United Nations

A/RES/46/119


General Assembly

Distr. GENERAL  

17 December 1991

ORIGINAL:
ENGLISH



                                                   A/RES/46/119
                                                   75th plenary meeting
                                                   17 December 1991
 
 
      46/119.  The protection of persosn with mental illness and
               the improvement of mental health care
 
      The General Assembly,
 
      Mindful of the provisions of the Universal Declaration of Human
Rights, the International Covenant on Civil and Political Rights, the
International Covenant on Economic, Social and Cultural Rights and other
relevant instruments, such as the Declaration on the Rights of Disabled
Persons and the Body of Principles for the Protection of All Persons under
Any Form of Detention or Imprisonment,
 
      Recalling its resolution 33/53 of 14 December 1978, in which it
requested the Commission on Human Rights to urge the Subcommission on
Prevention of Discrimination and Protection of Minorities to undertake, as a
matter of priority, a study of the question of the protection of those
detained on the grounds of mental ill-health, with a view to formulating
guidelines,
 
      Recalling also its resolution 45/92 of 14 December 1990, in which it
welcomed the progress made by the working group of the Commission on Human
Rights in elaborating a draft body of principles for the protection of persons
with mental illness and for the improvement of mental health care on the basis
of a draft submitted to the Commission by the Subcommission on Prevention of
Discrimination and Protection of Minorities,
 
      Taking note of Commission on Human Rights resolution 1991/46 of 5 March
1991, in which the Commission endorsed the draft body of principles that
had been submitted to it by the working group and decided to transmit it, as
well as the report of the working group, to the General Assembly, through the
Economic and Social Council,
 
      Taking note also of Economic and Social Council resolution 1991/29 of 31
May 1991, in which the Council decided to submit the draft body of
principles and the report of the working group to the General Assembly,
 
      Taking note further of the recommendations of the Commission on Human
Rights in its resolution 1991/46 and of the Economic and Social Council in its
resolution 1991/29 that, on the adoption by the General Assembly of the draft
body of principles, the full text thereof should be given the widest possible
dissemination and that the introduction to the body of principles should at
the same time be published as an accompanying document for the benefit of
Governments and the public at large,
 
      Taking note of the note by the Secretary-General, the annex to which
contains the draft body of principles and the introduction to the body of
principles,
 
      1.    Adopts the Principles for the Protection of Persons with Mental
Illness and for the Improvement of Mental Health Care, the text of which is
contained in the annex to the present resolution;
 
      2.    Requests the Secretary-General to include the text of the
Principles, together with the introduction, in the next edition of the
publication entitled "Human Rights: A Compilation of International
Instruments";
 
      3.    Requests the Secretary-General to give the Principles the widest
possible dissemination and to ensure that the introduction is published at the
same time as an accompanying document for the benefit of Governments and the
public at large.
 
                                     ANNEX
         Principles for the Protection of Persons with Mental Illness
                 and for the Improvement of Mental Health Care
 
                                  Application
      The present Principles shall be applied without discrimination on any
grounds, such as disability, race, colour, sex, language, religion, political
or other opinion, national, ethnic or social origin, legal or social status,
age, property or birth.
                                  Definitions
      In the present Principles:
 
      (a)   "Counsel" means a legal or other qualified representative;
 
      (b)   "Independent authority" means a competent and independent
      authority prescribed by domestic law;
 
      (c)   "Mental health care" includes analysis and diagnosis of a person's
      mental condition, and treatment, care and rehabilitation for a mental
      illness or suspected mental illness;
 
      (d)   "Mental health facility" means any establishment, or any unit of
      an establishment, which as its primary function provides mental health
      care;
 
      (e)   "Mental health practitioner" means a medical doctor, clinical
      psychologist, nurse, social worker or other appropriately trained and
      qualified person with specific skills relevant to mental health care;
 
      (f)   "Patient" means a person receiving mental health care and includes
      all persons who are admitted to a mental health facility;
 
      (g)   "Personal representative" means a person charged by law with the
      duty of representing a patient's interests in any specified respect or
      of exercising specified rights on the patient's behalf, and includes the
      parent or legal guardian of a minor unless otherwise provided by
      domestic law;
 
      (h)   "The review body" means the body established in accordance with
      principle 17 to review the involuntary admission or retention of a
      patient in a mental health facility.
 
