Less care under constraint: The Icelandic experience

Iceland has traditionally used less coercion within its mental health system than other northern European countries. Reported rates of involuntary admission are low and we may speculate that this is linked to Iceland’s being a small, homogenous society with high levels of trust. Emphasis on training in de-escalation and a tolerance for risk may also lead to better results through better negotiating skills. Mechanical restraint has not been used in Iceland for eighty-five years. Instead, non-coercive means of negotiation and de-escalation are used, along with coercive measures (holds, rapid tranquilization, seclusion, PICU). The pros and cons of different coercive measures are discussed, as well as the importance of a culture of tolerance and acceptance. Three recommendations are given: to abolish mechanical restraint, to build comprehensive mental health outreach services, and to emphasize negotiation with mental health users.