human rights and legislation who resource book on mental health

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4.1.3 Sanction, promulgation <strong>and</strong> publication of new <strong>legislation</strong> 104 4.2 Key actions during adoption of <strong>legislation</strong> 105 4.2.1 Mobilizing public opinion 105 4.2.2 Lobbying members of the executive branch of government <strong>and</strong> the legislature 105 5. Implementing mental health <strong>legislation</strong> 106 5.1 Importance <strong>and</strong> role of bodies responsible for implementation 106 5.2 Dissemination <strong>and</strong> training 108 5.2.1 Public education <strong>and</strong> awareness 108 5.2.2 Users, families <strong>and</strong> advocacy organizations 108 5.2.3 Mental health, health <strong>and</strong> other professionals 109 5.2.4 Developing information <strong>and</strong> guidance materials 110 5.3 Financial <strong>and</strong> <strong>human</strong> <strong>resource</strong>s 110 References 113 Bibliography 118 Annexes Annex 1 WHO Checklist on Mental Health Legislation 119 Annex 2 Summary of major provisions <strong>and</strong> international instruments related to the <strong>rights</strong> of people with mental disorders 155 Annex 3 United Nations Principles for the Protection of Persons with Mental Illness <strong>and</strong> the Improvement of Mental Health Care 157 Annex 4 Extract from the PAHO/WHO Declaration of Caracas 165 Annex 5 Extract from the Declaration of Madrid of the World Psychiatric Association 166 Annex 6 Example: Rights of a Patient as specified in Connecticut, USA 169 Annex 7 Example: Rights of Recipients of Mental Health Services, State of Maine Department of Behavioral <strong>and</strong> Developmental Services, USA 171 Annex 8 Example: Forms for involuntary admission <strong>and</strong> treatment (combined approach) <strong>and</strong> appeal form, Victoria, Australia 173 Annex 9 Example: New Zeal<strong>and</strong> Advance Directives for Mental Health Patients 178 xiv
Preface There are many ways to improve the lives of people with mental disorders. One important way is through policies, plans <strong>and</strong> programmes that lead to better services. To implement such policies <strong>and</strong> plans, one needs good <strong>legislation</strong>–that is, laws that place the policies <strong>and</strong> plans in the context of internationally accepted <strong>human</strong> <strong>rights</strong> st<strong>and</strong>ards <strong>and</strong> good practices. This Resource Book aims to assist countries in drafting, adopting <strong>and</strong> implementing such <strong>legislation</strong>. It does not prescribe a particular legislative model for countries, but rather highlights the key issues <strong>and</strong> principles to be incorporated into <strong>legislation</strong>. As is true for all aspects of health, the marked differences in the financial <strong>and</strong> <strong>human</strong> <strong>resource</strong>s available in countries affect how mental health issues are addressed. Indeed, the needs expressed by mental health service users, families <strong>and</strong> carers, <strong>and</strong> health workers are highly dependent on current <strong>and</strong> past service provision, <strong>and</strong> peoples’ expectations vary significantly from country to country. As a result, certain services <strong>and</strong> <strong>rights</strong> that are taken for granted in some countries will be the objectives other countries strive for. However, efforts can be made in all countries to improve mental health services <strong>and</strong> promote <strong>and</strong> protect <strong>human</strong> <strong>rights</strong> in order to better meet the needs of people with mental disorders. Most countries could improve mental health significantly if they had additional <strong>resource</strong>s dedicated specifically to mental health. Yet, even when <strong>resource</strong>s are constrained, means can be found – as this Resource Book makes clear – for international <strong>human</strong> <strong>rights</strong> st<strong>and</strong>ards to be respected, protected <strong>and</strong> fulfilled. In certain instances, reform can be undertaken with few or no additional <strong>resource</strong>s, although a minimum level of <strong>resource</strong>s is always necessary to attain even basic goals <strong>and</strong>, clearly, additional <strong>resource</strong>s will need to be committed – especially in countries that now have only minimal or no mental health <strong>resource</strong>s – if basic international <strong>human</strong> <strong>rights</strong> st<strong>and</strong>ards are to be met. Legislation can itself be a means to secure more <strong>resource</strong>s for mental health, improve <strong>rights</strong> <strong>and</strong> mental health st<strong>and</strong>ards <strong>and</strong> conditions in a country. However, in order for a law to make a positive difference to the lives of people with mental disorders, it must have realistic <strong>and</strong> attainable goals. An unrealistic law on which the country cannot deliver serves no purpose at all, <strong>and</strong> can result in unnecessary expenses related to litigation, thereby diverting <strong>resource</strong>s from service development. Legislatures should therefore only pass a law after exploring the <strong>resource</strong> implications. The question of how the objectives set out in this Resource Book can realistically be achieved in each country should be a major consideration for all readers of this <strong>book</strong>. What does this Resource Book provide? The chapters <strong>and</strong> annexes of this <strong>book</strong> contain many examples of diverse experiences <strong>and</strong> practices, as well as extracts of laws <strong>and</strong> other law-related documents from different countries. These examples do not represent recommendations or “models” to be replicated; rather, they are designed to illustrate what different countries are doing in the area of mental health, <strong>human</strong> <strong>rights</strong> <strong>and</strong> <strong>legislation</strong>. Three key elements of effective <strong>legislation</strong> are outlined: context, content <strong>and</strong> process – in other words, the “why”, “what” <strong>and</strong> “how” of mental health <strong>legislation</strong>. In addition, Annex 1 contains a Checklist on Mental Health Legislation, which can be used in conjunction with the Resource Book. The checklist is designed to assist countries in assessing whether key components are included in their mental health law, <strong>and</strong> in ensuring that the broad recommendations contained in the Resource Book are carefully examined <strong>and</strong> considered. Throughout the <strong>book</strong>, reference is also made to the WHO Mental Health Policy <strong>and</strong> Service Guidance Package. This Package consists of a series of interrelated modules on issues such as mental health policy development, advocacy, financing <strong>and</strong> service organization, among others, designed to assist countries in addressing key mental health reform issues. xv