                           General limitation clause
 
       The exercise of the rights set forth in the present Principles may be
subject only to such limitations as are prescribed by law and are necessary to
protect the health or safety of the person concerned or of others, or
otherwise to protect public safety, order, health or morals or the fundamental
rights and freedoms of others.
 
                                  Principle 1
                     Fundamental freedoms and basic rights
 
1.    All persons have the right to the best available mental health care,
which shall be part of the health and social care system.
 
2.    All persons with a mental illness, or who are being treated as such
persons, shall be treated with humanity and respect for the inherent dignity
of the human person.
 
3.    All persons with a mental illness, or who are being treated as such
persons, have the right to protection from economic, sexual and other forms of
exploitation, physical or other abuse and degrading treatment.
 
4.    There shall be no discrimination on the grounds of mental illness.
"Discrimination" means any distinction, exclusion or preference that has the
effect of nullifying or impairing equal enjoyment of rights. Special measures
solely to protect the rights, or secure the advancement, of persons with
mental illness shall not be deemed to be discriminatory. Discrimination does
not include any distinction, exclusion or preference undertaken in accordance
with the provisions of the present Principles and necessary to protect the
human rights of a person with a mental illness or of other individuals.
 
5.    Every person with a mental illness shall have the right to exercise all
civil, political, economic, social and cultural rights as recognized in the
Universal Declaration of Human Rights, the International Covenant on
Economic, Social and Cultural Rights, the International Covenant on Civil
and Political Rights and in other relevant instruments, such as the
Declaration on the Rights of Disabled Persons and the Body of Principles
for the Protection of All Persons under Any Form of Detention or
Imprisonment.
 
6.    Any decision that, by reason of his or her mental illness, a person
lacks legal capacity, and any decision that, in consequence of such
incapacity, a personal representative shall be appointed, shall be made only
after a fair hearing by an independent and impartial tribunal established by
domestic law. The person whose capacity is at issue shall be entitled to be
represented by a counsel. If the person whose capacity is at issue does not
himself or herself secure such representation, it shall be made available
without payment by that person to the extent that he or she does not have
sufficient means to pay for it. The counsel shall not in the same proceedings
represent a mental health facility or its personnel and shall not also
represent a member of the family of the person whose capacity is at issue
unless the tribunal is satisfied that there is no conflict of interest.
Decisions regarding capacity and the need for a personal representative shall
be reviewed at reasonable intervals prescribed by domestic law. The person
whose capacity is at issue, his or her personal representative, if any, and
any other interested person shall have the right to appeal to a higher court
against any such decision.
 
7.    Where a court or other competent tribunal finds that a person with
mental illness is unable to manage his or her own affairs, measures shall be
taken, so far as is necessary and appropriate to that person's condition, to
ensure the protection of his or her interests.
 
                                  Principle 2
                             Protection of minors
 
      Special care should be given within the purposes of the Principles and
within the context of domestic law relating to the protection of minors to
protect the rights of minors, including, if necessary, the appointment of a
personal representative other than a family member.
 
                                  Principle 3
                             Life in the community
 
      Every person with a mental illness shall have the right to live and
work, to the extent possible, in the community.
 
                                  Principle 4
                        Determination of mental illness
 
1.    A determination that a person has a mental illness shall be made in
accordance with internationally accepted medical standards.
 
2.    A determination of mental illness shall never be made on the basis of
political, economic or social status, or membership in a cultural, racial or
religious group, or for any other reason not directly relevant to mental
health status.
 
