Human Rights & Mental Health: Hungary Human Rights & Mental Health: Hungary Mental Disability Rights International a project of the Center for Human Rights & Humanitarian Law Washington College of Law, American University and the Bazelon Center for Mental Health Law Washington, D.C. March 1997 This report includes the full text of the United Nations Principles for the Protection of Persons with Mental Illness and the Declaration on the Rights of Mentally Retarded Persons Research and publication of this report were funded by the Open Society Institute. Copyright March 1997 Mental Disability Rights International Washington College of Law, American University Copies of this report are available for $20.00 from: Mental Disability Rights International Washington College of Law, American University 4801 Massachusetts Ave. NW Washington, DC Telephone: 202-274-4185 Fax: 202-274-4130 E-mail: [email protected] The full text of this report has been published in Hungarian. Copies of the Hungarian edition may be obtained at no charge by contacting MDRI in Washington, D.C. or the Awakenings Foundation, Kálvaria tér. 5, H-1083, Budapest, Hungary. Telephone 361-134-1550. The Summary and Conclusions of the report, along with commentaries by leading Hungarian psychiatrists and activists have also been published in Hungarian as Spotlight on Hungarian Psychiatry, 12 PSYCHIATRIA HUNGARICA 51 (1997). Also available from MDRI: HUMAN RIGHTS & MENTAL HEALTH: URUGUAY (1995) ($10.00). Mental Disability Rights International Mental Disability Rights International (MDRI) is an advocacy organization dedicated to the international recognition and enforcement of the rights of people with mental disabilities. MDRI documents human rights abuses, supports the development of mental disability advocacy abroad, assists advocates seeking legal and service system reforms, and promotes international oversight of the rights of people with mental disabilities in the United States and abroad. Drawing on the skills and experience of attorneys, mental health professionals, system users and their families, MDRI is forging a new alliance to challenge the discrimination and abuse of people with mental disabilities worldwide. MDRI is a joint project of the Bazelon Center for Mental Health Law and the Center for Human Rights & Humanitarian Law, Washington College of Law, American University. MDRI has assisted mental disability rights advocates in Uruguay, Argentina, Mexico, Ukraine, Hungary, the Czech Republic, Romania, and Slovenia. MDRI=s first report, Human Rights & Mental Health: Uruguay, was released in 1995. Authors Eric Rosenthal, JD, Georgetown University Law Center. Eric Rosenthal is the founder and Executive Director of Mental Disability Rights International (MDRI), Washington, D.C. Dr. Robert Okin, MD, University of Chicago Medical School. Dr. Robert Okin is Chief of Psychiatry, San Francisco General Hospital; Vice Chair, Department of Psychiatry, University of California, San Francisco; Professor of Clinical Psychiatry, University of California, San Francisco. Elizabeth W. Bauer, MA, Ohio State University. Elizabeth Bauer is Executive Director of the Michigan Protection and Advocacy Service and former President of the National Association of Protection and Advocacy Systems. Ira Burnim, JD, Harvard Law School. Ira Burnim is Legal Director of the Bazelon Center for Mental Health Law, Washington, D.C. Robert Dinerstein, JD, Yale University. Professor Robert Dinerstein is Director of Clinical Programs at the Washington College of Law, American University, Washington, D.C. Professor Dinerstein is also a member of the President=s Commission on Mental Retardation. Anita Bakos, JD, Etvos Lorand University. Anita Bakos is a former Legal Fellow at MDRI and is currently a Legal Intern at the Constitutional and Legislative Policy Institute, Budapest, Hungary. Max Lapertosa, JD, University of Maryland Law School. Max Lapertosa is a former Advocacy Associate at MDRI and is currently an Associate at the Advocacy for Children=s Rights, Los Angeles. Mental Disability Rights International Eric Rosenthal, JD Executive Director Catherine O=Malley, JD Charlotte Oldham-Moore, JD Director Director Americas Advocacy Initiative Central-Eastern Europe Advocacy Initiative Katherine Nahapetian Program Associate Board of Advisors Elizabeth Bauer, MA Juan Méndez, JD Michigan Protection and Advocacy Inter-American Institute of Human Gregg Bloche, MD, JD Rights Georgetown University Law Center Ellen Mercer Richard Bonnie, JD American Psychiatric Association University of Virginia Law School Robert Okin, MD Eugene Brody, MD San Francisco General Hospital World Federation for Mental Health Diane Orentlicher, JD Reed Brody, JD Washington College of Law Human rights consultant Gerald Provencal, MSW Ira Burnim, JD Macomb-Oakland Regional Center Bazelon Center for Mental Health Law Edwin Rekosh, JD Judi Chamberlin Consultant, Central-East European Boston University Center for Psychiatric affairs Rehabilitation Loren Roth, MD, MPH Paolo del Vecchio University of Pittsburgh Medical Center US Center for Mental Health Services Sheila Rothman, Ph.D. Robert Dinerstein, JD Center for the Study of Medicine & Washington College of Law Society, Columbia University Gunnar Dybwad, JD Leonard Rubenstein, JD* Professor Emeritus, Brandeis University Physicians for Human Rights Lawrence Gostin, JD Herman Schwartz, JD* American Society of Law & Medicine Washington College of Law Leyla Gulçur, Ph.D. Susan Stefan, JD International Women=s Health University of Miami School of Law Coalition Eric Stover Elizabeth Jones, MA Townsend Center for Human Rights Maryland Disability Law Center University of California at Berkeley Stanley Herr, JD Clarence Sundram, JD University of Maryland School of Law New York State Commission on Quality Arlene Kanter, JD of Care Syracuse University Law School Humberto Martinez, MD, MPH *Co-Chairs, MDRI Board of Advisors South Bronx Community Mental Health Council, Inc. Contents Acknowledgments ........................................................................................................................ xi Forward ...................................................................................................................................... xiii Conclusions and Recommendations...........................................................................................xv Preface: Goals and Methods of this Report........................................................................... xxxi I. Introduction........................................................................................................................1 A. Mental Disability Rights: An International Concern...............................................1 1. Transformation of national laws, policies, and practices.............................1 2. Recognition through the United Nations human rights system ...................4 3. Developments in the European Community................................................5 4. Requirements of the Principles for the Protection of Persons with Mental Illness...........................................................................................................7 B. Hungary's International Treaty Obligations...........................................................10 C. Political and Economic Context ............................................................................10 D. Structure of Mental Health Services......................................................................13 II. Social Care Homes...........................................................................................................16 A. Arbitrary and Improper Detention ........................................................................16 1. Lack of due process or judicial review of commitment to social care homes .........................................................................................................16 2. Improper commitment standard.................................................................18 3. Wrongful detention of social care home population..................................19 4. Promoting continued dependence and increased disability .......................19 5. Detention of people with mental retardation or other disabilities .............21 B. Degrading and Dangerous Conditions...................................................................22 1. Remoteness from the community ..............................................................23 2. Poor physical conditions ...........................................................................24 3. Detention in cages......................................................................................26 4. Lack of rehabilitation.................................................................................29 5. High rate of mortality ................................................................................33 C. Human Rights Ombudswoman=s Report ..............................................................33 1. Findings of the Gönczöl Report.................................................................34 2. Recommendation in the Gönczöl Report...................................................35 III. Hospital and Community Care.......................................................................................36 A. Inadequate Community-Based Services ................................................................37 1. Structure of services...................................................................................37