Page 1: WHO RESOURCE BOOK ON MENTAL HEALTH,
Page 4 and 5: All rights reserve
Page 6 and 7: Technical contribution and<
Page 8 and 9: Nacanieli Goneyali Maria Grazia Gia
Page 10 and 11: Leen Meulenbergs Harry I. Minas Alb
Page 12 and 13: Harvey Whiteford Ray G. Xerri XIE B
Page 14 and 15: 5. Rights of users of mental health
Page 18 and 19: For whom is this R
Page 20 and 21: This chapter covers five main areas
Page 22 and 23: 3.2 Violations of human</st
Page 24 and 25: 3.5 Promoting access to mental heal
Page 26 and 27: health legislation
Page 28 and 29: The right to health, as embodied in
Page 30 and 31: trade, torture and
Page 32 and 33: The MI Principles have also served
Page 34 and 35: 8.4 The Salamanca Statement <strong
Page 37 and 38: Chapter 2 Content of mental health
Page 39 and 40: persons with mental disorders. The
Page 41 and 42: Mental disability is not synonymous
Page 43 and 44: Mental Disability Mental Incapacity
Page 45 and 46: Definition of “mental ill health
Page 47 and 48: Example: Mental health in primary c
Page 49 and 50: Another means of promoting communit
Page 51 and 52: MI Principles: Access to informatio
Page 53 and 54: Legislation (or accompanying regula
Page 55 and 56: Rights of users of mental health se
Page 57 and 58: mentally ill offender. Countries ma
Page 59 and 60: 7.3 Determining incapacity
Page 61 and 62: • The presence of a major mental
Page 63 and 64: The concept of “voluntary” prec
Page 65 and 66: 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
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Figure 1. Procedure for combined in
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Emergency situations: Key issues
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10.1 Major medical and</str
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MI Principles: Seclusion an
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The MI Principles and</stro
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Authorize or prohibit intrusive <st
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• confidentiality • independent
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14.2 Responding to calls for assist
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15. Legislative provisions relating
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For minor offences, the court could
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15.4 The post-sentencing (serving s
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16. Additional substantive provisio
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• Right to work and</stro
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In countries where women are detain
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Kenya The Mental Health Act (Act No
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Figure 2. Process of mental health
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) Qualitative information from focu
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When examining another country’s
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• The process of building a conse
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Consultation should be undertaken w
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Written submissions have the advant
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The group, body or individual(s) m<
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4.1.2 Debate of draft legis
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mental health facts and</st
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Example: The National Commission ta
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5.2.4 Developing information <stron
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Human resource iss
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Rosenthal E, Sundram C (2002). Inte
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Declaration of Hawaii (1983). Appro
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Bibliography Araya R et al. (2001).
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Introduction and h
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2) Does the legislation</st
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C. Access to mental health care 1)
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3) Does the legislation</st
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E. Rights of families or other care
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G. Voluntary admission and<
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) there is serious likelihood of ha
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• Patient lacks the capacity to m
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2) Are all the criteria and
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O. Special treatments 1) Does the l
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3) Does the law specify a restricte
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R. Oversight and r
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3) (iv) Maintain registers of accre
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• the right of patients a
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3) Does the law allow for people <s
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2) Does the law provide for “reas
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3) Does the law ensure that all min
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AZ. Offences and p
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• Inter-American Convention on th
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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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