3.    Family or professional conflict, or non-conformity with moral, social,
cultural or political values or religious beliefs prevailing in a person's
community, shall never be a determining factor in the diagnosis of mental
illness. 
 
4.    A background of past treatment or hospitalization as a patient shall not
of itself justify any present or future determination of mental illness.
 
5.    No person or authority shall classify a person as having, or otherwise
indicate that a person has, a mental illness except for purposes directly
relating to mental illness or the consequences of mental illness.
 
                                  Principle 5
                              Medical examination
 
      No person shall be compelled to undergo medical examination with a view
to determining whether or not he or she has a mental illness except in
accordance with a procedure authorized by domestic law.
 
                                  Principle 6
                                Confidentiality
 
      The right of confidentiality of information concerning all persons to
whom the present Principles apply shall be respected.
                                                                          /...
                                  Principle 7
                         Role of community and culture
 
1.    Every patient shall have the right to be treated and cared for, as far
as possible, in the community in which he or she lives.
 
2.    Where treatment takes place in a mental health facility, a patient shall
have the right, whenever possible, to be treated near his or her home or the
home of his or her relatives or friends and shall have the right to return to
the community as soon as possible.
 
3.    Every patient shall have the right to treatment suited to his or her
cultural background.
                                  Principle 8
                               Standards of care
 
1.    Every patient shall have the right to receive such health and social
care as is appropriate to his or her health needs, and is entitled to care and
treatment in accordance with the same standards as other ill persons.
 
2.    Every patient shall be protected from harm, including unjustified
medication, abuse by other patients, staff or others or other acts causing
mental distress or physical discomfort.
 
                                  Principle 9
                                   Treatment
 
1.     Every patient shall have the right to be treated in the least
restrictive environment and with the least restrictive or intrusive treatment
appropriate to the patient's health needs and the need to protect the physical
safety of others.
 
2.    The treatment and care of every patient shall be based on an
individually prescribed plan, discussed with the patient, reviewed regularly,
revised as necessary and provided by qualified professional staff.
 
3.    Mental health care shall always be provided in accordance with
applicable standards of ethics for mental health practitioners, including
internationally accepted standards such as the Principles of Medical Ethics
relevant to the role of health personnel, particularly physicians, in the
protection of prisoners and detainees against torture and other cruel, inhuman
or degrading treatment or punishment, adopted by the United Nations General
Assembly.  Mental health knowledge and skills shall never be abused.
 
4.    The treatment of every patient shall be directed towards preserving and
enhancing personal autonomy.
                                 Principle 10
                                  Medication
 
1.     Medication shall meet the best health needs of the patient, shall be
given to a patient only for therapeutic or diagnostic purposes and shall never
be administered as a punishment or for the convenience of others. Subject to
the provisions of paragraph 15 of principle 11 below, mental health
practitioners shall only administer medication of known or demonstrated
efficacy.
 
2.    All medication shall be prescribed by a mental health practitioner
authorized by law and shall be recorded in the patient's records.
 
                                 Principle 11
                             Consent to treatment
 
1.    No treatment shall be given to a patient without his or her informed
consent, except as provided for in paragraphs 6, 7, 8, 13 and 15 of  the
present principle.
 
2.    Informed consent is consent obtained freely, without threats or improper
inducements, after appropriate disclosure to the patient of adequate and
understandable information in a form and language understood by the patient
on:
      (a)   The diagnostic assessment;
 
      (b)   The purpose, method, likely duration and expected benefit of the
proposed treatment;
 
      (c)   Alternative modes of treatment, including those less intrusive;
 
      (d)   Possible pain or discomfort, risks and side-effects of the
proposed treatment.
 
3.    A patient may request the presence of a person or persons of the
patient's choosing during the procedure for granting consent.
 
