ABSTRACT
Driven by the Convention on the Rights of Persons with Disabilities and supported by the World Health Organization’s QualityRights initiative, autonomy and patient choice are increasingly becoming hegemonic ethical principles in rights-based mental healthcare. To optimise patient care, it is important that psychiatry shift away from simply assessing capacity and instead focus first on building an individual’s capacity. During remission, proactive measures can be used to minimise future coercive measures. Mental health services can and should provide more informal support to enhance and facilitate communication. For individuals with more severe illness, these services can employ advance directives, nominated representatives and a supported decision-making process to help realise an individual’s rights, will and preference. As mental health legislation currently stands, there does not appear to be an obvious path to fully remove coercion while still protecting the rights of individuals with mental illness. Clearly, steps should be taken during involuntary treatment to minimise coercion and continue to allow individuals to exercise choice where possible. This can done within the restraints of local legislation and professional guidelines. Particular consideration is given in this chapter to the perinatal period and the treatment of minors, as they can be particularly vulnerable to coercion.
