Memorandum by Mental Disability Advocacy
Center
The Mental Disability Advocacy Center (MDAC)
is an international non-governmental organisation based in Budapest
that promotes and protects the human rights of people with mental
health problems and intellectual disabilities across central and
eastern Europe and central Asia. MDAC works to improve the quality
of life for people with mental disabilities through litigation,
research and international advocacy. MDAC has participatory status
at the Council of Europe and is a cooperating organization of
the International Helsinki Federation for Human Rights.
SUMMARY
As a response to the Green Paper, "Promoting
the Mental Health of the Population. Towards a Strategy on Mental
Health for the European Union", MDAC recommends:
— As a cross-cutting issue, Fundamental
Rights should be mainstreamed across all policies and programmes
in the proposed EU Strategy on Mental Health.
— More emphasis should be placed on
consultation with users of mental health services and their families.
— The issues of legal capacity, institutionalisation
and involuntary hospitalisation and treatment must be addressed
in a European Strategy on Mental Health.
1. INTRODUCTION
MDAC welcomes the development of a comprehensive
EU strategy on mental health as proposed by the Green Paper and
is in agreement that the mental health of the European population
can be improved significantly. While this positive initiative
on behalf of the EU certainly merits enthusiasm, there are some
areas of concern in the paper which MDAC addresses in this commentary.
MDAC makes a series of general comments before addressing specific
concerns which merit more discussion, namely (a) fundamental rights
and mental health, (b) legal capacity and guardianship, (c) institutionalisation
and (d) forced treatment.
2. GENERAL COMMENTS
2.1 Fundamental Rights Dimension
MDAC considers the almost total absence of a
fundamental rights dimension to the paper to be a serious omission.
Fundamental rights are a cross-cutting issue in mental health
and cannot be treated as a separate question. The Green Paper
appears to endorse a traditional medical model of mental health
rather than a social one. This can be observed, for example, in
the sections on the provision of effective care and treatment
services. [23]In
contrast, the improvement of the quality of life of persons with
mental health problems or disability is relegated to third position
in the list of priorities. [24]
2.2 Emphasise Importance of Empowerment and
Involvement of Users of Mental Health Services
The Green Paper lacks emphasis on the involvement
and empowerment of users of mental health services. Users and
ex-users of mental health services are in an expert position to
contribute to the development of a future EU strategy on mental
health. Consultation with users should therefore be mainstreamed
across any European research, policy development, and service/programme
development dealing with mental health. [25]
2.3 Expand Definition of "Vulnerable
Groups"
The reference to "vulnerable groups"
in society is too narrow. The Green Paper refers to "migrants
and other marginalised groups".[26]
Marginalised and isolated populations (eg ethnic minorities, indigenous
populations, Roma, adolescents, children, and women) [27]who
also suffer from mental health problems are at an even greater
risk of suffering stigma and discrimination. In particular, research
has shown that experiences of women in the mental health system
differ significantly from men and that they are more vulnerable
to discrimination and abuse. [28]Within
the mental disability group, persons with intellectual disabilities
have been particularly neglected and excluded. [29]In
addition, prisoners[30]
and persons in social care homes with mental health problems are
more vulnerable to abuse and mistreatment. Vulnerable groups need
to be explicitly mentioned and included in the consultation process
to the Green Paper and in any further strategic planning.
2.4 Include tangible action points
The initiatives outlined in the Green Paper
are pragmatically weak. In order to achieve any real change, the
proposals for action need to become more concrete and tangible,
with substantive, achievable and measurable actions set out. In
line with a cross-cutting approach, all actions should have a
fundamental rights basis and involve users of mental health services
and their families.
3. SPECIFIC AREAS
OF CONCERN
3.1 Fundamental Rights and Mental Health
The first major weakness in the Green Paper
is that fundamental rights are treated as a separate and distinct
issue. [31]From
the outset, it must be recognised that in the area of mental health,
fundamental rights are a cross-cutting issue which apply to all
areas mentioned in the Green Paper, including promotion of good
mental health, prevention of mental health problems, care and
treatment services and research.
