Camilla Parker  Mental Health & Human Rights Consultant  18 th  May 2009
Mental health policy, human rights & legislation  <ul><li>“ There are many ways to improve the lives of people </li></ul><...
A supportive & dynamic relationship
How they are connected: <ul><li>Mental Health Policy: underpinned by human rights principles; take forward action to ensur...
Core components of mental health policy (WHO)  <ul><li>Establishment of high quality mental health services </li></ul><ul>...
Emerging Principles: a Basis  for Positive Change  <ul><li>Respect for individuals’ inherent dignity & autonomy </li></ul>...
Legislation: far more than care and treatment  <ul><li>Protection from arbitrary detention/compulsory treatment: define ci...
Health as a human right <ul><li>Article 12 ICESCR: the right of everyone to the enjoyment of the highest attainable standa...
GC14: Right to health: Linked to other rights  <ul><li>...closely connected to and dependent upon the realization of other...
4 Elements of right to health Element  Examples of possible relevance to legislation  Available  - Requirement to provide ...
Obligations to respect, promote & fulfil the right to health   <ul><li>Respect: refrain from denying or limiting equal acc...
UN Convention Rights of Persons with Disabilities <ul><li>Rights of disabled people must be respected and promoted </li></...
Article 19 UNCRPD  <ul><li>States recognise the equal right of disabled people:  </li></ul><ul><ul><li>To live  in the com...
Article 19: Effective & appropriate measures <ul><li>Equal opportunity to choose place of residence & where & with whom to...
Implications for Mental Health Policy: Services  <ul><li>Assessment to address individuals’ health, social care and other ...
Implications for Mental Health: Protection of Rights <ul><li>Individuals should be given the opportunity to make decisions...
Implications for Mental Health: Addressing Stigma & Discrimination  <ul><li>Anti-discrimination laws and policies to prote...
Mental Health Policy and Legislation (1) <ul><li>Clarify circumstances justifying compulsion and safeguards when compulsor...
Mental Health Policy and Related Legislation (2) <ul><li>Provision of support to meet assessed health and social care need...
Legislation for community-based  services: suggested components <ul><li>Powers & responsibilities of relevant agencies for...
What’s possible in Ireland? <ul><li>Legislation not a panacea: need </li></ul><ul><ul><li>Political will, adequate resourc...
Further information  <ul><li>World Health Organisation (WHO) (2003) Mental Health Policy and Service Guidance Package, Men...
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Camilla Parker A Legislative Approach To Embedding Rights Whats Possible In Ireland

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A Legislative Approach to Embedding Rights -What's Possible in Ireland

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  • In this presentation I will consider Interrelationship between mental health policy, legislation and human rights Role of legislation Article 12 (Right to health) International Covenant Economic, Social &amp; Cultural Rights Article 19 (Living independently and being included in the community) Implications for mental health services Examples of where legislation will be relevant
  • Camilla Parker A Legislative Approach To Embedding Rights Whats Possible In Ireland

    1. 1. Camilla Parker Mental Health & Human Rights Consultant 18 th May 2009
    2. 2. Mental health policy, human rights & legislation <ul><li>“ There are many ways to improve the lives of people </li></ul><ul><li>with mental disorders. One important way is </li></ul><ul><li>through policies, plans and programmes that lead to better services. To implement such policies and </li></ul><ul><li>plans, one needs good legislation–that is, laws that </li></ul><ul><li>place the policies and plans in the context of </li></ul><ul><li>internationally accepted human rights standards </li></ul><ul><li>and good practices.” </li></ul><ul><li>WHO, 2005 </li></ul>
    3. 3. A supportive & dynamic relationship
    4. 4. How they are connected: <ul><li>Mental Health Policy: underpinned by human rights principles; take forward action to ensure compliance with human rights obligations, including a review to identify legislative barriers & need for new legislation </li></ul><ul><li>Legislation: can codify human rights principles; give framework on how policy implemented & enforced; ensure the protection & promotion of human rights </li></ul><ul><li>Human Rights: provide the principles on which policy & legislation developed, implemented and enforced; identify areas of policy and legislation not complying with human rights </li></ul>
