human rights and legislation who resource book on mental health

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5.2.4 Developing information <strong>and</strong> guidance materials A guide<strong>book</strong> (or <strong>book</strong>s) can be developed to provide information that would be important to different role players such as health practitioners, patients <strong>and</strong> family members. This guide could give particular information about aspects of the <strong>legislation</strong> that may be difficult to underst<strong>and</strong>. It could provide detail or guidance about interpretation. Algorithms could also be developed that clearly illustrate processes, such as involuntary admission <strong>and</strong> treatment, <strong>and</strong> indicate which forms are needed at which stages of the process. Example: British Columbia develops a "Guide to the Mental Health Act" In British Columbia, a Guide to the Mental Health Act was developed to assist in implementing new <strong>legislation</strong>. It provides an overview of the entire Act <strong>and</strong> has appendices for different actors, such as how the community physician may certify an involuntary patient, how families can get help accessing physicians <strong>and</strong> the courts, <strong>and</strong> criteria <strong>and</strong> procedures for the police. (Personal correspondence with Dr John Gray, International Association of Gerontology, Canada) Formal guidance to professionals, such as a code of practice, is another important way of ensuring that <strong>legislation</strong> is properly implemented. Such guidance can re-emphasize the values <strong>and</strong> principles underpinning the <strong>legislation</strong>, explain what the various aspects of the <strong>legislation</strong> were meant to achieve, <strong>and</strong> include relevant case law. Example: Code of Practice for Engl<strong>and</strong> <strong>and</strong> Wales In Engl<strong>and</strong> <strong>and</strong> Wales, the mental health <strong>legislation</strong> required the Secretary of State for Health to produce a code of practice. This guidance exp<strong>and</strong>s considerably on the basic text, <strong>and</strong> affords professionals <strong>and</strong> the public the opportunity to see how the <strong>legislation</strong> should be implemented (see www.doh.gov.uk/mhac1983.htm). (Mental Health Act 1983, Code of Practice (1999), London, Stationary Office) 5.3 Financial <strong>and</strong> <strong>human</strong> <strong>resource</strong>s The speed <strong>and</strong> effectiveness of implementation is likely to depend on the availability of adequate financial <strong>resource</strong>s. Difficulties associated with drafting laws that cannot be implemented owing to financial constraints have already been discussed (see Chapter 2, section 4). An added <strong>resource</strong> problem is that new mental health <strong>legislation</strong> usually requires a shift from institutional to community-based care, <strong>and</strong> this can require additional funding. While in the long run, reallocation of funds from institutions to community-based facilities is feasible, in the short-term, there may need to be both institutional <strong>and</strong> community-based facilities – until community-based facilities are fully developed enough to provide adequate services. The proportion of a country’s budget or health budget that should be spent on mental health is debatable <strong>and</strong> falls outside the scope of this Resource Book. It is important to emphasize, however, that mental health is often given low priority vis-à-vis other health care issues, <strong>and</strong> that for effective implementation of good mental health <strong>legislation</strong> a fairer allocation of <strong>resource</strong>s for mental health may be needed. Secondly, there is debate concerning potential conflict in the distribution of <strong>resource</strong>s in support of the different provisions contained within the mental health law; for example, should <strong>resource</strong>s be deployed for employing additional personnel in community care, or for the establishment <strong>and</strong> running of a mental health review body? 110
Many aspects of progressive <strong>legislation</strong> will need adequate budgetary provision for implementation activities. Funds are required for setting up <strong>and</strong> operationalizing the review body, for training mental health professionals in the use of the <strong>legislation</strong>, <strong>and</strong> for making the necessary changes to the mental health services as required by the <strong>legislation</strong>. Negotiation for this should be done simultaneously with the process of drafting <strong>and</strong> adopting mental health <strong>legislation</strong> (Issues regarding mental health financing can be found in the Mental Health Policy <strong>and</strong> Service Guidance Package: Mental Health Financing (WHO, 2003d): http://www.<strong>who</strong>.int/mental_health/<strong>resource</strong>s/policy_services/en/). Example: Obstacles to <strong>and</strong> facilitating factors for effective implementation of mental health <strong>legislation</strong> Obstacles Lack of coordinated action in the implementation of mental health law (absence of a centralized agency or authority overseeing the process of implementation) Lack of knowledge, misunderst<strong>and</strong>ing <strong>and</strong> resistance by the general public, users <strong>and</strong> carers to the changes brought about by the new mental health <strong>legislation</strong> Mental health, health <strong>and</strong> other professionals are unaware, or resist the provisions, of mental health <strong>legislation</strong> Facilitating factors Appoint a coordinating agency, or ensure that an agency is appointed (e.g. a mental health review body) to oversee the implementation process, by having this included in the text of the law Public education <strong>and</strong> awareness-raising campaigns could highlight the provisions <strong>and</strong> rationale of the new mental health law Training programmes for mental health, health <strong>and</strong> other professionals could include explanations on the provisions of mental health <strong>legislation</strong> Guidance documents could inform people of the details of the <strong>legislation</strong> Shortage of mental health <strong>human</strong> <strong>resource</strong>s to implement some of the m<strong>and</strong>ates of the law Insufficient funding to develop the mechanisms needed to implement the law (e.g. advocacy, awareness-raising, training, visiting boards, complaints procedures) Mental health training should be provided to general health professionals <strong>and</strong> staff (for further details, see modules on Organization of Services for Mental Health (WHO, 2003c); <strong>and</strong> Human Resources <strong>and</strong> Training in Mental Health (WHO, 2005): (http://www.<strong>who</strong>.int/mental_health/<strong>resource</strong>s /policy_services/en/) Additional funding for mental health as well as protecting budgets should be allocated to mental health <strong>and</strong> for implementation of mental health <strong>legislation</strong> 111