The section in the Green Paper on fundamental
rights is weak and MDAC is concerned that it does not emphasise
strongly enough the uncontentious fact that there continue to
be serious fundamental rights abuses caused by mental health and
social care services. [32]Such
basic fundamental rights violations throughout the EU have been
well documented. In particular, the European Committee for the
Prevention of Torture (CPT) has raised human rights concerns during
visits to psychiatric facilities in many EU Member States. [33]Such
instances of fundamental rights violations need to be acknowledged
in the Green Paper.
Further, concrete measures to promote fundamental
rights and to prevent abuses should be laid out. There must be
a clear statement on the absolute prohibition of inhuman and degrading
treatment and punishment, which still exists in many mental health
systems within the EU. In addition, the mechanisms necessary to
protect persons from fundamental rights abuses in mental health
care should be further elaborated. MDAC proposes the following:
— State-funded independent inspectorate
systems. [34]
For example, a properly resourced Ombudsman office,
a specialised permanent commission, or other inspectorate systems.
[35]
— Lay advocacy in institutions
By this, MDAC means non-lawyers providing advocacy
services in institutional settings in order to ensure that patients
receive information about their rights, and about other agencies
and professionals that can assist. [36]
— Adequate legal representation in
mental health cases.
It is a requirement under the European Convention
on Human Rights that lawyers represent people with mental health
difficulties where detention in psychiatric settings is concerned.
[37]MDAC
is concerned that in many cases, this legal representation is
purely cosmetic. [38]
In the framework of a strategy to develop a
mental health information, research and knowledge system for the
EU, [39]information
should also be gathered on the state of fundamental rights in
the mental health field, including information on the existence
of fundamental rights abuses and whether and how human rights
considerations are implemented into policies. [40]
In summary, an approach that separates fundamental
rights from other mental health issues will prove to be ineffective
and will only serve to reinforce the unfortunate prevailing attitude
in many Member States of fundamental rights being an optional
extra.
3.2 Legal Capacity and Guardianship
The issues of legal capacity and guardianship
are ignored in the Green Paper. Legal incapacitation removes recognition
of a person before the law and often results in the withdrawal
of a number of fundamental rights: the right to decide on residence,
the right to manage property, the right to respect for family
life, to marry and to found a family and the right to vote. Guardianship
also prevents people from working, which has an economic impact
on individuals, families and Member States as a whole. With the
demographics of Europe indicating that people are living longer,
guardianship is becoming an increasing concern. [41]
Adults with mental health problems are commonly
deprived of their legal capacity because they may (or are perceived
to) require assistance in decision-making. To address such circumstances,
most Member States operate a system of substitute decision-making,
by which the legal capacity of the person is removed by a judicial
authority and decision-making authority is vested in another person.
This type of system is commonly called "guardianship"
.
However, guardianship is too often used to remove
a person's rights and autonomy. Guardianship systems do not comply
with international due process guarantees, are susceptible to
abuse and frequently lead to a range of other fundamental rights
violations. [42]Some
of the more commonly occurring abuses are: lack of fair trial
in the deprivation of legal capacity, lack of sufficient legal
flexibility to allow the person any meaningful participation in
decision-making once guardianship is established, and lack of
regular review of capacity or guardianship. Once under guardianship,
an individual can be "placed" in a social care institution
for their entire life, on the decision of the guardian: the person
is de facto detained but enjoys none of the legal guarantees
provided to people who are detained in law.
Adults under guardianship in some countries
are also stripped of their right to access courts. This blocks
access to justice to remedy any rights violations or to modify
or terminate guardianship.
In order to tackle this growing issue, MDAC
suggests that the future EU strategy on mental health should,
at a minimum, require all Member States to bring guardianship
laws into compliance with international human rights standards.
This means that Member States must make every effort to ensure
respect for the rights of the person concerned at every stage
of the guardianship process from incapacitation to establishment
of the guardianship arrangement to oversight of the guardianship
and finally to termination of guardianships when no longer appropriate.
