Camilla Parker Mental Health & Human Rights Consultant 18th May 2009

Mental health policy, human rights & legislation “There are many ways to improve the lives of peoplewith mental disorders. One important way isthrough policies, plans and programmes that lead to

better services. To implement such policies andplans, one needs good legislation–that is, laws thatplace the policies and plans in the context ofinternationally accepted human rights standardsand good practices.”WHO, 2005

A supportive & dynamic relationship

How they are connected:Mental Health Policy: underpinned by human rights

principles; take forward action to ensure compliance with human rights obligations, including a review to identify legislative barriers & need for new legislation

Legislation: can codify human rights principles; give framework on how policy implemented & enforced; ensure the protection & promotion of human rights

Human Rights: provide the principles on which policy & legislation developed, implemented and enforced; identify areas of policy and legislation not complying with human rights

Core components of mental health policy (WHO) Establishment of high quality mental health

servicesAccess to quality mental health careProtection of human rights Patients’ rights to treatmentDevelopment of robust procedural protections Integration of persons with mental disorders

into the community; and Promotion of mental health throughout society.

Emerging Principles: a Basis for Positive Change Respect for individuals’ inherent dignity & autonomyProtect against discrimination Promote equality & social inclusion: remove barriers to

exercise of rights & freedoms, facilitate participationPromote personal autonomy: enabling people to make

decisions for themselves Protect from arbitrary interference (least restrictive

alternative) Provision of support based on individuals’ needs and

strengthsEnsure full & effective participation

Legislation: far more than care and treatment Protection from arbitrary

detention/compulsory treatment: define circumstances justifying compulsory care and treatment

Ensuring availability of community-based services

Safeguarding the rights of individuals seeking/receiving mental health services (whether as in-patients or in the community)

Addressing the barriers to social inclusion

Health as a human rightArticle 12 ICESCR: the right of everyone to the

enjoyment of the highest attainable standard of physical and mental health

Progressive realisation: recognition of resource constraints and competing duties – some rights cannot be achieved immediately BUT requires means to measure progress

Immediate obligations: including to take steps towards fully realising these rights

Participation in all health-related decision-making at community, national and international levels

GC14: Right to health:Linked to other rights ...closely connected to and dependent upon the

realization of other human rights....including the rights to food, housing, work, education, human dignity, life, non-discrimination, equality, the prohibition against torture, privacy, access to information... These rights and freedoms address integral components of the rights to health.

Embraces a wide range of socio-economic factors that promote conditions for a healthy life, extends to the underlying determinants of health e.g. housing, healthy working conditions and healthy environment

4 Elements of right to healthElement Examples of possible relevance to legislation Available - Requirement to provide a sufficient range of mental

health care facilities, goods & services Accessible - Anti-discrimination law : ensure equality of access

to services; no presumptions made about quality of life & potential - Legislation to uphold presumption of capacity (challenge presumptions that individuals not able to make decisions about their own care)

Acceptable -Respect for individuals’ cultural background -Ensure treatment & care based on individually prescribed plan, discussed with service user and reviewed regularly

Quality -Health professionals to receive adequate training -Mechanisms for monitoring and evaluation

Obligations to respect, promote & fulfil the right to health Respect: refrain from denying or limiting equal

access to health-care facilities Protect: protect individuals from health-related

abuses in private health care or support services Fulfil: range of measures including:

Empower people to make choices about their livesLegal protections for establishment of (and access to)

quality mental health facilities; care & support servicesEnsure integration into the communityPromote mental health throughout society

Report of Special Rapporteur, 2005

UN Convention Rights of Persons with DisabilitiesRights of disabled people must be

respected and promotedSeek full participation in societyTake action to eliminate

discrimination Take concrete steps to achieving all

rights set out in the Convention Involve disabled people in this work

Article 19 UNCRPD States recognise the equal right of

disabled people: To live in the community With choices equal to others

States shall take effective & appropriate measures to facilitate people’s:Full enjoyment of this right Full inclusion and participation in the

community

Article 19: Effective & appropriate measuresEqual opportunity to choose place of

residence & where & with whom to liveNot obliged to live in a particular living

arrangement Access to a range of community support

services (to support community living and prevent isolation/segregation)

Access to general public community services and facilities on an equal basis (& services responsive to their needs)

Implications for Mental Health Policy: Services Assessment to address individuals’ health, social

care and other support requirementsProvide services to meet individuals assessed needs,

taking their views and preferences into account Wherever possible, provide community based

services Service planning to involve service users & familiesEstablish mechanisms to monitor and review the

services provided, involving service users & families

Implications for Mental Health: Protection of RightsIndividuals should be given the opportunity

to make decisions for themselves and provided with the support to assist this where necessary

Any intervention to be on the principle of least restrictive alternative

Establish mechanism to safeguard individuals’ rights e.g. Complaints, independent review of detention

Implications for Mental Health: Addressing Stigma & Discrimination Anti-discrimination laws and policies to

protect people with mental health problems Workforce to receive training on mental

health and disability issues Develop public awareness campaigns

Mental Health Policy and Legislation (1)Clarify circumstances justifying compulsion

and safeguards when compulsory powers used

Complaints procedures and powers of monitoring & inspection bodies to take action against poor care and/or abuse

Anti-discrimination legislation – and review of laws to check against unfair discrimination

Mental Health Policy and Related Legislation (2)Provision of support to meet assessed health

and social care needsLegal and financial mechanisms setting out

different agencies responsibilities for the planning and delivery of services

Supported decision-making for individuals who lack capacity

Legislation for community-based services: suggested componentsPowers & responsibilities of relevant agencies for

commissioning & provision of servicesProcedures to ensure individuals receive appropriate

care and support e.g. comprehensive assessment of their needs for health, social care, accommodation etc

Service user involvement: a) developing their care plans and b) monitoring and evaluation of services

Availability of independent advocatesComplaints procedures Accessible information (procedures, complaints)Independent monitoring and evaluation of services

What’s possible in Ireland?Legislation not a panacea: need

Political will, adequate resources , trained professionals Strategy for implementing legislation e.g. raising

awareness, training and guidance, ensuring remedies are effective and accessible

Advocating for action: Vision – ‘Vision for Change’Dissatisfaction with existing situationExamples of what can be achievedWorking together to remove the barriers to realising

the vision and facilitate positive reform.

Further information World Health Organisation (WHO) (2003)

Mental Health Policy and Service Guidance Package, Mental Health Legislation and Human Rights, World Health Organisation, Geneva

WHO Resource Book on Mental Health, Human Rights and Legislation (2005)

Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt, E/CN.4/2005/51