Human Rights in mental health care - The scope for renouncing compulsion and violence

In 2013, the UN Special Rapporteur Juan E. Mendez demanded an absolute ban on all coercive and non-consensual measures, including restraint and solitary confinement of people with psychological or intellectual disabilities. This amounts to a huge challenge for mental healthcare systems. The heterogeneity of the German mental health care system allows for a description of conducive conditions to renounce compulsion and violence in psychiatric institutions such as non-specialised open wards, advance directives and advance crisis plans, alternatives to inpatient admission, user involvement, minimal use of antipsychotics and open dialogue. Obstacles to comply with human rights are identified: closed wards, specialised wards in large institutions, insistence on a biomedical model of mental illness and a focus on the concepts of compliance and insight.