Member States should move laws towards a system of supported decision-making
with guardianship to be increasingly used only as a protective
measure of last resort. [43]In
order to achieve these changes, Member States must commit to provision
of community-based services rather than institutional care.
3.3 Institutionalisation
The Green Paper's position on institutions is
unclear. By institution, MDAC means "any place in which people
who have been labelled as having a disability are isolated, segregated
and/or compelled to live together. An institution is also any
place in which people do not have, or are not allowed to exercise
control over their lives and their day-to-day decisions. An institution
is not defined merely by its size".[44]
While the focus on the community as the ideal setting for mental
health services is welcomed, [45]the
Green Paper lacks a clear vision about how mental health systems
should be reformed. There is ample evidence to show that large
institutions such as psychiatric hospitals, social care homes
and large residential establishments are no longer acceptable
in modern day Europe. [46]Essentially,
they do not meet modern European standards of core fundamental
rights. As referenced above, fundamental rights abuses in such
institutions have been extensively documented. Fundamental rights
violations caused and exacerbated by institutions include: deprivation
of liberty, inhuman and degrading treatments and punishments (physical
and chemical restraints and solitary confinement), lack of healthcare,
overcrowding, physical and sexual abuse and neglect. [47]
The European Union is in a powerful position
to encourage governments to show leadership and pledge to find
an appropriate balance of hospital and community services. Across
Europe, especially in the new Member States, there is a lack of
political will to commit to a process of closure of institutions
and establishment of community-based services.
MDAC recommends that the mental health strategy
include:
— An EU commitment to fund research
on the experiences, including successes, limitations and failings,
of Member States which have already established community care
services. Such an action is clearly within the competencies of
the EU as it will involve access to healthcare, education, cooperation
across Member States, EU wide coalition-building and planning.
This research would develop joint strategies to address the successes
and failures of European mental health systems and to provide
information on which to base more effective health policies, strategies
and actions at Member State and EU levels. [48]
— A timeframe within which to achieve
appropriate closure of large institutions and effective monitoring
of the process. [49]
— Biennial meetings of all Member States,
WHO, UN Special Rapporteur on the Right to Health and civil society
to discuss progress.
— A commitment to include examination
of mental health systems into annual progress reports on accession
States.
Despite recognising that the community is the
key location for mental health services, the Green Paper incongruously
encourages Member States to "assess with the regions and
the Commission how the Structural Funds can be better used to
improve long-term care facilities and health infrastructure in
the field of mental health".[50]
The Green Paper therefore appears to support the continued existence
of institutions and long term social care homes. This is an alarming
direction, maintaining and expanding lifelong social exclusion,
and one which runs counter to a modern community-based approach
already endorsed by the EU. [51]MDAC
suggests that the Commission should instead insist that structural
funds be used to create and promote diverse community-based services,
such as recovery-oriented services, self-help groups, sheltered
and supported accommodation, supported employment schemes, peer-run
drop-in centres and community-based crisis services.
Finally, MDAC would like to draw attention to
the current fundamental rights situation of people with mental
health problems in EU accession countries, Bulgaria[52]
and Romania. [53]During
the last wave of accession in 2004, disability rights issues were
not high on the agenda despite the existence of the Copenhagen
criteria. [54]The
fundamental rights situation of people with mental health problems
in Bulgaria and Romania is even worse than in previous accession
countries. MDAC urges the Commission to take seriously this continuing
human crisis when considering membership. [55]
3.4 Forced Treatment
Compulsory admission to psychiatric hospitals
and involuntary treatment remain commonplace throughout Europe.
Persons with mental health problems in Europe are routinely subjected
to forced medical treatment and drugging on the basis that it
is in the person's best interests. The unregulated and severe
use of methods such as electroconvulsive therapy (ECT), psychosurgery
and the forced administration of chemical drugs often results
in violations of human rights and dignity and can amount to inhuman
and degrading treatment under international law. [56]All
of these interventionist methods can have severe physical, neurological
and psychological side effects, including significant memory loss,
depression, apathy, anxiety, vomiting, muscle paralysis, the lethal
Malignant Neuroleptic Syndrome and the frequently occurring tardive
dyskinesia and metabolic syndrome. The pain and suffering often
caused by such methods is well documented by users and survivors
of psychiatric services themselves. [57]Research
has shown that coercion, including forced treatment, is counterproductive
in treating mental health problems and a wide range of alternative
and non-medical treatments have proved successful for many persons.
