Reframing involuntary treatment as a sentinel event: a model for improving rights-based mental health care

Cossu, Giulia;Atzeni, Michela;Zreik, Thurayya;Tusconi, Massimo;Carta, Mauro Giovanni

2026-01-01

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Abstract

Background: The UN Convention on the Rights of Persons with Disabilities (CRPD) has sparked debates on psychosocial disabilities, particularly Article 12, which guarantees legal capacity without restrictions. The CRPD Committee opposes involuntary treatment and strongly advocates for support mechanisms to ensure autonomy. This raises questions about decision-making in psychiatric care and the role of involuntary treatment. Advocacy groups, which push for the elimination of involuntary treatment in favor of alternative measures, argue that involuntary treatment results from inadequate resources, while psychiatric associations highlight ethical concerns about withholding care and emphasize risks to service users and others. Methods: This article presents a model that reframes involuntary treatment as a preventable sentinel event. The approach outlines the components of a monitoring and quality improvement system, including structured reporting, root cause analysis, and co-designed interventions involving service staff members and service users. Results: The application of this model may identify key structural and systemic drivers of involuntary treatment, such as insufficient community-based services, lack of training, and power asymmetries. It also highlights the potential of participatory governance mechanisms and user-led monitoring to foster accountability and drive rights-based reforms. Conclusion: This approach may help align mental health services with CRPD principles, reduce involuntary treatment, and enhance accountability, legitimacy, and foster collaborative relationships between users and providers. It may also help overcome the current impasse around coercive practices by enabling the identification and analysis of the structural and cultural mechanisms that sustain them over time, thereby opening up new possibilities for their management and overcoming.