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      Mental health disabilities and human rights protections

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          Abstract

          Background.

          Around the world, reports regularly expose persistent and systemic human rights violations of patients in mental health services and facilities, and of those who are unable to access needed supports. A number of factors contribute – political will; the range and quality of services available; public and professional attitudes to mental health; stigma; health professionals’ training and expertise; and available resources.

          Methods.

          This paper examines one of the main determinants, the legal framework. This sets the parameters for mental health policies and services and for applicable human rights norms and standards that can be realized in practice.

          Results.

          We provide an overview of international human rights instruments in relation to mental health disabilities, and of the major human rights violations in this area. Key implications for mental health law reform are drawn with a particular focus on discrimination and coercive interventions. The major challenges posed by the UN Convention on the Rights of Persons with Disabilities (2006) are examined. Current mental health laws, to greater or lesser degrees, fail to meet the newly required standards. We discuss reforms based on ‘generic law’ and ‘legal capacity’ principles that seek to meet those standards.

          Conclusions.

          We outline some emergent and promising examples of reform. The role of civil society and the importance of the standing of those with mental health disabilities in this process is noted.

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          Most cited references15

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          Elements of a Theory of Human Rights

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            Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis.

            This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Mental health law and the UN Convention on the rights of persons with disabilities

              People with a mental illness may be subject to the UN Convention on the Rights of Persons with Disabilities (CRPD), depending on definitions of terms such as ‘impairment’, ‘long-term’ and the capaciousness of the word ‘includes’ in the Convention's characterisation of persons with disabilities. Particularly challenging under the CRPD is the scope, if any, for involuntary treatment. Conventional mental health legislation, such as the Mental Health Act (England and Wales) appears to violate, for example, Article 4 (‘no discrimination of any kind on the basis of disability’), Article 12 (persons shall ‘enjoy legal capacity on an equal basis with others in all aspects of life’) and Article 14 (‘the existence of a disability shall in no case justify a deprivation of liberty’). We argue that a form of mental health law, such as the Fusion Law proposal, is consistent with the principles of the CRPD. Such law is aimed at eliminating discrimination against persons with a mental illness. It covers all persons regardless of whether they have a ‘mental’ or a ‘physical’ illness, and only allows involuntary treatment when a person's decision-making capability (DMC) for a specific treatment decision is impaired — whatever the health setting or cause of the impairment — and where supported decision making has failed. In addition to impaired DMC, involuntary treatment would require an assessment that such treatment gives the person's values and perspective paramount importance.
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                Author and article information

                Journal
                Glob Ment Health (Camb)
                Glob Ment Health (Camb)
                GMH
                Global Mental Health
                Cambridge University Press (Cambridge, UK )
                2054-4251
                2015
                1 October 2015
                : 2
                : e20
                Affiliations
                [1 ]Institute of Psychiatry , King's College London, UK
                [2 ]IRIS – Institute for Research and Development on Inclusion and Society, Kinsmen Building, York University , North York, Ontario, Canada
                Author notes
                [* ]Address for correspondence: G. Szmukler, Institute of Psychiatry , De Crespigny Park, London SE5 8AF, UK. (Email: george.szmukler@ 123456kcl.ac.uk )
                Article
                S2054425115000187 00018
                10.1017/gmh.2015.18
                5269623
                a426ce03-e786-4810-808a-c1c47cc337c3
                © The Author(s) 2015

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 April 2015
                : 18 July 2015
                : 26 July 2015
                Page count
                References: 24, Pages: 9
                Categories
                Policy and Systems
                Original Research Paper
                WHO Action Plan

                human rights,mental disability,mental disorder,mental health law,policy & systems

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