[58]
While the Green Paper acknowledges that "compulsory
placement of patients in psychiatric institutions and involuntary
treatment affects severely their rights",[59]
there is no further discussion on this serious topic. The Green
Paper states that "a first priority is to provide effective
and high-quality mental health care and treatment services, accessible
to those with mental ill-health",[60]
without addressing the fact that many of the medical interventions
used to "treat" persons with mental health problems
are highly controversial and contested. MDAC recommends that the
EU co-ordinate research on the availability and effectiveness
of alternative voluntary treatment services. Such research would
probably illustrate what existing research has convincingly shown:
that the need for forced interventions is significantly less when
a range of alternative treatments are readily available.
In addition to involuntary treatment in hospitals,
there is also the issue of involuntary outpatient commitment.
In some European countries where de-institutionalisation has already
been initiated, community treatment orders (or outpatient commitments)
exist, which force a person to receive medication in the community.
[61]MDAC
contends that such treatment is inconsistent with the aim of deinstitutionalisation
and the purpose of community-based services, which is to enable
and empower persons with mental health problems to live in society
to the best of his/her ability. The introduction of community
treatment orders merely relocates compulsion from an institution
into the community.
It is important to note that the right to physical
and mental integrity and the right to be protected from inhuman
and degrading treatment are enshrined in the European Charter
of Fundamental Rights. [62]While
the Charter of Fundamental Rights does not yet have any legally
binding force, [63]the
European Court of Justice has held that "the Charter has
undeniably placed the rights which form its subject-matter at
the highest level of values common to the Member States".[64]
All Member States have ratified the European
Convention on Human Rights, [65]a
legally binding document which explicitly prohibits inhuman and
degrading treatment and punishment in Article 3 and protects the
right to respect for private and family life in Article 8, concepts
which include physical and moral integrity of the person, [66]and
compulsory medical treatment. [67]
MDAC contends that the lack of a serious discussion
on forced hospitalisation and treatment is a serious omission
in the Green Paper, which needs to be rectified and adequately
tackled in a European strategy on mental health.
4. MDAC RESPONSE
TO QUESTIONS
POSED BY
THE COMMISSION
In this section MDAC summarises its views in
response to specific questions posed by the Commission. [68]
1. How relevant is the mental health of the
population for the EU's strategic policy objectives, as detailed
in section 1?
The improvement of the mental health of European
citizens is clearly relevant to the policy aims and objectives
of the EU. It is important for social justice, non-discrimination
and the socio- economic development of the European population.
However, it is not possible to achieve these aims without an underlying
basis of fundamental rights. Achieving non-discrimination for
such a heavily stigmatised and marginalised "group"
requires positive and pro-active measures in order to ensure that
persons with mental health problems enjoy their rights on an equal
basis with other European citizens. In this context, MDAC recommends
that the Commission finally commit itself to a Disability Specific
Directive. [69]
2. Would the development of a comprehensive
EU strategy on Mental Health add value to the existing and envisaged
actions and does section 5 propose adequate priorities?
As mental health services differ greatly between
Member States, a comprehensive EU strategy on Mental Health would
have the potential to harmonise and link existing policies and
strategies in order to make them more effective. However, the
priorities of the proposed EU strategy outlined in section 5 are
questionable. Primacy is given to the promotion of mental health
and prevention of mental ill health. MDAC believes that the quality
of life of persons who have experience of mental health problems
should be a dominant priority. The empowerment of users of mental
health services and their families is the key to the improvement
of their quality of life and the process of empowerment itself
will give such persons ownership over their mental health, which
is also keeping in line with the European ideal of active citizenship.
