International Expert Priorities for Promoting Recovery and Coercion-Free Practices in Psychosocial Disability: A Delphi Study

Abstract

The global crisis of recent years, including pandemics, armed conflicts, climate emergencies, and economic instability, has disproportionately jeopardized the health and rights of persons with psychosocial disabilities, who remain among the most marginalized groups. In this context, promoting a rights-based approach to mental health care is both urgent and ethically imperative. Building on the United Nations (UN) Convention on the Rights of Persons with Disabilities and the World Health Organization (WHO) QualityRights initiative, this study aimed to identify expert-informed priorities for implementing recovery-oriented, coercion-free practices in consultation-liaison psychiatry within a general hospital in Italy, while also incorporating perspectives from international stakeholders. A two-round Policy Delphi study was conducted between December 2024 and May 2025 with 17 invited experts from diverse professional and cultural backgrounds. Nine completed both rounds. The Delphi approach was used to identify areas of convergence while also capturing the diversity of expert perspectives. No fixed consensus threshold was set, reflecting the view that in ethically and contextually complex domains such as human rights in mental health, divergent opinions can yield valuable insights. In Round 1, participants provided qualitative responses to four open-ended questions, which were analyzed thematically to generate items for Round 2. In Round 2, participants prioritized structured response options (n = 8 items) derived from the thematic analysis. Descriptive statistics summarized the response distributions. Round 1 revealed strong convergence on the importance of community inclusion, user participation, and professional training. Round 2 confirmed these priorities: 78% identified 'mutual exchange and learning' as the main benefit of international collaboration, while 44% and 33% prioritized social inclusion and staff training, respectively, as essential for rights-based recovery. Reported barriers included control-oriented care cultures (33%) and insufficient training or tools (22% each). Experts envisioned future mental health care as fully integrated into community life (56%), with reduced reliance on institutional structures or technocratic solutions. This Delphi study underscores that rights-based, recovery-oriented mental health services must prioritize community inclusion, shared governance, and contextual adaptability. Experts cautioned against top-down or standardized reforms, favoring relational and participatory models. These findings provide actionable insights for developing coercion-free consultation-liaison psychiatry within general hospitals and can inform broader international efforts toward sustainable, rights-based mental health reform.