Leverage and Human Rights

a senior consultant psychiatrist quotes this from the United Nation Convention on Human rights when he raised the question of undue 'leverage' being exerted on people with mental illness to choose, emphasising the right of those with disability to make 'choice' - here, those with continuing schizophrenia.

[ I have substituted 'schizophrenia ' for disability ]

para 49.
Legislation authorising the institutionalisation [ as defined ? ] of persons with 'schizophrenia ' , on the grounds of their disability, without their free and informed consent, must be abolished.

This must include the repeal of provisions authorising institutionalisation of persons for their care and treatment
without their free and informed consent ,
as well as provisions authorising the preventive detention of persons with schizophrenia
on ground such as the likelihood of them posing a danger to themselves or others,
in all cases in which such grounds of care , treatment and public security are linked in legislation to an apparent or diagnosed mental illness. [ schizophrenia ]

This should not be interpreted to say that persons with schizophrenia cannot be lawfully subject to detention for care and treatment or to preventative detention,
but that the legal grounds upon which restriction of liberty is determined
must be 'de-linked' from schizophrenia and neutrally defined so as to apply to all persons on an equal basis.

]


[ Ed. This means that the condition alone does not warrant intervention, but leaves it as it says in the Mental Health Act - the degree of the illness must be clearly be the grounds for intervention. The disturbing consequence to raising doubts about the right to be clear of 'leverage is, in the real world, indecision by those who have the legal power to intervene with legal leverage. for those with an illness whose degree of the ilness is not always easy to observe because kept hidden, or to define. Professionals vary in degree also, and how they get information aboiut illness behaviour varies as well. Schizophrenia fluctuates in what is leading the person , the misbeliefs in schizophrenia, or behaviour that is equal to some norm - the standards forwhat other people are doing. Or, both at the same time. There are many tragedies down to leverage not being applied. Usuall there is some filure in care delivery, and in observation of community observation versus interview assessment. One hesitation is down to the poor aftercare services - will they be any better engaged when they are once again in the community. The other is the public view of schizophrenia. ]

United Nations. Annual Report of the United Nations High Commissioner for Human Rights and Reports of the Office of the High Commissioner and the Secraetary-General: A/HRC/10/48,26 January 2009.

States "to ensure and promote the full realisation of all human rights and fundamental freedoms for all persons with disabilities without discrimination of any kind on the basis of disability"

Article 14,paragraph 1(b)of the Convention unambiguously states that
" the existence of a disability shall in no case justify a deprivation of liberty ".

Proposals made during the drafting of the Convention to limit the prohibition of detention to cases "solely " determined by disability were rejected

para 43
... As a result, unlawful detention encompasses situations where the deprivation of liberty is grounded on the combination between a mental or intellectual disability and other elements, such as 'dangerousness', or care and treatment

Since such measures are partly justified by the person's disability, they are to be considered
discriminatory
and in violation of the prohibition of deprivation on the grounds of disability
and the right to liberty on an equal basis with others prescribed by Article 14.

para 49.
Legislation authorising the institutionalisation [ as defined ? ] of persons with disabilities , on the grounds of their disability, without their free and informed consent, must be abolished.

This must include the repeal of provisions authorising institutionalisation of persons for their care and treatment
without their free and informed consent ,
as well as provisions authorising the preventive detention of persons with disabilities
on ground such as the likelihood of them posing a danger to themselves or others,
in all cases in which such grounds of care , treatment and public security are linked in legislation to an apparent or diagnosed mental illness.

This should not be interpreted to say that persons with disabilities cannot be lawfully subject to detention for care and treatment or to preventative detention,
but that the legal grounds upon which restriction of liberty is determined
must be 'de-linked' [ ? ] from the disability
and neutrally defined so as to apply to all persons on an equal basis.

De-institutalisation s necessary but not sufficient to achieve the goal of indepenent living. In most cases, a national strategy that integrates interventions in the area of social services,health,housing and employment at a very minimum, will be required

For the effective implementation of such strategies it is necessay that the independent living principles be rooted in a legislative framework which clearly establishes it as a legal right and inturn places duties on authorities and service providers, while also allowing for recourse in case of violation

Such legislative frameworks shall include the recognition of the right to access the support services required to independen living, and inclusion in community life, and the gurantee that independent living support should be provided and arranged on the basis of the individual's own choices and aspirations, in line with the principles of the Convention.

... that civil society and " in particular persons with disabilities [ schizophrenia ] and their reprentative organisations be involved and participate fully in the monitoring process ".













10.











20.















40.











50.











90.










100.

Article 25 - Health

States Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability.

States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation.

In particular, States Parties shall: Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes;

Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons;

Provide these health services as close as possible to people’s own communities, including in rural areas;

Require health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and the promulgation of ethical standards for public and private health care;

Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance where such insurance is permitted by national law, which shall be provided in a fair and reasonable manner;

Prevent discriminatory denial of health care or health services or food and fluids on the basis of disability.

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