MDAC contends that improvement of the quality of life of persons
with mental health problems as well as the promotion and prevention
of mental health problems will remain impossible without proactive
measures to promote fundamental rights in the field of mental
health. The promotion of fundamental rights should be a first
priority, which applies throughout the realm of mental health.
3. Are the initiatives proposed in sections
6 and 7 appropriate to support the coordination between Member
States, to promote the integration of Mental Health into the health
and non-health policies and stakeholder action, and to better
liaise research and policy on Mental Health aspects?
The initiatives proposed on page 12 of the Green
Paper with regard to social inclusion and fundamental rights are
pragmatically weak and inappropriate to achieve the above aims.
The first proposal to identify "best practice for promoting
the social inclusion and protecting the rights of people with
mental ill health and disability" lacks any substantive content.
Secondly, the proposal to include people with mental ill health
or disability and the situation in psychiatric institutions in
the activities of the future Fundamental Rights Agency is quite
a basic and rudimentary suggestion from the Commission as it would
be grossly discriminatory not to include disability within the
competencies of the FRA. Furthermore, this type of proposal embodies
the top-down approach for which the Commission has often been
criticised. In order to achieve long term impact, clear guidance
is needed on all levels in order to ensure that mental health
services comply with fundamental rights.
MDAC looks forward to further consultation with
the European Commission during the process of developing a Mental
Health Strategy for Europe.
23 "... there is agreement that a first priority
is to provide effective and high-quality mental health care and
treatment services, accessible to those with mental ill-health."
See Green Paper, Section 4 "Developing Responses: Policy
Iniatives on Mental Health", page 5. Back
24
See Section 5 "The need for an EU Strategy on Mental Health,"
page 8. Back
25
Such involvement of users has already been emphasised strongly
by the WHO European Ministerial Conference on Mental Health, Mental
Health Declaration for Europe, Helsinki, Finland, January 2005
EUR/04/5047810/6 at paragraph 11 and also paragraphs 7(ii), 8(iii)
and 10(iv); UN Standard Rules on the Equalization of Opportunities
for Persons with Disabilities, rules 14 and 18; Report of the
Special Rapporteur on the right of everyone to the enjoyment of
the highest attainable standard of physical and mental health,
Paul Hunt, February 2005, paragraphs 59-61; Conclusions of the
Commissioner, Seminar organized by the Council of Europe Commissioner
for Human Rights and hosted by the World Health Organization Regional
Office for Europe, Copenhagen, Denmark 5-7 February 2003. Back
26
See Section 6 "Seeking Solutions-Options for Action"
, page 9. Back
27
See the reference to vulnerable groups in the Report of the Special
Rapporteur on the right of everyone to the enjoyment of the highest
attainable standard of physical and mental health, Paul Hunt,
February 2005, paragraph 12. Back
28
See Grobe, Jeanine, "Beyond Bedlam: Contemporary Women Psychiatric
Survivors Speak out", Third Side Press, Chicago IL, 1995
and Beresford, Peter and Wallcraft, Jan, "Psychiatric System
Survivors and Emancipatory Research: Issues, Overlaps and Differences"
in "Doing Disability Research", Colin Barnes and Geof
Mercer (Eds.). Leeds, The Disability Press 1997 at pp 66-87. Back
29
See Report of the Special Rapporteur on the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health, Paul Hunt, February 2005, where he states "For
many years persons with intellectual disabilities were placed
at the edges of the margins.", paragraphs 77-82. Back
30
See Report of the Special Rapporteur on the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health, Ibid at paragraph 11. Back
31
See page 8 of the Green Paper where the Commission proposes that
an EU-strategy could focus on 4 distinct aspects: 1) promotion
of the mental health of all; 2) address mental ill health through
preventive action; 3) improve the quality of life of people with
mental ill health or disability through social inclusion and the
protection of their rights and dignity; 4) the development of
a mental health information, research and knowledge system for
the EU. See also Section 6.2 "Promoting the Social Inclusion
of Mentally Ill or Disabled People and Protecting their Fundamental
Rights and Dignity", page 11. Back
32
See Section 6.2 of the Green Paper, ibid, page 11. Back
33
See http://www.cpt.coe.int/en/states.htm to view CPT country reports. Back
34
The European Committee for the Prevention of Torture in its "Standards",
states: The CPT also attaches considerable importance to psychiatric
establishments being visited on a regular basis by an independent
outside body (eg a judge or supervisory committee) which is responsible
for the inspection of patients' care. This body should be authorised,
in particular, to talk privately with patients, receive directly
any complaints which they might have and make any necessary recommendations.
