human rights and legislation who resource book on mental health

9.2 Professional groups
Which professional group may make a judgement about the presence or absence of a mental
disorder must be determined within countries, <strong>and</strong> must be linked to questions of availability,
accessibility, affordability, training <strong>and</strong> competence of various professional groups. In some
developed countries, only a psychiatrist (a medical doctor with special training in mental health
<strong>and</strong> mental disorder, <strong>and</strong> certified as such) is qualified to undertake this exercise, while in others,
general practitioners are considered competent. The MI Principles are silent on this issue, noting
only “in accordance with internationally accepted medical st<strong>and</strong>ards”. The European
Commission of Human Rights, on the other h<strong>and</strong>, has accepted that medical evidence may
come from a general practitioner rather than a psychiatrist (Schuurs v. the Netherl<strong>and</strong>s, 1985).
In many low-income countries with a scarcity of psychiatrists <strong>and</strong> general practitioners, it may
be appropriate to designate other mental health practitioners, such as psychologists, psychiatric
social workers <strong>and</strong> psychiatric nurses, as competent to determine mental disorders. Where this
is permitted, <strong>legislation</strong> (or accompanying regulations) should clearly specify the level of
knowledge, experience <strong>and</strong> training required for such accreditation.
Staff requirements for determining mental disorders: Key issues
• Legislation (or regulations) should outline the following:
> define the level of experience <strong>and</strong> skills required to determine mental disorder;
> delineate the professional groups permitted to do so.
• A system of accreditation needs to exist whereby practitioners <strong>who</strong> are involved in the
process of determining mental disorder are recognized as having demonstrable competence
in this task.
• Which professional group may make a judgement about the presence or absence of a mental
disorder must be determined within countries. In countries with a scarcity of psychiatrists
<strong>and</strong> general practitioners, it may be appropriate to designate other mental health
practitioners as competent to determine mental disorders. Where this is permitted,
<strong>legislation</strong> (or accompanying regulations) should clearly specify the level of knowledge,
experience <strong>and</strong> training required for such accreditation.
10. Special treatments
Countries may decide to enact <strong>legislation</strong> to protect people against abuses in the use of certain
treatments such as major medical <strong>and</strong> surgical procedures, ECT, psychosurgery or other
irreversible treatments. Some countries may also need to specifically ban certain interventions if
they are being unjustifiably utilized as treatments for mental disorders. Sterilization as a treatment
for mental illness is an example of this. In addition, the mere fact of having a mental disorder
should not be a reason for sterilization or abortion without informed consent.
MI Principles: Sterilization
Sterilization shall never be carried out as a treatment for mental illness.
(Principle 11(12), MI Principles)
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