4.    A patient has the right to refuse or stop treatment, except as provided
for in paragraphs 6, 7, 8, 13 and 15 of the present principle. The
consequences of refusing or stopping treatment must be explained to the
patient. 
 
5.    A patient shall never be invited or induced to waive the right to
informed consent. If the patient should seek to do so, it shall be explained
to the patient that the treatment cannot be given without informed consent.
 
6.    Except as provided in paragraphs 7, 8, 12, 13, 14 and 15 of the present
principle, a proposed plan of treatment may be given to a patient without a
 
patient's informed consent if the following conditions are satisfied:
 
      (a)   The patient is, at the relevant time, held as an involuntary
patient; 
                                                                          /...
      (b)   An independent authority, having in its possession all relevant
information, including the information specified in paragraph 2  of the
present principle, is satisfied that, at the relevant time, the patient lacks
the capacity to give or withhold informed consent to the proposed plan of
treatment or, if domestic legislation so provides, that, having regard to the
patient's own safety or the safety of others, the patient unreasonably
withholds such consent;
 
      (c)   The independent authority is satisfied that the proposed plan of
treatment is in the best interest of the patient's health needs.
 
7.    Paragraph 6 above does not apply to a patient with a personal
representative empowered by law to consent to treatment for the patient; but,
except as provided in paragraphs 12, 13, 14 and 15 of the present principle,
treatment may be given to such a patient without his or her informed consent
if the personal representative, having been given the information described in
paragraph 2  of the present principle, consents on the patient's behalf.
 
8.    Except as provided in paragraphs 12, 13, 14 and 15 of the present
principle, treatment may also be given to any patient without the patient's
informed consent if a qualified mental health practitioner authorized by law
determines that it is urgently necessary in order to prevent immediate or
imminent harm to the patient or to other persons. Such treatment shall not be
prolonged beyond the period that is strictly necessary for this purpose.
 
9.    Where any treatment is authorized without the patient's informed
consent, every effort shall nevertheless be made to inform the patient about
the nature of the treatment and any possible alternatives and to involve the
patient as far as practicable in the development of the treatment plan.
 
10.   All treatment shall be immediately recorded in the patient's medical
records, with an indication of whether involuntary or voluntary.
 
11.   Physical restraint or involuntary seclusion of a patient shall not be
employed except in accordance with the officially approved procedures of the
mental health facility and only when it is the only means available to prevent
immediate or imminent harm to the patient or others. It shall not be prolonged
beyond the period which is strictly necessary for this purpose. All instances
of physical restraint or involuntary seclusion, the reasons for them and their
nature and extent shall be recorded in the patient's medical record. A patient
who is restrained or secluded shall be kept under humane conditions and be
under the care and close and regular supervision of qualified members of the
staff. A personal representative, if any and if relevant, shall be given
prompt notice of any physical restraint or involuntary seclusion of the
patient. 
 
12.   Sterilization shall never be carried out as a treatment for mental
illness. 
 
13.   A major medical or surgical procedure may be carried out on a person
with mental illness only where it is permitted by domestic law, where it is
considered that it would best serve the health needs of the patient and where
the patient gives informed consent, except that, where the patient is unable
to give informed consent, the procedure shall be authorized only after
independent review.
                                                                          /...
14.   Psychosurgery and other intrusive and irreversible treatments for mental
illness shall never be carried out on a patient who is an involuntary patient
in a mental health facility and, to the extent that domestic law permits them
to be carried out, they may be carried out on any other patient only where the
patient has given informed consent and an independent external body has
satisfied itself that there is genuine informed consent and that the treatment
best serves the health needs of the patient.
 
15.   Clinical trials and experimental treatment shall never be carried out on
any patient without informed consent, except that a patient who is unable to
give informed consent may be admitted to a clinical trial or given
experimental  treatment, but only with the approval of a competent,
independent review body specifically constituted for this purpose.
 
