human rights and legislation who resource book on mental health

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Who can make an advance directive? The Code of Health <strong>and</strong> Disability Services Consumers’ Rights gives any person <strong>who</strong> is legally competent to make a health care choice the right to make an advance directive. What can I make an advance directive about? Advance directives should focus on treatment <strong>and</strong> care. For example, you could state: · the treatments you do or don’t want to be given when you are in a crisis, including drugs or ECT · the places you would prefer to receive services when in crisis, such as hospital, home or a crisis house. Example: An advance directive requesting a specific drug Sally knows that when she starts to feel a certain way, it’s really important to begin treatment with a low dose of drug X. During her first episodes of mental illness she became very unwell <strong>and</strong> was hospitalised. Recently she shifted to a new city <strong>and</strong> is unsure whether her new doctor really respects her own knowledge of her condition. She decided to prepare an advance directive, which states that if she has another episode she wishes to be prescribed drug X by her GP, rather than waiting for psychiatric referral. While Sally’s request will be respected by her clinicians, the drug will be provided only if clinically appropriate at the time. How do I go about making an advance directive? It’s not difficult to make an advance directive. You don’t need a lawyer. In fact, you have the right to make an advance directive without involving anyone else in its preparation. However, taking the following steps will help ensure that your advance directive is respected, <strong>and</strong> the decisions contained within it acknowledged <strong>and</strong> acted upon. · If possible, make your advance directive in writing rather than verbally. State your preferences as clearly as you can, then sign <strong>and</strong> date it. · If you prepare your advance directive with the help of your clinician or another health worker, he or she can verify that you are competent <strong>and</strong> sufficiently informed about your stated preferences, <strong>and</strong> can help you clarify the type of situation you intend your directive to cover. · If you involve your family or whanau in preparing your advance directive, or at least inform them of it, they will be better equipped to support you <strong>and</strong> to advocate for your wishes in a crisis. · Regularly review <strong>and</strong> update your advance directive so that it reflects any changes in your condition or your preferences, <strong>and</strong> is viewed by clinicians as still representing your wishes. · Keep a copy of your advance directive yourself, <strong>and</strong> give copies to your family or support persons, <strong>and</strong> the clinicians most often involved in your care. Will my advance directive always be followed? No. When deciding whether or not to follow your advance directive, your clinician will consider five questions: · Were you competent to make the decision when you made the advance directive? · Did you make the decision of your own free will? · Were you sufficiently informed to make the decision? · Did you intend your directive to apply to the present circumstances, which may be different from those anticipated? · Is the advance directive out of date? The Code of Health <strong>and</strong> Disability Services Consumers’ Rights sets out your right to be fully informed, make an informed choice, <strong>and</strong> give informed consent. However, your advance directive will not override the ability of your clinician to authorise compulsory treatment if you are subject to a compulsory treatment order under the Mental Health (Compulsory 180
Assessment <strong>and</strong> Treatment) Act 1992. The Mental Health Act also directs the responsible clinician to attempt to get your consent to treatment even though he or she may give you treatment without your consent. It may still be worth having an advance directive if you are subject to a compulsory treatment order because it will give your clinician an indication of your wishes. Example of an advance directive refusing drug X. I do not wish to receive drug X under any circumstances. I have discussed this decision with my psychiatrist, Dr , <strong>who</strong> has explained my treatment options <strong>and</strong> the expected benefits, risks <strong>and</strong> side effects of drug X. I confirm that I have made this decision of my own free will <strong>and</strong> that, unless revoked by me, it is to apply for the next years. Date Signature I confirm that directive. is competent at the time of making this advance Date Clinician Mental Health Commission: Phone: (04) 474 8900 Fax: (04) 474 8901 Email: info@mhc.govt.nz Website: www.mhc.govt.nz HDI Health <strong>and</strong> Disability Commission: Ph/TTY: (09) 373 1060 Fax: (09) 373 1061 Freephone: 0800 11 22 33 Email: hdc@hdc.org.nz Website: www.hdc.org.nz 181
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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
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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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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
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Page 162 and 163: 3) (iv) Maintain registers of accre
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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
Page 178 and 179: 5. A patient shall never be invited
Page 180 and 181: Principle 15 Admission principles 1
Page 182 and 183: Principle 20 Criminal offenders 1.
Page 184 and 185: Annex 5. Extract from the Declarati
Page 186 and 187: 5. Organ Transplantation: The role
Page 188 and 189: Restraint & Seclusion: If condition
Page 190 and 191: Rights of Recipients Summary in Eng
Page 192 and 193: PART C TAKING PERSON TO APPROVED ME
Page 194 and 195: I base my opinion on the following
Page 196 and 197: Annex 9. Example: New Zeala
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