Name it, don’t numb it: Coercion in mental health services can create harm
This week is Mental Health Week, a week picked by the Canadian Mental Health Association to focus on our mental health. For 2021, people have been asked to #GetReal about how they feel, so our Lived Experience Experts Group members decided to get real about their experiences of mental health services.
Our Lived Experience Experts Group have all had experiences of BC’s mental health system, including involuntary treatment under the Mental Health Act. We asked them to tell us what it feels like to experience coercion in mental health services, and what it feels like to access mental health services that supported their dignity.
Why does dignity matter?
Being able to make informed decisions about our own body and health care is a fundamental human right – it is core to our humanity and ensuring that we are all equally valued as people. That’s why the right to make decisions about your own body and health is protected in Canada’s Charter of Rights and Freedoms and international human rights treaties.[i]
When you experience involuntary mental health treatment under the Mental Health Act, your right to make your own health care decisions is taken away, which can have serious negative impacts.
The harms of coercion
Word cloud setting out the words LEEG identified with coercion under the Mental Health Act.
The Lived Experience Experts Group’s word clouds reveal the real harms that can be caused by coercive mental health care. When we imagine how we’d like to be treated when we’re in need of mental health support, we don’t imagine services that make us feel powerless, dehumanized, or violated.
Research confirms that when people experiencing involuntary treatment are made to feel disempowered, when we totally excluded them from decisions about their health and wellbeing, involuntary mental health treatment is a terrifying or traumatizing experience.[ii] It should come as no surprise that this will make people less likely to seek help voluntarily in the future. It alienates them from important services because the health care system feels unsafe.
Supporting dignity supports health
Word cloud setting out the words LEEG identified with experiencing dignity in the mental health system.
The Lived Experience Experts Group’s word clouds also reveal that it matters when we create services that respect a person’s dignity. Dignified services allow people to feel empowered, respected, heard and seen. Those are the very feelings that help us get better and stay well.[iii]
Research confirms that people are more likely to have a positive experience and feel safe, even during involuntary treatment, if they feel respected and when services providers work in partnership with them instead of “steamrolling” their views and wishes.[iv] If people have a positive experience when they access service, it should be no surprise that they will be more likely to seek help in the future and proactively access support for their health.
Even when a person being involuntary treated, there are ways to reduce the negative impacts of coercion and support dignity. For example, it can make a big difference if we provide people with information so they understand what is happening, if we ask them what they want and really listen to their answers, and if we support them to make choices for themselves whenever possible (like choices about what clothes to wear and when to eat, etc.). [v]
This Mental Health Week, let’s #GetReal about creating services and laws that support people’s dignity and wellbeing in a meaningful way.
[i] Canadian Charter of Rights and Freedoms, s. 7; United Nations Convention on the Rights of People with Disabilities, Article 25; International Covenant of Economic, Social and Cultural Rights, Article 12 (see Economic and Social Council General Comment No.14); United Nations Convention on the Rights of the Child, Article 24 (see Committee on the Rights of the Child General Comment No. 15); United Nations Declaration on the Rights of Indigenous Peoples, Articles 24.
[ii] Tara Seed et al, “The experience of involuntary detention in acute psychiatric care. A review and synthesis of qualitative studies” International Journal of Nursing Studies 61 (2016).
[iii] Mental Health Commission of Canada, Guidelines for Recovery-Oriented Practice (2015).
[iv] See note ii.
[v] See note ii.