16.   In the cases specified in paragraphs 6, 7, 8, 13, 14 and 15 of the
present principle, the patient or his or her personal representative, or any
interested person, shall have the right to appeal to a judicial or other
independent authority   concerning  any treatment given to him or her.
 
                                 Principle 12
                               Notice of rights
 
1.    A patient in a mental health facility shall be informed as soon as
possible after admission, in a form and a language which the patient
understands, of all his or her rights in accordance with the present
Principles and under domestic law, and the information shall include an
explanation of those rights and how to exercise them.
 
2.    If and for so long as a patient is unable to understand such
information, the rights of the patient shall be communicated to the personal
representative, if any and if appropriate, and to the person or persons best
able to represent the patient's interests and willing to do so.
 
3.    A patient who has the necessary capacity has the right to nominate a
person who should be informed on his or her behalf, as well as a person to
represent his or her interests to the authorities of the facility.
 
                                 Principle 13
               Rights and conditions in mental health facilities
 
1.    Every patient in a mental health facility shall, in particular, have the
right to full respect for his or her:
 
      (a)   Recognition everywhere as a person before the law;
 
      (b)   Privacy;
 
      (c)   Freedom of communication, which includes freedom to communicate
with other persons in the facility; freedom to send and receive uncensored
private communications; freedom to receive, in private, visits from a counsel
or personal representative and, at all reasonable times, from other visitors;
and freedom of access to postal and telephone services and to newspapers,
radio and television;
                                                                          /...
      (d)   Freedom of religion or belief.
 
2.    The environment and living conditions in mental health facilities shall
be as close as possible to those of the normal life of persons of similar age
and in particular shall include:
 
      (a)    Facilities for recreational and leisure activities;
 
      (b)    Facilities for education;
 
      (c)    Facilities to purchase or receive items for daily living,
recreation and communication;
 
      (d)    Facilities, and encouragement to use such facilities, for a
patient's engagement in active occupation suited to his or her social and
cultural background, and for appropriate vocational rehabilitation measures to
promote reintegration in the community. These measures should include
vocational guidance, vocational training and placement services to enable
patients to secure or retain employment in the community.
 
3.     In no circumstances shall a patient be subject to forced labour. Within
the limits compatible with the needs of the patient and with the requirements
of institutional administration, a patient shall be able to choose the type of
work he or she wishes to perform.
 
4.     The labour of a patient in a mental health facility shall not be
exploited. Every such patient shall have the right to receive the same
remuneration for any work which he or she does as would, according to domestic
law or custom, be paid for such work to a non-patient. Every such patient
shall, in any event, have the right to receive a fair share of any
remuneration which is paid to the mental health facility for his or her work.
 
                                 Principle 14
                    Resources for mental health facilities
 
1.    A mental health facility shall have access to the same level of
resources as any other health establishment, and in particular:
 
      (a)   Qualified medical and other appropriate professional staff in
sufficient numbers and with adequate space to provide each patient with
privacy and a programme of appropriate and active therapy;
 
      (b)   Diagnostic and therapeutic equipment for the patient;
 
      (c)   Appropriate professional care;
 
      (d)   Adequate, regular and comprehensive treatment, including supplies
of medication.
 
2.    Every mental health facility shall be inspected by the competent
authorities with sufficient frequency to ensure that the conditions, treatment
and care of patients comply with the present Principles.
                                                                          /...
                                 Principle 15
                             Admission principles
 
1.    Where a person needs treatment in a mental health facility, every effort
shall be made to avoid involuntary admission.
 
2.    Access to a mental health facility shall be administered in the same way
as access to any other facility for any other illness.
 
3.    Every patient not admitted involuntarily shall have the right to leave
the mental health facility at any time unless the criteria for his or her
retention as an involuntary patient, as set forth in principle 16 below,
apply, and he or she shall be informed of that right.
 
