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      Mental health law and the UN Convention on the rights of persons with disabilities

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          Abstract

          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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          Most cited references17

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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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            Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial.

            To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment. Single blind randomised controlled trial, with randomisation of individual patients. The investigator was blind to allocation. Eight community mental health teams in southern England. 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years. The joint crisis plan was formulated by the patient, care coordinator, psychiatrist, and project worker and contained contact information, details of mental and physical illnesses, treatments, indicators for relapse, and advance statements of preferences for care in the event of future relapse. Admission to hospital, bed days, and use of the Mental Health Act over 15 month follow up. Use of the Mental Health Act was significantly reduced for the intervention group, 13% (10/80) of whom experienced compulsory admission or treatment compared with 27% (21/80) of the control group (risk ratio 0.48, 95% confidence interval 0.24 to 0.95, P = 0.028). As a consequence, the mean number of days of detention (days spent as an inpatient while under a section of the Mental Health Act) for the whole intervention group was 14 compared with 31 for the control group (difference 16, 0 to 36, P = 0.04). For those admitted under a section of the Mental Health Act, the number of days of detention was similar in the two groups (means 114 and 117, difference 3, -61 to 67, P = 0.98). The intervention group had fewer admissions (risk ratio 0.69, 0.45 to 1.04, P = 0.07). There was no evidence for differences in bed days (total number of days spent as an inpatient) (means 32 and 36, difference 4, -18 to 26, P = 0.15 for the whole sample; means 107 and 83, difference -24, -72 to 24, P = 0.39 for those admitted). Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness. The reduction in overall admission was less. This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services.
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              Fusion of mental health and incapacity legislation.

              The enactment of a single legislative scheme governing nonconsensual treatment of both 'physical' and 'mental' illnesses, based on incapacity principles, has been mooted in recent law reform debates in the UK. We propose a framework for such legislation and consider in more detail the provisions it should contain. The design of legislation that combines the strengths of both incapacity and civil commitment schemes can be readily imagined, based on the criteria for intervention in England and Wales found in the Mental Capacity Act 2005. Such legislation would reduce unjustified legal discrimination against mentally disordered persons and apply consistent ethical principles across medical law.
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                Author and article information

                Contributors
                Journal
                Int J Law Psychiatry
                Int J Law Psychiatry
                International Journal of Law and Psychiatry
                Elsevier
                0160-2527
                1873-6386
                1 May 2014
                May 2014
                : 37
                : 3
                : 245-252
                Affiliations
                [a ]Institute of Psychiatry, King's College London De Crespigny Park, London, UK
                [b ]Legal Consultant; formerly Royal College of Psychiatrists, London, UK
                [c ]Durham University, Durham, UK
                Author notes
                [* ]Corresponding author at: Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Tel.: + 44 207 848 0096. george.szmukler@ 123456kcl.ac.uk
                Article
                S0160-2527(13)00126-X
                10.1016/j.ijlp.2013.11.024
                4024199
                24280316
                d237f0ee-6637-4c72-8208-cf9b3744b106
                © 2014 Elsevier Ltd. All rights reserved.
                History
                Categories
                Article

                Law
                rights,disabilities,mental illness,involuntary treatment,crpd
                Law
                rights, disabilities, mental illness, involuntary treatment, crpd

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