EQUALITY Involuntary placement and involuntary treatment of persons with mental health problems The report addresses matters related to the integrity of the person (Article 3), the prohibition of torture and inhuman or degrading treatment or punishment (Article 4), the right to liberty and security (Article 6), respect for private and family life (Article 7), non-discrimination (Article 21), integration of persons with disabilities (Article 26) and healthcare (Article 35) falling under the Chapters 1 ‘Dignity’, II ‘Freedoms’ and III ‘Equality’ of the Charter of Fundamental Rights of the European Union. Europe Direct is a service to help you find answers to your questions about the European Union New freephone number (*): 00 800 6 7 8 9 10 11 (*) Certain mobile telephone operators do not allow access to 00800 numbers or these calls may be billed. In certain cases, these calls may be chargeable from telephone boxes or hotels. Cover image: © SXC More information on the European Union is available on the Internet (http://europa.eu). FRA – European Union Agency for Fundamental Rights Schwarzenbergplatz 11 – 1040 Vienna – Austria Tel.: +43 158030-0 – Fax: +43 158030-699 Email: [email protected] – fra.europa.eu Cataloguing data can be found at the end of this publication. Luxembourg: Publications Office of the European Union, 2012 ISBN 978-92-9192-949-8 doi:10.2811/87077 © European Union Agency for Fundamental Rights, 2012 Reproduction is authorised, except for commercial purposes, provided the source is acknowledged. Printed in Belgium Printed on FSC paper Involuntary placement and involuntary treatment of persons with mental health problems Foreword The entry into force of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) in May 2008 represented a milestone in the development of human rights law. The first human rights treaty of the 21st century provides persons with disabilities with a wide range of fundamental rights guarantees covering all aspects of their lives. Although intended to reiterate existing rights enshrined in previous universal treaties rather than to create new rights, the principles of non-discrimination, autonomy and inclusion embedded in the convention ensure that it marks a paradigm shift in the concept of disability under international law. The CRPD’s combination of human rights and overarching non-discrimination guarantees serves one essential purpose: to ensure the equal treatment of persons with disabilities. This clear yet comprehensive goal helps to explain the overwhelming adherence of European Union (EU) Member States to the CRPD. All EU Member States have signed the convention and 20 have already ratified it, with more to come in the near future. Moreover, the European Union itself, by ratifying the convention in December 2010, is empowered to combat discrimination and protect the rights of persons with disabilities more effectively. The legal framework is therefore in place. However, given its novelty, the CRPD needs to find its place in the legal systems of the European Union and its Member States. This report highlights this process. Processes of involuntary placement and involuntary treatment of persons with mental health problems can affect the most fundamental rights, including the right to integrity of the person and the right to liberty. For this reason human rights standards, whether at United Nations or European level, have set out strict safeguards to limit undue interference in these rights. The CRPD strongly confirms these safeguards while calling for persons with mental health problems to be treated on an equal basis with others. The report examines the current international and European legal standards and offers a comparative legal analysis of the EU Member States’ legal frameworks. The legal analysis is supported by evidence from the results of fieldwork research conducted by the European Union Agency for Fundamental Rights in nine EU Member States, which shows how individuals interviewed actually experienced processes of involuntary treatment and involuntary placement. The report’s findings point to the need for a renewed discussion of compulsory placement and treatment in the European Union. Morten Kjaerum Director 3 Contents FOREWORD .......................................................................................................................................................3 EXECUTIVE SUMMARY .....................................................................................................................................7 INTRODUCTION ................................................................................................................................................ 9 1 INTERNATIONAL AND EUROPEAN STANDARDS.....................................................................................13 1.1. Involuntary placement ..........................................................................................................................................14 1.1.1. Right to liberty: United Nations standards ............................................................................................ 14 1.1.2. Right to liberty: Council of Europe standards ....................................................................................... 16 1.2. Involuntary treatment ...........................................................................................................................................21 1.2.1. United Nations standards ........................................................................................................................ 21 1.2.2. Council of Europe standards ....................................................................................................................24 2 EU MEMBER STATES LEGAL FRAMEWORK ............................................................................................ 29 2.1. Legislation ..............................................................................................................................................................29 2.2. Criteria for involuntary placement and involuntary treatment ........................................................................31 2.2.1. The risk of harm and the therapeutic purpose ..................................................................................... 31 2.2.2. Less restrictive alternatives ....................................................................................................................33 2.2.3. Opinion of the patient taken into account ............................................................................................34 2.3. Assessment and decision procedures ................................................................................................................ 34 2.3.1. Qualification and number of experts involved in the assessment ...................................................35 2.3.2. Authorities or persons authorised to decide on an involuntary placement ....................................36 2.3.3. Mandatory hearing of the person ..........................................................................................................37 2.3.4. Authorities or persons authorised to decide on termination of the measure .................................38 2.4. Review and appeal of institutionalisation ......................................................................................................... 39 2.4.1. Free legal support ...................................................................................................................................39 2.4.2. Review and appeal concerning lawfulness of involuntary placement and/or involuntary treatment ................................................................................................................39 3 PERSONAL ACCOUNTS – EVIDENCE FROM FIELDWORK RESEARCH ......................................................41 3.1. Involuntary placement .........................................................................................................................................42 3.1.1. Experiences of involuntary placement ..................................................................................................42 3.1.2. Experiences of ‘voluntary’ placements without choice and control .................................................43 3.1.3. Opportunities to exercise choice and control over stays in hospital or other establishments ......43 3.2. Involuntary treatment ..........................................................................................................................................44 3.2.1. Involuntary treatment in hospitals ........................................................................................................44 3.2.2. Involuntary treatment in the community ..............................................................................................46 3.3. Seclusion and restraint ......................................................................................................................................... 47 3.4. Challenging the lawfulness of involuntary placement or treatment .............................................................48 THE WAY FORWARD .......................................................................................................................................51 BIBLIOGRAPHY .............................................................................................................................................