Mental health policy and practice across Europe: an overview

A human rights perspective 315
Equality and social inclusion
Quinn et al. (2002: 16) consider that ‘human equality’ is ‘central to the system of
basic freedoms postulated by human rights law’. As the Standard Rules illustrate,
the equalization of opportunities and full inclusion within societies of
disabled people is a key goal for the UN. Governments should take steps to
remove the barriers preventing disabled people from exercising their rights and
freedoms and making it difficult for them to participate fully in the activities of
their societies (Standard Rules, para. 15). Article 25 of the EU Charter provides
for the integration of disabled people: ‘The Union recognizes and respects the
right of persons with disabilities to benefit from measures designed to ensure
their independence, social and occupational integration and participation in
the life of the community’.
Promoting personal autonomy and independence
Promoting individuals’ independence and ensuring they are given the opportunity
to make decisions about their own care and treatment are key features
of the MI Principles and the Standard Rules. The European Court of Human
Rights considers that the right to self-determination and the notion of personal
autonomy are inherent to the right to private and family life under Article 8
of the ECHR (Pretty v. United Kingdom 2002).
Least restrictive alternative/proportionality
Individuals with a mental illness have the right to live and work in the community
(MI Principle 3) and to be treated and cared for in the community in
which they live (MI Principle 7) so far as possible. They also ‘have the right to be
treated in the least restrictive environment and with the least restrictive or
intrusive treatment appropriate’ to their health needs and the need to protect
others (MI Principle 9(1)). This is similar to the principle of ‘proportionality’
under the ECHR. Even where it is clear that there is a legitimate reason for
restricting a right guaranteed by the ECHR, the restriction must not exceed
what is strictly necessary to achieve that purpose. The action taken will not be
considered to be proportionate if a less restrictive, but equally effective, alternative
is available (Starmer 1999: 4.37–55). This principle is particularly relevant
to decisions about the level, and type, of care and treatment provided to individuals
and should be reflected in legislation relating to detention and treatment
without consent.
Provision of care on the basis of individual needs
The importance of providing care and support to meet the individual’s needs
is emphasized by both the Standard Rules (para. 26) and the MI Principles
(Principle 8). The MI Principles state that individuals’ treatment and care shall
be based on an individually prescribed plan which is discussed with the patient
and regularly reviewed, revised as necessary and provided by qualified professional
staff (Principle 9). Furthermore, the treatment must be suited to the
person’s cultural background (Principle 7(1)).