(para 55) Back
35
MDAC will be issuing a report on inspectorate mechanisms later
in 2006. Back
36
See for example, the right to advocacy contained in the Mental
Health Bill, England and Wales, 2005. Back
37
See Article 5 ECHR, discussion in Mental Disability Advocacy Center,
Training Pack on ECHR and Mental Disability, (Budapest:
MDAC, 2003). Back
38
See Mental Disability Advocacy Center, Liberty Denied: Human
Rights Violations in Criminal Psychiatric Detention Reviews in
Hungary, (Budapest: MDAC, 2004). Back
39
See Section 6.3 "Improving Information and Knowledge on Mental
Health in the EU", page 12. Back
40
There are established research and monitoring tools now used widely,
including the WHO's Resource Book on Mental Health, Human Rights
and Legislation, WHO, 2005, available at Back
41
See Green Paper "Confronting Demographic Change: a new solidarity
between the generations" 2005. Back
42
See forthcoming publications on the findings of MDAC's Guardianship
Assessment Project. Back
43
Supported decision-making provides an alternative to guardianship
because it is premised on the notion that decision-making generally
is an interdependent activity as opposed to an independent activity
and therefore with proper support and assistance a person who
might be otherwise deemed to lack capacity is in fact able to
make personal decisions on his or her own behalf. Back
44
This is the definition of "Institution" used by the
European Coaliton for Community Living, of which MDAC is a member
organisation. See http://www.community-living.info/?page=205 Back
45
"The deinstitutionalisation of mental health services and
the establishment of services in primary care, community centres
and general hospitals, in line with patient and family needs,
can support social inclusion." See Section 6.3 of the Green
Paper "Improving Information and Knowledge on Mental Health
in the EU", page 11. Back
46
See "Included in Society". Results and Recommendations
of the European Research Initiative on Community-Based Residential
Alternatives for Disabled People. European Commission 2003. Back
47
See Report of the Special Rapporteur on the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health, supra note 7, paragraph 9. Back
48
See http://ec.europa.eu/comm/dgs/health_consumer/general_info/mission_en.html Back
49
See Interaction Official Response to European Union Green Paper
on Mental Health, page 3. Back
50
See Section 5 "The need for an EU- Strategy on Mental Health",
page 7. Back
51
See WHO Mental Health Declaration for Europe, Helsinki, Finland,
January 2005 EUR/04/5047810/6 at paragraph 10 (xi) where the Ministers
of Health of the Member States in the WHO European Region, committed
themselves to "develop community-based services to replace
care in large institutions for those with severe mental health
problems". Back
52
In its May 2006 Monitoring Report on Bulgaria, the European Commission
noted that, "[b]asic conditions in institutions caring for
the elderly, the physically and mentally handicapped and children
are appalling. The legal basis for their institutionalisation,
along with the slow and sometimes badly planned process towards
real de-institutionalisation are unsatisfactory and still give
cause for considerable concern. Continued increased efforts are
still needed." Available at http://ec.europa.eu/comm/enlargement/report_2006/pdf/monitoring_report_bg_en.pdf.
See also the Amnesty International Annual Report 2006 at http://web.amnesty.org/report2006/index-eng
and Amnesty International, "Bulgaria. Far from the Eyes of
Society. Systematic Discrimination against People with Mental
Disabilities." 2001. Available at http://web.amnesty.org/library/Index/ENGEUR150052002. Back
53
The European Commission recently highlighted the lack of progress
made by Romania in the area of social policy and inclusion in
its Monitoring Report reviewing pre-accession progress in May
2006 and referred in particular to institutionalisation: "Increased
efforts are needed to close or restructure large residential institutions
for people with disabilities by developing alternative community-based
services, support to families and smaller residential units."
