THE TREATMENT OF MENTALLY ILL IN THE INTERNATIONAL HUMAN RIGHTS INSTRUMENTS AN STUDY ON THE EVOLUTION OF THE LEGAL TREATMENT OF MENTALLY ILL Maria Àngels Porxas Roig Supervisor: Dr. Peter Vedel Kessing 20 June 2012 ABSTRACT This work is the result of a research on the evolution of the legal treatment received by mentally ill in the international human rights instruments. Especially focused on a comparisson between the European Convention on Human Rights (ECHR) and the Convention for the Rights of Persons with Disabilities (CRPD). The initial idea was to determine the consequences of deinstitutionalisation on the human rights field. But, when deeply studying article 5 of the ECHR, which permits forced detention, the author realised the contradiction of this provision with the deinstitutionalisation process and with human rights standards overall. Therefore, it was decided to focus on the study of the legal treatment of mentally ill through the study of their forced institutionalisation and forced treatment through history. However, during the study, the author finds out that the human rights instruments had not prohibited this practices until recently (CRPD), rather have regulated and legitimated them (ECHR). Autonomy and capability arise as two key elements in order to finish with disempowerment practices and give the rights back to mentally ill in an equalitarian ground. The contributions of this project are twofold. First, is demonstrated that human rights are not free from contextual influences and they evolve through time parallell to society’s attitudes and awareness. Secondly, the benefits of applying the CRPD provisions to mentally ill are exposed. But it will be necessary to abolish existing mental health laws and article 5 of the ECHR in order to comply with the CRPD. INDEX: INTRODUCTION .......................................................................................................... 5 1. Historical overview....................................................................................................... 5 2. The aim of the thesis..................................................................................................... 7 PART 1 CONTEXTUALISATION ........................................................................................... 10 1. What is a mental illness? Controversies and lack of a definition............................... 10 1.1. Importance of a clear meaning of the term mental illness........................... 10 1.2 Legal definition............................................................................................. 11 1.3 Clinical definitions....................................................................................... 13 1.4 Social definition of mental illness and its link to disability..........................15 1.5 Working definition of mental illness for this thesis..................................... 16 1.6 Conclusion.................................................................................................... 17 2. Mental health as a human right................................................................................... 17 2.1 The importance of a right to mental health as a human right....................... 18 2.2 Dispersed treatment or consolidate treatment of mental health................... 18 2.3 The international legal framework on the protection of the right to health and mental health................................................................................. 19 2.4 Conclusion.................................................................................................... 23 PART 2 ANALYSE OF THE TREATMENT OF MENTALLY ILL ON THE EUROPEAN CONVENTION ON HUMAN RIGHTS AND ITS BODIES .................................. 24 1. Human rights issues. Violations and abuses concerning the mentally ill................... 24 1.1 Limitation on the rights of the mentally ill................................................... 24 1.2 Mentally ill human rights abuses’ claimed to the European Court of Human Rights....................................................................................... 25 1.3 Conclusion.................................................................................................... 28 1 2. The treatment of mentally ill in the ECHR. Analyse of article 5.1.e)........................ 29 2.1 Deprivation of liberty in the ECHR and its bodies.......................................29 2.2 The term “unsound mind”............................................................................ 30 2.3 Safeguards.................................................................................................... 33 2.3.1 Judicial review.............................................................................. 34 a) The role of medicine............................................................... 34 2.3.2 Not arbitrary detention.................................................................. 36 2.3.3 Objective and reasonable justification.......................................... 38 a) Objective medical expertise and true mental disorder........... 38 a.1) Examples of discerning psychiatric diagnoses........ 40 b) The disorder is of the kind of degree warranting compulsory confinement: Dangerousness and public security...................... 41 b.1) Uncertainty of the prediction of danger................. 42 b.2) Discrimination inherent in the “dangerousness” criteria............................................... 44 b.3) Conflict of interests between the rights of the individual and the collective interests.................. 46 c) A reasonable justification....................................................... 48 c.1) Less restrictive methods than forced detention....... 49 2.4. Conclusion on article 5.1.e)......................................................................... 50 3. Stigma and discrimination of mentally ill and its consequences……………….……51 3.1. Stigma as a human rights abuse............................................................ 51 3.2. Discrimination and mentally ill in the international human rights bodies........................................................................................................... 53 3.3. Conclusion............................................................................................ 56 2 PART 3 ANALYSE OF THE CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITES AND ITS APPLICABILITY TO MENTALLY ILL .......... 57 1. Disability as a human rights issue and other innovations of the CRPD..................... 58 2. The medical and the social models............................................................................. 58 2.1. Classification............................................................................................... 59 2.2. On the application of the social model to questions of mentally ill. Why the medical model is more harmful?.......................................................... 60 3. Scope of the Convention................................................. ........................................... 64 3.1. Mental illness as a disability........................................................................ 65 4. The paradgim shift...................................................................................................... 66 4.1 The shift on the approach. Aim: to tackle the structural conflict................. 67 4.2 The human rights values of the paradigm shift............................................ 68 4.2.1 Human dignity............................................................................... 68 4.2.2 Equality.......................................................................................... 68 4.2.3 Autonomy...................................................................................... 70 5. Possible impacts and benefits on the treatment of mentally ill................................. 71 5.1. How the CRPD approaches involuntary detention...................................... 74 6. Abolishing mental health laws to comply with the Convention................................. 76 7. Critics on the CRPD................................................................................................... 78 7.1. Not definition of disability and impairment................................................ 78 7.2. Not preventive protection............................................................................ 79 7.3. Indeterminate scope of the Convention....................................................... 79 8. Conclusion on the CRPD............................................................................................ 80 9. Real impacts of the CRPD.......................................................................................... 81 9.1. The enforcement mechanisms..................................................................... 81 9.2. The initial reports to the Committe on the Rights of Persons with Disabilities...................................................................................................................... 83 9.2.1. Few quantity of reports................................................................. 83 9.2.2. Mentally ill on the reports............................................................ 84 3 9.2.3. Treatment of mentally ill through articles 12, 14 and 17............. 85 9.3. Conclusion on the real impact of the CRPD................................................ 89 10. Comparison between the CRPD and the ECHR......................................................