20th century,...
Reducing compulsory admission at a psychiatry emergency outpatient clinic – Norway
A psychiatric emergency outpatient clinic in Storgata, Oslo, sought to reduce compulsory admission by providing ‘focused interventions’ for people experiencing acute mental health crises (Submission 17B), and improving the decision-making of staff who impose compulsory admission. Hence, the aim...
‘Citizen Psychiatry’ – East Lille mental health service network – France
The Eastern Lille mental health service network (59G21 France operates with a sectorised mental health system. For adult services the country is divided into approximately 850 sectors, each with a population of about 70,000. The East Lille sector has the number 59G21 and only serves adults. Six...
TANDEMplus: Mobile Crisis Support and Social Network Development – Belgium
‘TANDEMplus’ is a small mobile crisis service that supports people during, and shortly after, they experience a crisis. A key aim of TANDEMplus is to help a person to ‘(re)activate her/his local support network’ (Submission 7). This includes identifying the kind of support that the person would...
Respite Houses
Crisis or respite houses tend to offer a smaller scale residential alternative for people in crisis, sometimes designed for specific groups, including women, minority ethnic groups and homeless people (see Gooding et al., 2018, pp.67-77). Such alternatives to hospitalisation may be staffed...
Personal Ombud Programme – Sweden
In 1995, the Swedish Personal Ombudsman Programme (‘Personligt Ombud Skåne’ or ‘PO’) was founded by persons with psychosocial disabilities as a ‘User-controlled Service with Personal Agents’ (Submission 27). This form of personal assistance involves facilitating decision-making, including by...
Training
Various forms of human rights based training exist (see, for example, Part I, Section B ‘World Health Organisation – QualityRights Toolkit and Good Practice Guidance’ p.17). The Médiateur de santé pairs, for example, could be described as a training program in addition to being a workforce...
Peer Support and the Peer Workforce, International
Formal ‘peer support’, in which former or current service users take on a professional role in services, are associated with numerous improvements on numerous issues that can impact the lives of persons with mental health conditions and psychosocial disabilities (Repper & Carter, 2011). There...
Advance Planning
There is a large body of research on the use by persons with mental health conditions and psychosocial disabilities of various forms of advance planning (Weller, 2013). Advance planning includes practices variously described in English as ‘advance statements’, ‘advance directives’, ‘joint crisis...
Workbook for Hospitals and Wards to Reduce Coercion and Increase Occupational and Patient Safety: Combining Six Core Strategies and Safewards – Finland
In 2016, the Finnish National Institute for Health and Welfare published a working paper to help ‘hospitals and wards providing involuntary psychiatric care to reduce the use of coercion against patients and to increase occupational and patient safety’ (Makkonen et al., 2016, p.6). The Finnish...
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...
Safewards – International
The ‘Safewards’ model is a program that aims to reduce the restraint and seclusion of people on psychiatric wards, as well as reducing conflict between service users and staff (Submission 25). The model provides staff with practices and concepts to help improve the culture of hospital settings,...
Reducing mechanical restraint and seclusion in acute mental health inpatient wards
Across Europe, it is lawful for individuals to be secluded and/or restrained in mental health services and other settings to control or manage their behaviour. Attempts have been made by governments, mental health services and others to reduce and even eliminate the use of restraint and seclusion...
Activity quality of care - project Deinstitutionalization of care for the mentally ill of the Ministry of Health of the Czech Republic paid from the European Social Fund’
Several COE Member States are continuing to ‘deinstitutionalise’, in the sense of various policies and practices designed to close down large-scale institutions in which persons with mental health conditions and psychosocial disabilities, and other disabilities, are placed and detained. Efforts...
Open Dialogue Model – Finland and Internationally
The 'Open Dialogue Approach to Acute Psychosis' is a practice developed in Finland in which care decisions are made in the presence of the individual and his or her wider networks. The practice is presented as an alternative to hospital, particularly where it is practiced as home or...
Mental Health Mobile Units – Greece
In Greece, Mental Health Mobile Units aim to reduce involuntary hospital admissions by working to keep individuals, particularly those in remote and rural areas, connected to their family and communities (Submission 27). According to Mental Health Europe (Mental Health Europe, 2019, p.7): From...
Hugarafl – Iceland
Hugarafl (which roughly translates as ‘Mindpower’) is a non-profit, peer-run, non-government organisation in operation in Reykjavík since 2003 (Submission 22). According to its website: Hugarafl [translation: Mindpower] is an Icelandic peer run NGO founded in the year 2003 by individuals with a...
Family Group Conferencing – The Netherlands
Family Group Conferencing is a ‘“family-driven” decision-making model and social network strategy’ (Schout, Meijer, et al., 2017). In the Netherlands, where it was developed for the mental health context, a Family Group Conference is called an Eigen Kracht-conference. This translation emphasises...
Community mental health initiative – Novara, Italy
In the Northern Italian city of Novara, a mobile support program was developed by the South Unit Area to assist people in mental health crisis in their own home, including those who have been just discharged from a psychiatric ward. The program has reportedly produced relatively low rates of...
Open Dialogue in a High Security Psychiatric Ward: ‘Reflecting Processes in the Care of Persons with Severe Mental Disorders’ – Norway
The Department of Specialised Psychiatry at Akershus University Hospital, which is a high security psychiatric ward in Norway, has undertaken a program based on the ‘Open Dialogues’ practice. (Open Dialogues is discussed more fully under the ‘Community-Based Initiatives’). Open Dialogues is...
‘Open Door Policy’ – Internationally
‘Open door policy’ refers to a policy of maintaining open doors in mental health settings and particularly hospital-based settings that otherwise would be ‘closed’ or ‘locked’. Germany appears to have the most advanced use and evaluation of open door policies in acute psychiatric settings in...
No Force First – United Kingdom
The ‘No Force First’ initiative aims to change ward cultures from a focus on containment to one of recovery. The ultimate aim is to create coercion-free environments. This approach, which began in th United States, is being adopted by some UK based mental health trusts (Submission 27). The...
High and Intensive Care Units – The Netherlands
As part of a national policy to reduce the use of seclusion in the Netherlands, High and Intensive Care (HIC) Units were developed. HIC Units are acute admission wards focusing on ‘restoring and maintaining contact and crisis prevention’ (Submission 27). The Units require a multidisciplinary team...
Guidelines on Prevention of Coercion and Therapy for Aggressive Behaviour – Germany
In 2018, an expert group of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) published guidelines on how to deal with ‘coercion and violence’ in adult psychiatric services in Germany. The DGPPN is the largest scientific medical association focussing on mental health...
Basal Exposure Therapy (BET) combined with Complementary External Control (CER) – Norway
Basal Exposure Therapy (BET) and Complementary External Regulation (CER) are Norwegian practices with a strong psychotherapeutic focus that are designed for people who do not find success with conventional treatments. BET involves a hospital ward where people are given ‘an opportunity to expose...