Both the United Nations and a coalition of Civil Society organizations and human rights bodies have issued Open letters to the Council of Europe prior to the Committee of Ministers meeting on the 5th of February. The Committee of Ministers at the meeting will be resuming work on a controversial draft text on regulations of use of coercion in psychiatry. This follows that the Committee had received the data it had asked for in June 2022 for it to be able to consider the matter appropriately and the possible need for these regulations in a broader perspective.
The UN Committee on the Rights of Persons with Disabilities with its Open letter restated a concern that the Council of Europe with the continued work on the draft additional protocol to the Biomedical Convention is not moving towards the end of the use of any form of coercion in the provision of mental health policies and services for persons with disabilities. The UN Committee strongly recommends the Council to withdraw the draft Additional Protocol.
At the same time a coalition of civil society organisations and human rights bodies submitted an open letter to the Council of Europe reiterating a profound concerns and request to withdraw the draft Additional Protocol to the Biomedical Convention. The organisations representing the concern in society at large urge the Council of Europe to focus on promoting voluntary, rights-based mental healthcare and to abandon the draft additional protocol. They request that the Council of Europe is aligning its regulative work on mental health practices with modern human rights standards.
The International Human Rights standards in mental health
The UN Committee on the Rights of Persons with Disabilities (CRPD Committee) in clear words noted that all Member States of the Council of Europe, which are as well States parties to the UN Convention on the Rights of Persons with Disabilities, are bound by the UN Convention. It is an international legally binding treaty, ratified by 192 States, and it as the Committee noted “outlaws forced and involuntary institutionalization and any form of deprivation of liberty based on impairment, including in situation of persons with disabilities experiencing individual crisis.”
The UN Committee further stated that the Convention, likewise, “outlaws the use of coercion in the provision of mental health services, which should be available in the community and not in institutionalized settings and shall be provided upon the free and informed consent of persons with disabilities themselves and not through third parties.”
The protection of persons with disabilities and their rights, the UN Committee pointed out, “shall never be achieved through involuntary or forced institutionalization and any other form of deprivation of liberty based on impairment or using coercion in mental health, but by embracing and implementing their right to live independently and being included in the community, access to community-based support services, including mental health services, and the restoration of their legal capacity.”
The UN Committee stressed that “Respect for autonomy rights is central to the contemporary approach taken by the CRPD. This requires respect for one’s own choices shaped by individual will and preferences, and the promotion of personal autonomy through supported decision-making. It requires new models of mental health policy and practice that embrace non-coercion, personal choice, community living and peer engagement.”
In extension of this the civil society organisations stressed that forced treatment and forced placement of persons on the basis of their disabilities, including persons with psychosocial disabilities and persons with mental health problems, even if regulated by law, breach the rights of non-discrimination, legal capacity, liberty and security, physical and mental integrity, and health enshrined in the UN CRPD.
Several other bodies and mandate holders of the United Nations hold a similar position against involuntary treatment and placement, even when States try to justify these practices on the basis of a “medical necessity” or for the alleged security of the person or others. Instead, they have stressed that coercive practices amount to torture, calling for a paradigm shift to rights-based approaches through the involvement of persons with psychosocial disabilities and mental health issues, and through respect for their will and preferences.
Opposition from civil society and users of mental health services
The Civil society organisations in their Open letter noted that users of mental health services and survivors of psychiatry have strongly opposed the draft additional protocol since 2014.
“While we understand the goals of the draft Additional Protocol, the draft Recommendation on respecting autonomy in mental healthcare achieves these objectives more effectively while avoiding unnecessary harm. The Additional Protocol risks entrenching coercion and institutionalization, worsening human rights abuses for people with psychosocial disabilities, and creating legal conflicts between Council of Europe obligations and the CRPD,” the coalition stated.
A growing consensus against coercion within the provider community
An increasing number of medical and scientific professionals are questioning coercive measures in mental healthcare, with some deeming them incompatible with human rights-based care, the civil society coalition noted. They highlight a lack of evidence supporting the generalisability or sustainability of such practices, while pointing to clear harm to physical and mental health, poorer outcomes, and significantly reduced life expectancy for those subjected to them. Researchers are also challenging the validity of justifications like dangerousness and proportionality, noting these assumptions are often unjustified and biased by factors such as race, gender, and disability.
Human rights-based solutions are feasible and effective
Since the suspension of work on the draft Additional Protocol in 2022, the World Health Organization (WHO) has launched the QualityRights initiative. The programme, based on the CRPD, has helped hospitals, regions, and countries evaluate their mental health systems and implement trainings for providers to address stigma and the use of coercion, as well as structural changes that improve service user satisfaction and treatment adherence by decreasing the use of coercion.
The Civil Society coalition pointed out that programmes early successes across diverse countries demonstrate the feasibility and positive impacts, for persons and for health systems, of eliminating coercion in mental healthcare.
The Civil Society coalition concluded that “Collectively, these references speak to the need for more investment and research as well as the feasibility and success of alternative practices in diverse settings and with diverse populations.”
We acknowledge The European Times for the information.