                                 Principle 16
                             Involuntary admission
 
1.    A person may be admitted involuntarily to a mental health facility as a
patient or,) having already been admitted voluntarily as a patient, be
retained as an involuntary patient in the mental health facility if, and only
if, a qualified mental health practitioner authorized by law for that purpose
determines, in accordance with principle 4 above, that that person has a
mental illness and considers:
 
      (a)   That, because of that mental illness, there is a serious
likelihood of immediate or imminent harm to that person or to other
persons; or
 
      (b)   That, in the case of a person whose mental illness is severe and
whose judgement is impaired, failure to admit or retain that person is likely
to lead to a serious deterioration in his or her condition or will prevent the
giving of appropriate treatment that can only be given by admission to a
mental health facility in accordance with the principle of the least
restrictive alternative.
 
In the case referred to in subparagraph (b), a second such mental health
practitioner, independent of the first, should be consulted where possible. If
such consultation takes place, the involuntary admission or retention may not
take place unless the second mental health practitioner concurs.
 
2.    Involuntary admission or retention shall initially be for a short period
as specified by domestic law for observation and preliminary treatment pending
review of the admission or retention by the review body. The grounds of the
admission shall be communicated to the patient without delay and the fact of
the admission and the grounds for it shall also be communicated promptly and
in detail to the review body, to the patient's personal representative, if
any, and, unless the patient objects, to the patient's family.
 
3.    A mental health facility may receive involuntarily admitted patients
only if the facility has been designated to do so by a competent authority
prescribed  by domestic law.
                                 Principle 17
                                  Review body
 
1.    The review body shall be a judicial or other independent and impartial
body established by domestic law and functioning in accordance with procedures
laid down by domestic law. It shall, in formulating its decisions, have the
assistance of one or more qualified and independent mental health
practitioners and take their advice into account.
 
2.    The initial review of the review body, as required by paragraph 2 of
principle 16 above, of a decision to admit or retain a person as an
involuntary patient shall take place as soon as possible after that decision
and shall be conducted in accordance with simple and expeditious procedures as
specified by domestic law.
 
3.    The review body shall periodically review the cases of involuntary
patients at reasonable intervals as specified by domestic law.
 
4.    An involuntary patient may apply to the review body for release or
voluntary status, at reasonable intervals as specified by domestic law.
 
5.    At each review, the review body shall consider whether the criteria for
involuntary admission set out in paragraph 1 of principle 16 above are still
satisfied, and, if not, the patient shall be discharged as an involuntary
patient. 
 
6.    If at any time the mental health practitioner responsible for the case
is satisfied that the conditions for the retention of a person as an
involuntary patient are no longer satisfied, he or she shall order the
discharge of that person as such a patient.
 
7.    A patient or his personal representative or any interested person shall
have the right to appeal to a higher court against a decision that the patient
be admitted to, or be retained in, a mental health facility.
 
                                 Principle 18
                             Procedural safeguards
 
1.    The patient shall be entitled to choose and appoint a counsel to
represent   the patient as such, including representation in any complaint
procedure or appeal. If the patient does not secure such services, a counsel
shall be made available without payment by the patient to the extent that the
patient lacks sufficient means to pay.
 
2.    The patient shall also be entitled to the assistance, if necessary, of
the services of an interpreter. Where such services are necessary and the
patient does not secure them, they shall be made available without payment by
the patient to the extent that the patient lacks sufficient means to pay.
 
3.    The patient and the patient's counsel may request and produce at any
hearing an independent mental health report and any other reports and oral,
written and other evidence that are relevant and admissible.
                                                                          /...
4.    Copies of the patient's records and any reports and documents to be
submitted shall be given to the patient and to the patient's counsel, except
in special cases where it is determined that a specific disclosure to the
patient would cause serious harm to the patient's health or put at risk the
safety of others. As domestic law may provide, any document not given to the
patient should, when this can be done in confidence, be given to the patient's
personal representative and counsel. When any part of a document is withheld
from a patient, the patient or the patient's counsel, if any, shall receive
notice of the withholding and the reasons for it and it shall be subject to
judicial review.
 
