WEEK 7 READING (A REJECTION TO INVOLUNTARY TREATMENT) (RECOVERY: Even…
WEEK 7 READING (A REJECTION TO INVOLUNTARY TREATMENT)
Social work has tended to seek to
improve social work practice within involuntary frameworks
- rather than challenge their validity.
AIM OF ARTICLE
To challenge this approach, to illustrate that involuntary treatment is inconsistent with:
Contemporary research on risk management
The adoption of the recovery model
It argues that social work as a profession should reject the notion of involuntary treatment, and work towards a mental health support system, which respects capacity, agency and recovery.
'The challenge for social workers includes remaining consistent with their ethical principles while also being capable of competently balancing the care and control dimensions of practice' (Brophy and McDermott).
The act of persuading someone to do something by using force or threats.
Coercion is at the heart of involuntary treatment (whether it's formal legal coercion, or informal threats, demands or leveraging access to resources).
STATED JUSTIFICATIONS FOR COERCION:
(Morgan and Felton)
1. In the best interest of the individual
2. For the greater good / community protection
However, these justifications are rejected in this paper, as they deny agency and restrict citizenship.
BEST-INTEREST OF THE INDIVIDUAL (PREVENTION OF SUICIDE):
The risk that people with a diagnosis of mental illness pose to themselves is a reason to justify involuntary treatment. This can be seen as discriminatory, as people who are not diagnosed with a mental illness cannot be involuntarily treated to prevent suicide.
There's evidence that challenges the assumption that good risk assessment can prevent suicide.
They conclude that only a very limited prediction of suicide is possible, and majority of suicides are committed by people assessed as low risk (rather than high risk).
The assumption regarding risk also have the consequence of diverting resources away from high risk groups at the expense of low risk groups.
Social work should reject the justification for involuntary treatment based on risk and focus instead of challenging the social structures that create social disadvantage and risk, and championing the rights of marginalised groups (rather than trying to measure their potential to be harmed).
AGENCY AND CITIZENSHIP:
Citizenship and involuntary treatment are incompatible
When people are denied rights associated with citizenship on the basis of belonging to a minority group (eg. people with mental illness being denied the right to refuse treatment) they are denied citizenship and denied participation in society.
Liberal citizenship -
protects only civil and political rights
Social citizenship -
extends to social rights (rights that prevent segregation or discrimination)
Neo-liberal citizenship -
only those who participate in the market are afforded citizenship.
HUMAN RIGHTS AND INTERNATIONAL LAW:
Informed consent -
an individual has the right to make freely formed, information-based decisions about their healthcare.
Mental health legislation around the world extinguish this right to refuse treatment, for people who have a mental illness diagnosis. This rejects their agency and denies them citizenship.
However, The Convention on the Rights of Persons with Disabilities calls for ‘an absolute prohibition of detention on the basis of impairment’, requiring States parties to ensure that ‘the provision of health services, including mental health services, are based on free and informed consent of the person concerned’. This results in a clear right for people with a mental illness diagnosis to refuse treatment at inter- national law.
The idea that you can't assess someone's legal capacity based on their mental capacity.
Ability to make decisions, it is necessary to achieve participatory/social citizenship.
Legal ability to participate in the legal system, it is necessary to achieve liberal citizenship.
The Convention on the Rights of Persons with Disabilities requires State parties to ensure that 'persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life'.
It is possible for social workers to reject justifications for involuntary treatment, and to oppose it, while working to reduce its impacts (eg trauma and stigma).
Social workers, who are genuinely committed to the recovery model, need to develop alternatives to involuntary treatment, not strive to maintain two inconsistent approaches.
Social workers should instead consider a rights-based rejection of involuntary treatment, with the right to treatment'.
This links to the Convention, which requires States parties to provide quality care and support, but
on the basis of free and informed consent.
The right to treatment does not convey a right on the state to involuntarily treat a person - it instead conveys a responsibility to provide voluntary, timely, appropriate and high quality treatment, and to uphold their social citizenship.
Social workers can position themselves as supports for decision-making, not substitute decision-makers.
Just because social workers can't accurately predict and prevent risk, it doesn't justify involuntary treatment.
More violence occurs in people without a mental illness diagnosis, so it's discriminatory to apply a link between the two based on the assumption that mental illness increases violence and creates a greater risk to people.
People such as race car drivers and boxers who are given high social status for their extremely violent or risk taking behaviour. This suggests that people who are afforded neoliberal citizenship and who participate in the economy are afforded the right to make risky decisions. However, those with mental illnesses and do not do these things are not given the same right.
An approach is required which appreciates risk, and the dignity of risk, without discriminating on the basis of diagnosis (a practice described as 'positive risks', Yianni 2009).
Such approaches have shown success in providing violence-free treatment settings, however they are rarely employed by social workers.
Social exclusion contributes to the dangerousness by reducing community links.
By rejecting involuntary treatment and supporting social citizenship, social workers can reduce the likelihood of a person harming others.
(By supporting their engagement with their community, based on mutual respect, trust and compassion).
Even though risk-management and community-based involuntary treatment has been dominating mental health services, there has been a positive shift towards a recovery model of treatment.
EG. The NSW Mental Health Act 2007 requires people to be supported to pursue their own recovery and that every effort should be made to include them in the development of their recovery plans.
One criticism about the recovery-based model is that it preferences individual choice, so the individual is blamed when they fail to 'recover'.
THREE OVERLAPPING UNDERSTANDINGS OF RECOVERY:
1. Biomedical model of recovery:
(incompatible with involuntary treatment)
Characterised by medication compliance and insight into diagnosis.
It is the most compatible with involuntary treatment.
Better access to voluntary services, relational and dignified engagement and supporting sovereignty in engaging with medications can make use of the benefits of medication without the need for involuntary treatment.
Social workers can support people to make their own decisions about medication, rather than take those decisions away from them.
2. Social model:
(incompatible with involuntary treatment)
Focused on building skills and resources which reduce mental distress.
It requires people to develop skills and resources on their own
involuntary treatment prevents people from developing skills and attaining full citizenship.
3. Rights-based model:
(incompatible with involuntary treatment)
Views recovery as freedom from coercion, in particular iatrogenic harm (illness caused by medical assessment or treatment).
Identifies involuntary treatment as the main barrier to recovery.
If people are not allowed to choose, or refuse, they will be forced into adversarial relationships with those who restrict their choices and their recovery.
This may be a difficult process for social workers, who may struggle to watch people they know deal with struggle, and assume they can avert their suffering with involuntary treatment.
The coercive nature of involuntary treatment may work against goals of medication compliance and psychological education, as people subject to involuntary treatment generally
develop a deep-seated mistrust of service providers and a fear of mental health treatment settings.