    5. 5. Core components of mental health policy (WHO) <ul><li>Establishment of high quality mental health services </li></ul><ul><li>Access to quality mental health care </li></ul><ul><li>Protection of human rights </li></ul><ul><li>Patients’ rights to treatment </li></ul><ul><li>Development of robust procedural protections </li></ul><ul><li>Integration of persons with mental disorders into the community; and </li></ul><ul><li>Promotion of mental health throughout society. </li></ul>
    6. 6. Emerging Principles: a Basis for Positive Change <ul><li>Respect for individuals’ inherent dignity & autonomy </li></ul><ul><li>Protect against discrimination </li></ul><ul><li>Promote equality & social inclusion: remove barriers to exercise of rights & freedoms, facilitate participation </li></ul><ul><li>Promote personal autonomy: enabling people to make decisions for themselves </li></ul><ul><li>Protect from arbitrary interference (least restrictive alternative) </li></ul><ul><li>Provision of support based on individuals’ needs and strengths </li></ul><ul><li>Ensure full & effective participation </li></ul>
    7. 7. Legislation: far more than care and treatment <ul><li>Protection from arbitrary detention/compulsory treatment: define circumstances justifying compulsory care and treatment </li></ul><ul><li>Ensuring availability of community-based services </li></ul><ul><li>Safeguarding the rights of individuals seeking/receiving mental health services (whether as in-patients or in the community) </li></ul><ul><li>Addressing the barriers to social inclusion </li></ul>
    8. 8. Health as a human right <ul><li>Article 12 ICESCR: the right of everyone to the enjoyment of the highest attainable standard of physical and mental health </li></ul><ul><li>Progressive realisation: recognition of resource constraints and competing duties – some rights cannot be achieved immediately BUT requires means to measure progress </li></ul><ul><li>Immediate obligations: including to take steps towards fully realising these rights </li></ul><ul><li>Participation in all health-related decision-making at community, national and international levels </li></ul>
    9. 9. GC14: Right to health: Linked to other rights <ul><li>...closely connected to and dependent upon the realization of other human rights....including the rights to food, housing, work, education, human dignity, life, non-discrimination, equality, the prohibition against torture, privacy, access to information... These rights and freedoms address integral components of the rights to health. </li></ul><ul><li>Embraces a wide range of socio-economic factors that promote conditions for a healthy life, extends to the underlying determinants of health e.g. housing, healthy working conditions and healthy environment </li></ul>
    10. 10. 4 Elements of right to health Element Examples of possible relevance to legislation Available - Requirement to provide a sufficient range of mental health care facilities, goods & services Accessible <ul><li>Anti-discrimination law : ensure equality of access to services; no presumptions made about quality of life & potential </li></ul><ul><li>Legislation to uphold presumption of capacity (challenge presumptions that individuals not able to make decisions about their own care) </li></ul>Acceptable <ul><li>Respect for individuals’ cultural background </li></ul><ul><li>Ensure treatment & care based on individually prescribed plan, discussed with service user and reviewed regularly </li></ul>Quality <ul><li>Health professionals to receive adequate training </li></ul><ul><li>Mechanisms for monitoring and evaluation </li></ul>
    11. 11. Obligations to respect, promote & fulfil the right to health <ul><li>Respect: refrain from denying or limiting equal access to health-care facilities </li></ul><ul><li>Protect: protect individuals from health-related abuses in private health care or support services </li></ul><ul><li>Fulfil: range of measures including: </li></ul><ul><ul><li>Empower people to make choices about their lives </li></ul></ul><ul><ul><li>Legal protections for establishment of (and access to) quality mental health facilities; care & support services </li></ul></ul><ul><ul><li>Ensure integration into the community </li></ul></ul><ul><ul><li>Promote mental health throughout society </li></ul></ul><ul><li>Report of Special Rapporteur, 2005 </li></ul>
    12. 12. UN Convention Rights of Persons with Disabilities <ul><li>Rights of disabled people must be respected and promoted </li></ul><ul><li>Seek full participation in society </li></ul><ul><li>Take action to eliminate discrimination </li></ul><ul><li>Take concrete steps to achieving all rights set out in the Convention </li></ul><ul><li>Involve disabled people in this work </li></ul>
