This report uses the term ‘persons with mental health conditions and psychosocial disability’ to broadly describe the individuals who have experienced mental health crises or ongoing impairments, including those who use mental health services or have been subject to involuntary interventions in mental health settings. This terminology draws from the COE Strategic Action Plan 2020-2025 (Council of Europe, 2019, p.15), which uses the terms ‘persons with mental health difficulties’ and ‘persons with psychosocial disabilities’.[1] ‘Persons with mental health conditions and psychosocial disabilities’ is also used by the United Nations Human Rights Council (2017, p.4) in its Resolution on Mental Health and Human Rights, and the terms also appear in the World Psychiatric Association (WPA) 2020 Position Statement on Implementing Alternatives to Coercion: A Key Component of Improving Mental Health Care (Rodrigues et al., 2020).

[1] A slight change is adopted for this report, replacing ‘mental health difficulties’, as used in the COE Strategic Action Plan, with the ‘mental health conditions’ as used by the UN Human Rights Council and World Psychiatric Association.

The term ‘psychosocial disability’ is simply used here to refer to disability related to mental health conditions. It is a term that has become prominent since the Convention on the Rights of Persons with Disabilities (CRPD) came into force in 2008. Psychosocial disability is distinct from intellectual disability (sometimes referred to as developmental or learning disability) and cognitive disabilities (such as persons with dementia and brain-injury). This report does not engage with services that are specifically designed for persons with intellectual disability and/or cognitive disability. However, it is acknowledged that these groups may also experience mental health conditions and engage with mental health services, including experiencing coercive interventions. Further, in some countries, there may be no clear separation of services for people with intellectual, cognitive and psychosocial disabilities.[1]

[1] There is also evidence that persons with intellectual and cognitive disabilities experience mental health conditions at higher rates compared to others (see eg, Hughes-McCormack et al., 2017), and may also experience coercion at higher rates (European Agency for Fundamental Rights, 2012). However, it is outside the scope of this report to include services designed specifically with attention to persons with intellectual and cognitive disabilities.

This report uses the term ‘good practices in mental healthcare’ to describe practices submitted by COE delegations that met the broad aim of ‘promot[ing] voluntary measures in mental healthcare, both at a preventive level and in situations of crisis’ (as per the DH-BIO Strategic Action Plan on Human Rights and Technologies in Biomedicine 2020-2025 (p.15)). This term is not used to imply that the practices are perfect models or 100 percent compliant with the CRPD. Instead, the practices are presented as examples of steps towards change—broadly, they are ‘good practices to promote voluntary measures in the field of mental healthcare’ and hence, aim to decrease the use of involuntary measures in fulfilment of COE Disability Strategy aims. Some are at an early stage of development. Others are more established. Some may have components that are viewed by human rights bodies or civil society advocates as being positive, while also retaining aspects viewed as negative. Finally, even if good practices are working well in one place, replication in other places always requires taking into account new settings, and generally requires participation of all stakeholders, particularly mental health service users and other persons with psychosocial disabilities (Flynn and Gómez-Carrillo, 2019).

‘Involuntary measures’ are defined by DH-BIO as ‘any placement and/or treatment of a person without that person’s free and informed consent or against the will of the person’. The term ‘involuntary measures’ will be used interchangeably with ‘coercion’ and ‘coercive practices’. These terms will be used to refer to a range of involuntary interventions.

All COE Member States have legal provisions for the assessment, admission and treatment of people on an involuntary basis. Intervention typically occurs through detention and involuntary treatment in hospital, or compulsory treatment in the community. Coercive practices also include the use of seclusion (when a person is confined alone in a room or area where free exit is prevented) and different forms of restraint (when a person’s freedom of movement is restricted by physical, mechanical or chemical means) in specialised mental health services.

Involuntary measures may also occur ‘unofficially’ (Molodynski et al., 2016); for example, where a person is threatened with formal involuntary intervention by clinicians if they do not accept ‘voluntary’ support. Where relevant, this report will depart from the broad terms of ‘involuntary measures’, ‘coercion’ and ‘coercive practices’, to describe specific interventions that are being addressed, such as involuntary electro-convulsive therapy, seclusion, and mechanical or physical restraint.