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WHO RESOURCE BOOK ON MENTAL HEALTH,
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All rights reserve
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Technical contribution and<
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Nacanieli Goneyali Maria Grazia Gia
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Leen Meulenbergs Harry I. Minas Alb
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Harvey Whiteford Ray G. Xerri XIE B
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5. Rights of users of mental health
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4.1.3 Sanction, promulgation <stron
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For whom is this R
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This chapter covers five main areas
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3.2 Violations of human</st
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3.5 Promoting access to mental heal
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health legislation
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The right to health, as embodied in
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trade, torture and
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The MI Principles have also served
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8.4 The Salamanca Statement <strong
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Chapter 2 Content of mental health
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persons with mental disorders. The
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Mental disability is not synonymous
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Mental Disability Mental Incapacity
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Definition of “mental ill health
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Example: Mental health in primary c
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Another means of promoting communit
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MI Principles: Access to informatio
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Legislation (or accompanying regula
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Rights of users of mental health se
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mentally ill offender. Countries ma
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7.3 Determining incapacity
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• The presence of a major mental
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The concept of “voluntary” prec
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The key issue for mental health <st
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“separate” process from admissi
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In some cases, certain families bel
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as an inpatient or outpatient. This
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Example: Successful appeal of an ad
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8.3.7 Involuntary treatment in comm
Page 77 and 78: Figure 1. Procedure for combined in
Page 79 and 80: Emergency situations: Key issues
Page 81 and 82: 10.1 Major medical and</str
Page 83 and 84: MI Principles: Seclusion an
Page 85 and 86: The MI Principles and</stro
Page 87 and 88: Authorize or prohibit intrusive <st
Page 89 and 90: • confidentiality • independent
Page 91 and 92: 14.2 Responding to calls for assist
Page 93 and 94: 15. Legislative provisions relating
Page 95 and 96: For minor offences, the court could
Page 97 and 98: 15.4 The post-sentencing (serving s
Page 99 and 100: 16. Additional substantive provisio
Page 101 and 102: • Right to work and</stro
Page 103 and 104: In countries where women are detain
Page 105: Kenya The Mental Health Act (Act No
Page 108 and 109: Figure 2. Process of mental health
Page 110 and 111: ) Qualitative information from focu
Page 112 and 113: When examining another country’s
Page 114 and 115: • The process of building a conse
Page 116 and 117: Consultation should be undertaken w
Page 118 and 119: Written submissions have the advant
Page 120 and 121: The group, body or individual(s) m<
Page 122 and 123: 4.1.2 Debate of draft legis
Page 124 and 125: mental health facts and</st
Page 126 and 127: Example: The National Commission ta
Page 130 and 131: Human resource iss
Page 132 and 133: Rosenthal E, Sundram C (2002). Inte
Page 134 and 135: Declaration of Hawaii (1983). Appro
Page 136 and 137: Bibliography Araya R et al. (2001).
Page 138 and 139: Introduction and h
Page 140 and 141: 2) Does the legislation</st
Page 142 and 143: C. Access to mental health care 1)
Page 144 and 145: 3) Does the legislation</st
Page 146 and 147: E. Rights of families or other care
Page 148 and 149: G. Voluntary admission and<
Page 150 and 151: ) there is serious likelihood of ha
Page 152 and 153: • Patient lacks the capacity to m
Page 154 and 155: 2) Are all the criteria and
Page 156 and 157: O. Special treatments 1) Does the l
Page 158 and 159: 3) Does the law specify a restricte
Page 160 and 161: R. Oversight and r
Page 162 and 163: 3) (iv) Maintain registers of accre
Page 164 and 165: • the right of patients a
Page 166 and 167: 3) Does the law allow for people <s
Page 168 and 169: 2) Does the law provide for “reas
Page 170 and 171: 3) Does the law ensure that all min
Page 172 and 173: AZ. Offences and p
Page 174 and 175: • Inter-American Convention on th
Page 176 and 177: Civil and Politica
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5. A patient shall never be invited
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Principle 15 Admission principles 1
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Principle 20 Criminal offenders 1.
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Annex 5. Extract from the Declarati
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5. Organ Transplantation: The role
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Restraint & Seclusion: If condition
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Rights of Recipients Summary in Eng
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PART C TAKING PERSON TO APPROVED ME
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I base my opinion on the following
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Annex 9. Example: New Zeala
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Who can make an advance directive?
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