    13. 13. Article 19 UNCRPD <ul><li>States recognise the equal right of disabled people: </li></ul><ul><ul><li>To live in the community </li></ul></ul><ul><ul><li>With choices equal to others </li></ul></ul><ul><li>States shall take effective & appropriate measures to facilitate people’s: </li></ul><ul><ul><li>Full enjoyment of this right </li></ul></ul><ul><ul><li>Full inclusion and participation in the community </li></ul></ul>
    14. 14. Article 19: Effective & appropriate measures <ul><li>Equal opportunity to choose place of residence & where & with whom to live </li></ul><ul><li>Not obliged to live in a particular living arrangement </li></ul><ul><li>Access to a range of community support services (to support community living and prevent isolation/segregation) </li></ul><ul><li>Access to general public community services and facilities on an equal basis (& services responsive to their needs) </li></ul>
    15. 15. Implications for Mental Health Policy: Services <ul><li>Assessment to address individuals’ health, social care and other support requirements </li></ul><ul><li>Provide services to meet individuals assessed needs, taking their views and preferences into account </li></ul><ul><li>Wherever possible, provide community based services </li></ul><ul><li>Service planning to involve service users & families </li></ul><ul><li>Establish mechanisms to monitor and review the services provided, involving service users & families </li></ul>
    16. 16. Implications for Mental Health: Protection of Rights <ul><li>Individuals should be given the opportunity to make decisions for themselves and provided with the support to assist this where necessary </li></ul><ul><li>Any intervention to be on the principle of least restrictive alternative </li></ul><ul><li>Establish mechanism to safeguard individuals’ rights e.g. Complaints, independent review of detention </li></ul>
    17. 17. Implications for Mental Health: Addressing Stigma & Discrimination <ul><li>Anti-discrimination laws and policies to protect people with mental health problems </li></ul><ul><li>Workforce to receive training on mental health and disability issues </li></ul><ul><li>Develop public awareness campaigns </li></ul>
    18. 18. Mental Health Policy and Legislation (1) <ul><li>Clarify circumstances justifying compulsion and safeguards when compulsory powers used </li></ul><ul><li>Complaints procedures and powers of monitoring & inspection bodies to take action against poor care and/or abuse </li></ul><ul><li>Anti-discrimination legislation – and review of laws to check against unfair discrimination </li></ul>
    19. 19. Mental Health Policy and Related Legislation (2) <ul><li>Provision of support to meet assessed health and social care needs </li></ul><ul><li>Legal and financial mechanisms setting out different agencies responsibilities for the planning and delivery of services </li></ul><ul><li>Supported decision-making for individuals who lack capacity </li></ul>
    20. 20. Legislation for community-based services: suggested components <ul><li>Powers & responsibilities of relevant agencies for commissioning & provision of services </li></ul><ul><li>Procedures to ensure individuals receive appropriate care and support e.g. comprehensive assessment of their needs for health, social care, accommodation etc </li></ul><ul><li>Service user involvement: a) developing their care plans and b) monitoring and evaluation of services </li></ul><ul><li>Availability of independent advocates </li></ul><ul><li>Complaints procedures </li></ul><ul><li>Accessible information (procedures, complaints) </li></ul><ul><li>Independent monitoring and evaluation of services </li></ul>
    21. 21. What’s possible in Ireland? <ul><li>Legislation not a panacea: need </li></ul><ul><ul><li>Political will, adequate resources , trained professionals </li></ul></ul><ul><ul><li>Strategy for implementing legislation e.g. raising awareness, training and guidance, ensuring remedies are effective and accessible </li></ul></ul><ul><li>Advocating for action: </li></ul><ul><ul><li>Vision – ‘Vision for Change’ </li></ul></ul><ul><ul><li>Dissatisfaction with existing situation </li></ul></ul><ul><ul><li>Examples of what can be achieved </li></ul></ul><ul><ul><li>Working together to remove the barriers to realising the vision and facilitate positive reform. </li></ul></ul>
    22. 22. Further information <ul><li>World Health Organisation (WHO) (2003) Mental Health Policy and Service Guidance Package, Mental Health Legislation and Human Rights, World Health Organisation, Geneva </li></ul><ul><li>WHO Resource Book on Mental Health, Human Rights and Legislation (2005) </li></ul><ul><li>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, E/CN.4/2005/51 </li></ul>

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