5.    The patient and the patient's personal representative and counsel shall
be entitled to attend, participate and be heard personally in any hearing.
 
6.    If the patient or the patient's personal representative or counsel
requests that a particular person be present at a hearing, that person shall
be admitted unless it is determined that the person's presence could cause
serious harm to the patient's health or put at risk the safety of others.
 
7.    Any decision on whether the hearing or any part of it shall be in public
or in private and may be publicly reported shall give full consideration to
the patient's own wishes, to the need to respect the privacy of the patient
and of other persons and to the need to prevent serious harm to the patient's
health or to avoid putting at risk the safety of others.
 
8.    The decision arising out of the hearing and the reasons for it shall be
expressed in writing. Copies shall be given to the patient and his or her
personal representative and counsel. In deciding whether the decision shall be
published in whole or in part, full consideration shall be given to the
patient's own wishes, to the need to respect his or her privacy and that of
other persons, to the public interest in the open administration of justice
and to the need to prevent serious harm to the patient's health or to avoid
putting at risk the safety of others.
 
                                 Principle 19
                             Access to information
 
1.    A patient (which term in the present Principle includes a former
patient) shall be entitled to have access to the information concerning the
patient in his or her health and personal records maintained by a mental
health facility. This right may be subject to restrictions in order to prevent
serious harm to the patient's health and avoid putting at risk the safety of
others. As domestic law may provide, any such information not given to the
patient should, when this can be done in confidence, be given to the patient's
personal representative and counsel. When any of the information is withheld
from a patient, the patient or the patient's counsel, if any, shall receive
notice of the withholding and the reasons for it and it shall be subject to
judicial review.
 
2.    Any written comments by the patient or the patient's personal
representative or counsel shall, on request, be inserted in the patient's
file.
                                 Principle 20
                              Criminal offenders
 
1.    The present Principle applies to persons serving sentences of
imprisonment for criminal offences, or who are otherwise detained in the
course of criminal proceedings or investigations against them, and who are
determined to have a mental illness or who it is believed may have such an
illness. 
 
2.    All such persons should receive the best available mental health care as
provided in principle 1 above.  The present Principles shall apply to them to
the fullest   extent possible, with only such limited modifications and
exceptions as are necessary in the circumstances. No such modifications and
exceptions shall prejudice the persons' rights under the instruments noted in
paragraph 5 of principle 1 above.
 
3.    Domestic law may authorize a court or other competent authority, acting
on the basis of competent and independent medical advice, to order that such
persons be admitted to a mental health facility.
 
4.    Treatment of persons determined to have a mental illness shall in all
circumstances be consistent with principle 11 above.
 
                                 Principle 21
                                  Complaints
 
      Every patient and former patient shall have the right to make a
complaint through procedures as specified by domestic law.
 
                                 Principle 22
                            Monitoring and remedies
 
      States shall ensure that appropriate mechanisms are in force to promote
compliance with the present Principles, for the inspection of mental health
facilities, for the submission, investigation and resolution of complaints and
for the institution of appropriate disciplinary or judicial proceedings for
professional misconduct or violation of the rights of a patient.
 
                                 Principle 23
                                Implementation
 
1.    States should implement the present Principles through appropriate
legislative, judicial, administrative, educational and other measures, which
they shall review periodically.
 
2.    States shall make the present Principles widely known by appropriate and
active means.
                                 Principle 24
           Scope of principles relating to mental health facilities
 
      The present Principles apply to all persons who are admitted to a mental
health facility.
                                 Principle 25
                           Saving of existing rights
 
      There shall be no restriction upon or derogation from any existing
rights of patients, including rights recognized in applicable international or
domestic law, on the pretext that the present Principles do not recognize such
rights or that they recognize them to a lesser extent.
                                                                             A