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| © WHO photo/P. Virot |
There are more than 450 million people worldwide with mental, neurological or behavioural problems, whose human rights are violated, often in psychiatric institutions through inadequate, degrading and harmful care and treatment, as well as unhygienic and inhumane living conditions.
In many countries, people with mental disorders live with their families or on their own, with no support from the Government, and are segregated from society due to the lack of community-based services. They often face isolation and stigmatization, resulting in discrimination in education, employment and housing, which affect their ability to gain access to appropriate care, integrate into society and recover. In some countries, they are prohibited from voting, marrying or having children. Nearly one of four countries has no mental health laws, while many do not have adequate legislation.
As part of an ongoing effort to provide support to an increasing number of countries implementing progressive mental health laws that respect, protect and fulfil the rights of people with mental disorders, the World Health Organization launched in June 2005 the WHO Resource Book on Mental Health, Human Rights and Legislation, which gives countries an important new legal tool to address these issues. It includes input from consultations with hundreds of experts and stakeholders worldwide, including leaders in psychiatry, psychology, law and human rights, as well as representatives from mental health service users, family groups and non-governmental organizations.
“All persons with a mental illness … shall be treated with humanity and respect for the inherent dignity of the human person. … There shall be no discrimination on the grounds of mental illness.”
—UN Principles for the Protection of Persons with Mental Illness, 1991
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The book also examines international human rights standards, showing how they apply to people with mental disorders, and provides practical guidance on issues countries need to consider and incorporate into their national health laws, as well as useful strategies to facilitate the development, adoption and implementation of the laws. “We have a moral and legal obligation to modernize mental health legislation. WHO is ready to help its member States to fulfil this obligation with technical support and expert advice”, said its Director-General, Dr. Lee Jong-wook.
Legislation enables the codification and consolidation of the fundamental principles, values and objectives of mental health policies and programmes, and provides a legal framework to ensure that critical issues affecting people with mental disorders are addressed. For the protection of the mentally ill, legislation should ensure that their rights to confidentiality are respected, and that they have the right to free and full access to clinical records, are guaranteed protection from cruel, inhuman and degrading treatment in mental health facilities and are informed of their rights when interacting with mental health services.
In addition, legislation needs to reflect that families and caretakers assume major responsibility for looking after people with mental disorders, identifying the actions to be taken and determining the appropriate authority for appointment of a guardian. It should also define the level of experience and skills required to determine mental disorder and delineate the professional groups permitted to do so.
Legislation may permit seclusion and restraint when they are the only means available to prevent immediate or imminent harm and danger to the patient and others. Informed consent for participation in clinical or experimental research must be obtained from voluntary and involuntary patients who have the capacity to consent. The police, in cases where they have to interact with mental patients and health services, are duty-bound to respect and protect their rights and act in a caring and compassionate manner. Independent review bodies should be set up to protect the human rights of persons with mental disorders. Also, the criminal justice system should prefer treatment rather than incarceration for offenders with mental disorders.
Mental health issues will be the focus of WHO on Human Rights Day on 10 December 2005.
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