collectif CONTRAST

consentement capacité contrainte santé mentale

Coercion & QRMH

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(Contrainte et recherche qualitative en santé mentale)

In early september, the 5th Qualitative Research on Mental Health Conference took place in the most pleasant venue on the hills of Chania, Crete. Actors and scholars from a variety of professional background, including sociologists and psychologists, gathered with the common, rather broad, interest of reflecting on current mental health practices using qualitative approaches. Although more that twenty nationalities were represented, a great number of participants came from the UK and Northern Europe. Livia Velpry attended this « international transdisciplinary forum » on behalf of the Collective Contrast. Her presentation, called « The Meaning of confinement in specialized psychiatric practices » and co-authored with Benoît Eyraud, relied on their paper that will appear soon in the journal Culture, Medicine and Psychiatry. Drawing on an analysis of the recent development of high-security psychiatric units in France, the paper describes the efforts of some psychiatrists to incorporate confinement and coercion practices as plain clinical tools, efforts which collapse when confronted to the public critique of being security-driven.

During the same session, the only other French participant to the conference, Yannis Gansel, a psychiatrist and a doctoral student in anthropology at IRIS, echoed this concern for the meaning of coercion practices in psychiatric care in contemporary France. Focusing on the use of containment as a clinical term in care practices with adolescents, he traced its genealogy through a review of professional literature. Interestingly, then, the only two French presentations discussed coercion practices in psychiatric care.

Another session of the conference offered insight into research on coercion practices in Europe. A sociologist involved in various research program on community compulsion in the UK, including the ambitious OCTET (Oxford Community Treatment Order Evaluation Trial), Jorun Rugkåsa explored in her presentation the ways in which family carers experience coercion and pressure in the UK. Given the family’s role in treatment, especially in community care, the carers are constantly confronted to this issue. In her account, Jorun Rugkåsa examined how family carers perceive and use both formal and informal coercion practices, replacing these in the dynamic relationship with mental health professionals. Also a sociologist, but at Umea University in Sweden, Stefan Sjöström attempted to grasp the pervasiveness of coercion practices in a hospital unit though the notion of “coercion context”. The notion helps delineate the various characteristics of a care settings, some not being directly coercive, which participate in creating a situation where service users end up doing what the professionals want them to do without clearly forcing them.

In the lively discussion that followed, it appeared that the concerns of the Collective Contrast resonate with some research initiatives and networks in other countries, which focus on the issue of coercion practices. Besides the already mentioned OCTET project, the Norwegian network on coercion opens up the perspective of comparative discussions. Analyzing professionals’ record was another discussed topic that resonates with the Collective Contrast’s current methodological issues. Niels Buus‘ critical reading of the papers that qualitatively analyze nurses’ records came to the conclusion that a real discourse analysis remained to be completed on this material. The next Qualitative Research on Mental Health Conference will be held in two years at the same venue. Let’s hope that at this occasion, the Collective Contrast will help foster a broad interdisciplinary and international discussion on coercion practices in mental health!

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