human rights and legislation who resource book on mental health

Consultation should be undertaken with users of mental health services, families of persons with
mental disorders, advocacy organizations, NGOs, professional groups, governmental bodies
<strong>and</strong> departments, service providers, community representatives <strong>and</strong> any others <strong>who</strong> will be
directly or indirectly affected by the <strong>legislation</strong>. Many of these would already have been involved
in the initial drafting, though this stage offers an opportunity for wider consultation. Each of these
interest groups may include many subgroups that may have distinctly different perspectives.
(See also, Mental Health Policy <strong>and</strong> Service Guidance Package: Advocacy for Mental Health
(WHO, 2003b) at: http://www.<strong>who</strong>.int/mental_health/<strong>resource</strong>s/policy_services/en/).
Within the government, the ministries responsible for health, welfare/social services, education,
employment, justice, police, correctional services, finance, housing (<strong>and</strong> possibly others) are
involved <strong>and</strong> need to be consulted. The exact division of responsibilities between government
departments varies in different countries. In some countries the department of health will have
jurisdiction over care <strong>and</strong> treatment aspects of the proposed <strong>legislation</strong>, while the needs for
rehabilitation <strong>and</strong> prevention may be the responsibility of the department of welfare/social
services. In other countries all these functions may fall under the department of health.
Whichever framework is in place, consultation with both the health <strong>and</strong> welfare departments
would be essential to avoid overlaps, duplication or conflicts. The department of finance would
also need to be consulted, as the proposed <strong>legislation</strong> is likely to have financial implications for
public <strong>and</strong> private service providers, <strong>and</strong> there are likely to be costs in setting up the regulatory
<strong>and</strong> monitoring agencies. This department’s support <strong>and</strong> commitment to the <strong>legislation</strong> is
therefore crucial to ensure adequate financial provision for effective implementation of the
<strong>legislation</strong>. Consultation would similarly be required with other government departments
concerning those sections of the <strong>legislation</strong> relevant to them.
Professional groups, including psychiatrists, nurses, psychologists, psychiatric social workers,
therapists, rehabilitation professionals <strong>and</strong> other professionals <strong>who</strong> interact with the mental
health system will have day-to-day responsibility for implementing the provisions of mental health
<strong>legislation</strong>. These groups are likely to be able to identify specific implementation difficulties in
treatment <strong>and</strong> care practice. It is therefore essential that their views be taken into consideration
when <strong>legislation</strong> is being drafted.
Users are the primary beneficiaries of the law <strong>and</strong> their input <strong>and</strong> involvement is crucial. In many
countries, families are more often than not the primary care givers, <strong>and</strong> are therefore also directly
concerned with such <strong>legislation</strong>. There is, at times, tension among user groups <strong>and</strong> groups
representing family members of people with mental disorders in their orientation <strong>and</strong> ideological
stance towards mental health treatment <strong>and</strong> <strong>legislation</strong>. It is important that the consultation
process embrace all opinions in this regard. In some countries, especially those where user <strong>and</strong>
family advocacy groups have been established for some time, <strong>and</strong> where an ethic of respect for
the view of the patient is entrenched, it is relatively easy to get useful inputs from these groups.
However, in many countries this can be a major difficulty. People with mental disorders often feel
completely disempowered, <strong>and</strong> many come from disadvantaged communities where their
opinions are generally not sought. The hegemony of doctors <strong>and</strong> other health professionals is
also often an obstacle to getting users’ <strong>and</strong> families’ perspectives. The view that “doctor knows
best” is extremely strong in many countries. The process of getting users’ views is thus often far
more complicated than simply requesting input; it may involve an intensive training <strong>and</strong>
empowerment process before valuable feedback is received. It also often means going out to
people, rather than waiting for people to come forward with their views.
The consultation process should also include the statutory agencies which will be involved in
implementation of the mental health <strong>legislation</strong>. These include the police, prison officials <strong>and</strong>
magistrates working on the ground, <strong>and</strong> not only national or “head office” people <strong>who</strong> may not
be as closely in touch with everyday occurrences. Representatives of minority groups <strong>and</strong> other
vulnerable groups should also be involved in the consultation process.
Other important groups that should be involved in consultation are politicians, legislators <strong>and</strong>
other opinion makers. These groups can play a key role in the subsequent process of adoption
<strong>and</strong> implementation of <strong>legislation</strong>. They can help raise awareness about mental health issues,
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