See http://ec.europa.eu/comm/enlargement/report_2006/pdf/monitoring_report_ro_en.pdf.
See also the Amnesty International Annual Report 2006 at http://web.amnesty.org/report2006/index-eng
and the recent report by Mental Disability Rights International,
Hidden Suffering: Romania's Segregation and Abuse of Infants
and Children with Disabilities, MDRI: Washington DC: May 2006.
Available at http://www.mdri.org/projects/romania/romania-May%209%20final.pdf. Back
54
See http://europa.eu/scadplus/glossary/accession_criteria_copenhague_en.htm Back
55
A requirement of basic human rights standards in mental health
should also be applied to the candidate countries of Turkey, Croatia
and Macedonia and also to future potential candidate countries. Back
56
See Report of the Special Rapporteur on the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health, supra note 7, paragraph 9. Back
57
See for example, Peter Lehmann "Schone Neue Psychiatrie"
(Peter Lehmann Publishing, Berlin) and the academic references
therein. See also Cobb A, Darton K & Juttla K "Mind's
Yellow Card for Reporting Drug Side Effects. A Report of Users'
Experiences." Mind Publications: London 2001. Back
58
For European research on coercion in psychiatry, see the EC-funded
EUNOMIA project, available at http://www.eunomia-study.net. See
also Hoyer G et al "Paternalism and Autonomy: a presentation
of a Nordic study on the use of coercion in the mental health
care system." Int. Journal of Law and Psychiatry 2002 Mar-April
25(2):93-108. On the consequences of coercion, see for example
"From Privileges to Rights: People labelled with Psychiatric
Disabilities speak for themselves." Report by the U.S. National
Council on Disability, available at http://www.ncd.gov/newsroom/publications/2000/privileges.htm.
See also Lidz, C W et al, "Factual Sources of Psychiatric
Patients' Perceptions of Coercion in the Hospital Admission Process"
, Am J Psychiatry 155:1254-1260, September 1998, and the references
therein. Back
59
See Section 6.2 "Promoting the Social Inclusion of Mentally
Ill or Disabled People and Protecting their Fundamental Rights
and Dignity", page 11. Back
60
See Green Paper, Section 4 "Developing Responses: Policy
Iniatives on Mental Health", page 5. Back
61
For example, such laws have been introduced in the Netherlands
and in some federal States in Germany. There is an ongoing debate
in the UK. On the contrary, Ireland provides an example of where
a conscious decision was made not to open up coercive treatment
in the community. Back
62
Article 3(1) states "Everyone has the right to respect for
his or her physical and mental integrity". Article 3(2) goes
on to state that "in the fields of medicine and biology,
the following must be respected in particular: the free and informed
consent of the person concerned, according to the procedures laid
down by law....". Article 4 states "No one shall be
subjected to torture or to inhuman or degrading treatment or punishment." Back
63
The Charter has been incorporated into the Treaty establishing
a Constitution for Europe, which if ratified would give the Charter
binding legal force. See http://europa.eu.int/constitution/. However,
there is also nothing to prevent the Charter from being adopted
as a stand alone document. Back
64
Advocates-General Tizzano, Le«ger and Mischo. See http://europa.eu/scadplus/leg/en/lvb/l33501.htm Back
65
Convention for the Protection of Human Rights and Fundamental
Freedoms, Rome, 4. XI. 1950. Back
66
X & Y v. The Netherlands, judgement of 26 March 1985,
para. 22. Back
67
Herczegfalvy v. Austria, judgement of 24 September 1992. Back
68
See Section 8 "Next Steps" at page 13. Back
69
For more information on the EU wide campaign for a Disability
Specific Directive, see the website of the European Disability
Forum. EDF has also drafted a proposal for a Disability Specific
Directive. See http://www.edf-feph.org/en/welcome.htm. Back
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