The human rights which support the medical model relate to mental illnesses in general. These generalised human rights have been codified in recent years, and all the most relevant ones are now specified in the United Nations (UN) Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care.[40] National governments have been encouraged by the UN to ensure their mental health systems are compatible with the UN objectives. In Australia, the Commonwealth government is advising state governments on any changes that might be necessary to bring mental health legislation into line with the UN Principles.[41]
Principle 1.1 sets out the right to treatment as being the primary human right on which other rights are based: ‘All persons have the right to the best available mental health care, which shall be part of the health and social care system.’ A number of ‘Fundamental Freedoms and Basic Rights’ are then listed including the ‘right to be treated with humanity and respect’, ‘protection from exploitation and discrimination’, and ‘the right to exercise all civil, political, economic, social and cultural rights as recognised in’ other UN human rights declarations and covenants.[42]
The UN Principles then go on to list a total of twenty-five areas of human rights protection. These include the right for people with mental illness ‘to live and work, as far as possible, in the community’ (Principle 3). This right gives rise to a further ‘right to be treated in the least restrictive environment with the least restrictive or intrusive treatment appropriate to the patient’s health needs and the need to protect the physical safety of others’ (Principle 9).
There is a stipulation that ‘a determination that a person has a mental illness shall be made in accordance with internationally accepted medical standards’ (Principle 4). Confidentiality is protected (Principle 6), standards of care are specified (Principle 8), ‘medication shall meet the best health needs of the patient’ (Principle 10), and informed consent to treatment is required, although, paradoxically, only from voluntary patients. The Principles specify that informed consent to treatment is not required from involuntary patients, patients who are thought to be incapable of giving their consent or patients who unreasonably withhold their consent (Principle 11).
A list of ‘Rights and Conditions in Mental Health Facilities’ are specified (Principle 13), along with the required ‘Resources for Mental Health Facilities’ (Principle 14). ‘Admission Principles’ are at first covered in a general way (Principle 15), for example ‘Access to a mental health facility shall be administered in the same way as access to any other facility for any other illness’, and then more specific conditions are given for ‘Involuntary Admission’ (Principle 16). The need for a review body, procedural safeguards, patient access to information and a complaints procedure are also specified in various other principles.
Most of these specifications are straightforward, aiming to provide a regulatory framework that minimises the social exclusion of voluntary mental patients and which ensures they receive humane treatment. But the simplicity of these ideas does not always extend to involuntary patients, and the standing of the Principles is largely dependent on the willingness of practitioners and proponents of the medical model to ignore the paradoxes that are created for involuntary patients.
There are two human rights specified in the Principles—the ‘right to treatment’ and the ‘right to informed consent’—which are worth analysing in some detail. When these rights are used to guide psychiatric practice on voluntary patients, they appear to simply enforce routine procedures that have long standing in other branches of medicine. But unlike other areas of medicine, psychiatry is frequently practised on involuntary patients, and these two human rights have special connotations when they are used to guide coercion in psychiatric treatment. More than half the people who receive psychiatric treatment for schizophrenia are involuntary patients.
Next: Right to Treatment
[40] United Nations, ‘Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care’, in Australian Human Rights and Equal Opportunity Commission (eds.), Human Rights and Mental Illness: report of the national inquiry into the human rights of people with mental illness.
[41] Fiona McDermott and Jan Carter, eds., Commonwealth Department of Human Services and Health: issues for research, No. 4, mental disorders: prevention and human services research, p. 3.
[42] United Nations Commission on Human Rights, op. cit., pp. 990–1.