DESK REVIEWS | 04.05.02.05. Provisions exist which aim to end coercive practices, including seclusion and mechanical/physical/chemical restraints for people with dementia (or all persons)

DESK REVIEW | 04.05.02.05. Provisions exist which aim to end coercive practices, including seclusion and mechanical/physical/chemical restraints for people with dementia (or all persons)

Yes and no.

There is guidance, for example, from the Brazilian Society of Geriatrics and Gerontology, in partnership with ‘Choosing Wisely’, which states that people should not be mechanically contained/restrained (SBGG, 2018). However, this is not prohibitive and still is common practice in Brazil. Mostly, the guidance available says restrains (chemical/physical/environmental) should be avoided and should be done only as a last resource to a) protect the person, b) protect others, c) guarantee effective treatment. This decision should be discussed among the multidisciplinary team and with the family, and the reasons for that should be documented.

References:

SBGG. (2018, June 7). CBGG 2018: SBGG divulga recomendações sobre escolhas sensatas em saúde em parceria com Choosing Wisely Brasil. SBGG. https://sbgg.org.br/cbgg-2018-sbgg-divulga-recomendacoes-sobre-escolhas-sensatas-em-saude-em-parceria-com-choosing-wisely-brasil/

 

This section to be updated soon.

There is no specific regulation regarding coercive practices targeted at people with dementia. However, stigma in mental illnesses often results through physical restraining of people living with mental illness, especially in areas where healthcare can be difficult to access. The practice is known as pasung (shackling) and can still be found in Indonesia despite being banned since 1977 (Human Rights Watch, 2016). In 2017, the Ministry of Health has issued a regulation which covers the prevention of the practice as well as management and rehabilitation guidelines for people affected by these practices. Management of ending of the practice is approached not only through advocacy and education, but also by making pharmacological and non-pharmacological interventions accessible. This is done by facilitating the registration of people affected with the NHIS as well as through home visits and home care, day care and vocational rehabilitation (Permenkes No. 54/2017 Tentang Penanggulangan Pemasungan Pada Orang Dengan Gangguan Jiwa (Ministry of Health Regulation No. 54/2017 on Countermeasures of Shackling Practice on People with Mental Illness), 2017).

References:

Human Rights Watch. (2016). Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia. Human Rights Watch.

Permenkes No. 54/2017 tentang Penanggulangan Pemasungan pada Orang dengan Gangguan Jiwa (Ministry of Health regulation No. 54/2017 on Countermeasures of Shackling Practice on People with Mental Illness). (2017). (Testimony of Ministry of Health Republic of Indonesia).

Kenya still relies on the Convention on the Rights of Persons with Disabilities (CRPD). Article 16: Freedom from exploitation, violence, and abuse states that “in order to prevent the occurrence of all forms of exploitation, violence, and abuse, States Parties shall ensure that all facilities and programmes designed to serve persons with disabilities are effectively monitored by independent authorities” (United Nations, 2006), page 12.

References:

United Nations. (2006). Convention on the Rights of Persons with Disabilities and Optional Protocol. https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf

 

The Official Mexican Standard 025 (DOF, 2015) for the Provision of Services in Psychiatric Medical Hospital Care Units, indicates a set of Provisions that regulate the treatment and rehabilitation of people with a mental disorder, respecting their human rights and covering two areas: a) Quality specialised medical care, and b) Preservation of the human rights of the user. With respect to this second item, it is stated that people with mental disorders have the right to receive dignified and humane treatment by mental health personnel, they are not to be discriminated against because of their condition, not to be the object of diagnosis or treatment for political, social, racial, religious or other reasons different from or external to the state of their health, they have to be protected against all exploitation, abuse or degrading treatment, and they are not to be subjected to physical restrictions or involuntary confinement.

References:

DOF. (2015). Norma Oficial Mexicana NOM-025-SSA2-2014. Para la prestación de servicios de salud en unidades de atención integral hospitalaria médico-psiquiátrica. http://www.dof.gob.mx/normasOficiales/5805/salud3a11_C/salud3a11_C.html