Mysore Declaration

Mysore Declaration on Coercion in Psychiatry

Raveesh BN and Peter Lepping
Indian Forensic Mental Health Association" (IForMHA) and European Violence
in Psychiatry Research Group (EViPRG), February 2013


Introduction

1.1 Coercion is recognized as a problem in health services around the world. There is a growing desire to explore the reasons for the use of coercion and develop an evidence base
of research to inform debates and discussion as well as change in practice. At a recent international symposium in Mysore, India a group of experts from Europe and India articulated a set of best practice principles to support the minimization of the use of coercion. We urge health practitioners and policy makers in government and medical education to consider these principles and translate them into clinical practice.


The Indian context

2.1 There is rapid change in socioeconomic, cultural, and psychosocial profiles of the traditional rural-oriented and family-centered societies of India and Asia in general. Despite these changes, family and friends are intimately involved in patients’ care in India. For example, covert administration of antipsychotic medication by family members under medical advice to noncompliant patients with schizophrenia is observed to be common practice. Various standards on coercion and restraint have been defined in Europe with varying degrees of success in implementing them. There is a lack of data in India regarding the use of coercive measures and other forms of leverage in medical practice. This makes international comparisons difficult. It is therefore all the more important to be aware of the patients’ individual rights and preferences regarding the necessity, mode, and venue of
psychiatric treatment, along with the recognition of the legitimate interests and wishes of family members.


2.2 The draft proposed amendments to the Mental Health Act of India 1987 (MHA 1987) classifies “admissions” as patients being 'independent' and able to decide for him/herself,
without support or requiring minimal support. ”Supported admissions” are those where the patient needs substantial or high levels of support, although the draft proposals remain
vague about provisions for assessing and implementing admissions. High levels of support (bordering on 100% support) are to be viewed as a temporary phenomenon and as soon as the person is judged to be able to make independent decisions, he or she should be allowed to make his or her own decisions.

The declaration

3.1 There is an urgent need for the recognition and implementation of the rights of persons with mental illness, following principles with regard to equality, security, liberty, health,
integrity and dignity of all people, with a mental illness or not. All parties responsible for the care and treatment of mental illness should work towards the elimination of all forms
of discrimination, stigmatization, and violence, cruel, inhuman or degrading treatment. We affirm that disproport