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Alternatives to Coercion Report

Overview

This 2018 literature review commissioned by the UN examined 169 studies on alternatives to coercion in mental health settings. It found that efforts to reduce, prevent and end coercive practices like seclusion and restraint are generally effective. The review identified various successful approaches including recovery-oriented care, trauma-informed support, peer-led initiatives, crisis resolution services, and organizational culture change. Most research was conducted in high-income Western countries by psychiatrists.

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Developed by Melbourne Social Equity Institute, University of Melbourne for UN Special Rapporteur on the Rights of Persons with Disabilities

Key insights

Key Insights:

  1. Most coercion reduction efforts show positive results across hospital and community settings
  2. Top-down and local-level leadership both essential for sustainable culture change initiatives
  3. Six Core Strategies effectively reduce seclusion and restraint in diverse facility types
  4. Open door policies don't increase suicide/absconding but reduce other coercive measures
  5. Peer-led crisis respites reduce hospital admissions and emergency service usage significantly
  6. Family Group Conferencing helps regain ownership and reduces coercion in psychiatry
  7. Research is dominated by Western countries; major gaps in low/middle-income country evidence
  8. Service user perspectives are under-represented despite being most affected by coercive practices

Did this resource draw on transformative evidence?

<p>The document had limited experiential expertise. Only four studies were led by researchers with mental health service experience, with several others as co-authors. Two report authors (Flick Grey and Cath Roper) had personal experience with mental health services and coercive interventions. The review explicitly noted that most empirical research was conducted by psychiatrists, with formal research typically not involving persons with psychosocial disabilities as active participants or co-researchers.</p>
<p>The document incorporated substantial practice wisdom through analysis of real-world implementations across diverse settings. It examined successful programs like the Six Core Strategies, Safewards model, crisis respite houses, and Family Group Conferencing. The review included "grey literature" from service providers and government reports documenting practical experiences. However, it noted a gap between existing practices promoted by user organisations and formal academic research, with many effective real-world interventions lacking peer-reviewed evaluation.</p>
<p>The document was heavily based on research and evaluation insights, systematically reviewing 121 empirical studies and 48 notable materials. It employed rigorous methodology including multiple database searches, thematic analysis, and quality assessment. The review encompassed quantitative studies (73), qualitative studies (26), mixed methods (17), and case studies (5). However, it noted limitations including small sample sizes, convenience sampling, methodological weaknesses, and lack of high-quality randomized controlled trials in many intervention areas.</p>

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Resource type

Literature Review