Chile, ECT without general anaesthesia, and the human rights of mental health patients
On 11th March 2022, Mr Gabriel Boric became Chile’s new president. Mr Boric has made human rights and mental health two central issues of his government and appointed Dr Maria Begoña Yarza, a paediatrician and MSc in public health, as the country’s Minister of Health.
On 11th May 2022, Dr Yarza referred findings that, until recently, ECT without general anaesthesia had been carried out at Hospital del Salvador (a public psychiatric hospital in the city of Valparaiso) to the National Public Prosecutor, the country’s autonomous prosecuting agency. Her report mentioned that the practice could amount to torture or other cruel, inhuman, or degrading treatment, as described in article 150 A of paragraph IV, Title Three, Book Two, of the Penal Code. Article 175 d) of the country’s Criminal Procedure Code creates a duty on medical professionals and health authorities to refer facts that could amount to a crime. The Ministry of Health had issued a Policy on Electroconvulsive Therapy (ECT) in the year 2000, indicating that general anaesthesia was a requirement and that there must be an anaesthetist as part of the team administering it.
There has been a strong reaction to the referral of the situation to the Public Prosecutor, including from the El Salvador Hospital’s workers’ unions. (https://www.msn.com/es-cl/noticias/otras/funcionarios-del-hospital-psiqui%C3%A1trico-de-valpara%C3%ADso-se-van-a-paro-y-exigen-a-ministra-yarza-retractarse-de-denuncia-%E2%80%9Cac%C3%A1-no-se-tortura%E2%80%9D/ar-AAYszv8).
On 9th June 2022, the Chilean Society of Neurology, Psychiatry, and Neurosurgery expressed their “support for the work of the professionals and administrators unjustly accused of carrying out acts of torture on their patients, understanding that the performance of electroconvulsive therapy (ECT) in the patients of the Hospital del Salvador in Valparaíso was under the principle of beneficence.” (https://www.sonepsyn.cl/web/noticia.php?id=5440).
On 10th June 2022, Dr Yarza sent a letter to the Public Prosecutor, attaching a report of a visit by the Comision de Proteccion de Derechos de Personas con Enfermedades Mentales (COREPREM) (Commission for the Protection of the Rights of Persons with Mental Illnesses) to the Hospital del Salvador on 10th March 2022. The latter report describes the precarious conditions in terms of infrastructure, equipment and processes of the hospital. Dr Yarza writes that these conditions could be important “both for their investigation and for a legal qualification different from that provided in article 150 A of the Criminal Code”, “since in light of the new information that I accompany, this seems inappropriate.” (https://www.t13.cl/noticia/nacional/minsal-rectifica-denuncia-hospital-psiquiatrico-calificacion-torturas-seria-improcedente).
On 14th and 15th June 2020, the Comité de Prevención Contra la Tortura (CPT) (Prevention Committee Against Torture) visited the Hospital del Salvador de Valparaiso. Their preliminary findings describe some human right violations, including the use of ECT without the application of general anaesthesia in adults and minors. (https://www.biobiochile.cl/noticias/nacional/region-de-valparaiso/2022/07/02/informe-acusa-algunas-vulneraciones-a-los-ddhh-en-hospital-siquiatrico-tras-denuncia-de-torturas.shtml).
On 15th June 2022, the National Council of the Colegio Medico (the Chilean Medical Association) decided to take the Minister of Health as an individual before its National Ethics Committee. (https://www.emol.com/noticias/Nacional/2022/06/16/1064229/colegiomedico-por-ministrasalud.html).
On 30th June 2022, the five professional organizations and workers’ unions of the Dr. José Horwitz Barak Psychiatric Institute of Santiago, added their support to that already expressed by other health workers to the Hospital El Salvador’s staff, indicating, amongst other things that “We believe that Minister Yarza’s complaints are unfair and inappropriate, especially serious, due to the imputation of alleged crimes of torture.” (https://www.sonepsyn.cl/web/noticia.php?id=5445).
Some users of psychiatric services have expressed other views. For example, Camila Reyes San Martín, president of the Association for Radiophonic Mental Health ( registration pending) wrote “that those who received electroshock without anaesthesia should receive an apology and that no one has asked how they are and who they are” (https://radio.uchile.cl/2022/06/17/sobre-las-denuncias-de-tortura/). On 22nd June 2022, the Colectivo Nacional por la Discapacidad (National Collective for Disabilities) pointed out, amongst other issues, that ECT without anaesthesia is a grave violation of human rights (https://www.elciudadano.com/chile/colectivo-nacional-por-la-discapacidad-aplicacion-de-electroshock-sin-anestesia-en-pacientes-es-una-tortura-y-no-puede-considerarse-una-practica-medica-aceptable/06/22/).
On 27th June 2022, Rodrigo Bustos Bottai, Executive Director of Amnesty International Chile, wrote that “If electroconvulsive treatments continue to happen that do not comply with internal regulations and the standards developed in International Human Rights Law, these facts must be investigated and measures adopted so that they do not continue to occur.” (https://www.latercera.com/opinion/noticia/hospitales-psiquiatricos-y-respeto-a-los-derechos-humanos/7ISQK6LNJBBZHHQB6V55JDQS2Y/)
‘It is extremely concerning to hear that so-called ‘unmodified ECT’ is still being used in 2022. It is unacceptable and we are hopeful that the Chilean government and health service will be able to work together to eradicate it in the very near future’ says Andrew Molodynski from the WASP coercion working group.
The World Association of Social Psychiatry (WASP) is affiliated to the World Psychiatric Association (WPA) and the two bodies share many common goals. The WASP working party on coercion in mental health care recently released a set of guiding principles and standards in late 2015, developed from the research and collaboration of members alongside issues highlighted in the literature and raised by human rights groups. These principles are set out below and are designed to be applicable in all countries:
- All individuals in a community should have access to the most effective affordable mental health care that is available.
- All individuals have the right to receive that care in the least restrictive manner possible.
- Individuals have the right to determine their own needs and requirements for treatment as far as is possible.
- Where treatment is compelled, this must be done proportionately, humanely, and in accordance with the relevant international conventions.
- Countries must give mental health care parity with physical healthcare and allocate budgets and support accordingly.
- High Income Group countries must support those in need to develop and improve their mental health services as a global ‘civic duty’.
NEW QUALITY RIGHTS RESOURCES FROM WHO FOR COMMUNITY MENTAL HEALTH SERVICES RELEASED IN 2021
Dear colleagues and friends,
We are pleased to announce that the response to the 10 June launch of the WHO guidance on rights based community mental health services was overwhelmingly positive, with close to 7000 people viewing the event via Zoom or the WHO YouTube account to date. The launch received significant attention both in social and traditional media and we have also received many positive comments and feedback from individuals from all corners of the world.
Furthermore, since the launch, hundreds of people in countries from around the world are keeping the momentum going by extensively disseminating the WHO guidance to their networks and governments. We would encourage you all to do the same.
Please find below some of the key links to the WHO Guidance documents and to resources related to the launch event itself which we would encourage you to share with your networks and contacts:
- WHO Guidance and Technical Packages – Please disseminate widely!
- WHO Press release in ENGLISH – SPANISH – RUSSIAN (Other languages will follow)
- WHO Feature story- Community-based mental health services using a rights-based approach
- Telegraph Article – Seclusion, restraint and coercion: abuse ‘far too common’ in mental health services across the world
- Video poem: The Power of Purpose – Community-based mental health care: the Power of Purpose
- YouTube livestream of the WHO Launch event
NEW JOURNAL AND WEBSITE LAUNCHED BY WASP IN EARLY 2020!!
Over recent months, the World Association of Social Psychiatry has launched a new journal and a new website.
The journal, World Social Psychiatry, is an ambitious adventure and accepts all types of articles with the aim of promoting and spreading the social psychiatry message. It can be found online at http://www.waspsocialpsychiatry.com
The website can be found at http://www.waspsocialpsychiatry.org and contains regular updates and newsletters about goings on. Most recently a position statement highlighting the effects of COVID 19 on mental health has been posted. The site is also a one stop shop for information about THE association. We hope that over time it will grow and include podcasts and an aver increasing variety of material
New Frontiers Online Journal section for Social and Rehabilitation launched!
Frontiers has recently launched a new journal section specifically to encourage submissions in social psychiatry and rehabilitation in conjunction with the European Society for Social Psychiatry (ESSPY):
We are really excited by this development and hope it will become a place for vigorous debate and evidence regarding coercion in mental health care. Submissions on such topics would be really welcome and both Yasser and Andrew are closely involved and will make sure they are highlighted. The link below gets you there:
Bucharest 2019- save the date!
the next WASP conference is in October this year in Bucharest and there will be varied programme on all aspects of mental health care and much about involuntary treatment around the world. Do come along and take part!
Article highlighting human rights issues in Uganda published
British journal of Psychiatry International has published an article from group members in conjunction with major international human rights charity MDAC on mental health care in Uganda. It highlights some of the challenges and looks at opportunities for change and better care going forwards. The link below will take you straight to it:
First international conference on crisis care and coercion 2018 Rotterdam
The first international conference on crisis care and coercion has taken place recently in Rotterdam, The Netherlands. There were many relevant talks and symposia for people interested in acute mental health care and human rights and people attended from a number of countries to share ideas and initiatives in what was a very well coordinated and vigorous small conference. It is hoped to repeat the conference in either one or two years. Presentations from the conference are available on its website.
Launch of a new European Society
The European Society of Social Psychiatry (ESSP) has recently been set up. The first congress of the ESSP, chaired by François Ferrero, was held in the early summer in Geneva. The conference contained many sessions regarding coercion ad was a great success, fostering interest, partnerships, and collaborations which we hope we can build on. For the first time, such a congress contained specific workshops on the practical aspects of what might be done to reduce coercion in clinical practice. Feedback was excellent and we hope to run more workshops at future events. We will keep updating the site with such news. The website is http://www.esspsy.org
Coercion In mental health care- International perspectives
Members of the group have worked over recent years with key academics, clinicians, and service users from around the world to create a book that takes a global perspective on the issue of coercion. There are chapters regarding the law, ethics, practical considerations, the effects of economy and culture and many more things. There is also a chapter from each continent identifying important regional issues for the first time in the literature.