Human rights for mentally ill persons

HUMAN RIGHTS
OF THE MENTALLY
ILL PATIENTS
NITHIYANANDAM. T
MSN, I YEAR,
CON, MTPG & RIHS.

“All Persons with a mental illness, or
who are being treated as such persons,
shall be treated with humanity and
respect for the inherent dignity of the
human person… there shall be no
discrimination on the grounds of
mental illness !!!“

People with mental disorder are exposed to wide range of
human rights violations. Violations often occur in
psychiatric institutions through inadequate , degrading
and harmful care and treatment as well as unhygienic &
inhuman living conditions.
They also occur outside the institutional context, with
people all over the world experiencing limitation in the
exercise of their civil liberties and in the fields of
employment, education, & housing, due to the stigma
myths & misconceptions associated with mental
disorders. This stigma & discrimination can, in turn,
impact on a person’s ability to gain access to appropriate
care, integrate into society, and recover from illness.

HUMAN RIGHTS
The simplest way of
defining human rights is
that they are about
balancing the
inalienable rights of all
of us as human beings
within the community
regardless of differences
in birth, social origin,
gender, physical
differences, faith and
belief, ideology,
nationality and so on.

…Contd / -
There can be no disagreement with the
universally acclaimed truth that human
dignity is the quintessence of human rights.
Every human being is entitled to be treated
with dignity, decency, equality and freedom
regardless of the fact that we are born
differently, grow differently, are different
in our mental make up, thought processes
and life-style. Negation of this would mean
negation of human rights.

…Contd / -
A person with mental illness is entitled to
treatment with the same dignity and decency as
any other human being. A mentally ill person
does not become a non person merely on account
of certain disabilities. His human rights flow
from the fundamental right to life as in Article
21 of the Constitution which includes:
Right to living accommodation, food, potable water, education, health,
medical treatment, decent livelihood, income, a clean and congenial
existence.
Right to privacy, speedy trial (if involved in any criminal offence),
information and means of communication.

INTERNATIONAL TREATIES,
DECLARATIONS AND
GUIDELINES
AFFIRMING / REAFFIRMING
RIGHTS OF PERSONS WITH
MENTAL ILLNESS

RIGHTS YEAR
The Universal Declaration of Human Rights 1948
The International Convention on the Elimination of all forms of racial
discrimination
1965
The International Covenant on Civil and Political Rights (ICCPR) 1966
The International Covenant on Economic, Social and Cultural Rights
(ICESCR)
1966
The Declaration on the Rights of Mentally Retarded Persons 1971
The Declaration on the Rights of Disabled Persons 1975
The Convention on the Elimination of forms of Discrimination
Against Women (CEDAW)
1979
The Convention against torture and other cruel, inhuman or degrading
treatment or punishment
1984

RIGHTS YEAR
The Declaration on the Right to Development 1986
The Convention on the Rights of the Child 1989
International Conventions on the Protection of the Rights of all
Migrant Workers and members of their families
1990
UN Principles for the protection of persons with mental illness and
improvement of mental health care
1991
The Declaration of Caracas 1990
The Declaration of Madrid 1996
The WHO Technical Standards (Mental Health Care Law: Ten Basic
Principles and Guidelines for the Promotion of Human Rights of
Persons with Mental Disorders)
1996
The UN Convention on the Rights of Persons with Disabilities 2006

MENTAL HEALTH CARE LAW:
TEN BASIC PRINCIPLES
 Promotion of mental health and prevention of mental
disorders
 Access to basic mental health care
 Mental health assessments in accordance with internationally
accepted principles
 Provision of least restrictive type of mental health care
 Self-determination
 Right to be assisted in the exercise of self-determination
 Availability of review procedure
 Automatic periodic review mechanism
 Qualified decision-maker (acting in official capacity or
surrogate)
 Respect of the rule of law

INTERNATIONAL HUMAN
RIGHTS LAW
CREATES A NUMBER OF BROAD PROTECTIONS THAT
PROVIDE IMPORTANT RIGHTS TO PEOPLE WITH
MENTAL DISABILITIES.

This document will review a few of those,
including:
The right to the highest attainable standard
of physical and mental health;
Protections against discrimination
Protections against torture, inhuman, or
degrading treatment;
Protections against arbitrary detention.
This section also describes the obligation to
“ensure and respect” human rights law,
including the creation of safeguards for
rights enforcement.

RIGHTS OF
MENTALLY ILL
CLIENTS

It is the responsibility of the nurses to
ensure that their actions promote the
welfare of patients. Psychiatric Patients
are often the least capable of protecting
their own rights.
Psychiatric problems may cause patients to
lack social skills or may cause an inability
to make a point clearly understood
because of difficulties in concentration. As
a result, the rights of psychiatric patients
have been ignored and abused for
centuries.

When a psychiatric patient enters a hospital,
he loses his freedom to come and go, to
schedule his day, to choose his activities,
and to control his activities of daily living.
If he is also adjudicated incompetent, he loses
his freedom to manage his financial & legal
affairs & make many important decisions.
Because of the loss of these important
freedoms, the authorities of health care
agencies closely guard and value those
rights that the psychiatric patient retains.

SOME OF THE RIGHTS OF THE
PSYCHIATRIC PATIENTS ARE:
SELF:
 The right to wear their own cloths.
 The right to keep and use their own personal
possessions, including toilet articles.
 The right to keep and be allowed to spend a
reasonable sum of their money for their own
expenses.
 The right to have access to individual storage
space for their private use.
 The right to see visitors every day.

 The right to have reasonable access to telephone
both to make & receive calls.
 The right to have ready access to letter – writing
materials.
 The right to mail and receive unopened
correspondence.
 The right to vote.
 The right to marriage.
LEGAL ASPECTS:
 The right to manage & dispose of property.
 The right to execute wills.
 The right to hold civil service status.

TREATMENT:
 The right to Refuse Electro Convulsive
therapy.
 The right to be provided with the
reasonable explanation of all aspects of
one’s one condition and treatment.
 The right to freedom from restraints or
seclusion, other than during an emergency
situation.
 The right to treatment in the least restrictive
setting.

 The right to get an informed consent.
 The right to witness
 The right to confidentiality of records.
 The right to refuse treatment, except during an
emergency situation, or as permitted under
law in the case of a person committed by a
court of treatment.
 The right to access, upon request, one’s own
mental health care records.
 The right to voluntary admission by the
patient, if he is a major.
 The right to voluntary discharge by the
patient, if he is a major.

PROTECTING THE RIGHTS OF
THE MENTALLY ILL
Availability, accessibility, acceptability and
quality are the core obligations and
elements of the right to health.
A mentally ill person is in need of special
care and attention both at home and in the
hospital for the simple reason that he/she
is unable to fend for himself/herself.
The responsibility for special care and
attention also lies with the care givers and
includes the following:

AT HOME
 Treating the mentally ill person with dignity, decency,
kindness and compassion
 Not suppressing the information that someone at home
has been affected by mental illness
 Recognising that time is of the essence, and taking the ill
person to a mental health facility for evaluation and
admission, if considered necessary by the treating mental
health professional
 Furnishing accurate postal address of the admitted
individual to the hospital authorities at the time of
admission
 Not suppressing any information about relationship with
the individual and about the nature of ailment

 Volunteering to stay with the admitted relative in the
family ward/ open ward, as the case may be
 If it is not convenient to stay with the person for personal
and family reasons, interacting with him/her at the
hospital at frequent intervals as necessary
 Ensuring that after the person has been effectively treated
and fit for discharge, he/she is taken home, treated kindly
and given the best care and attention, ensuring strict and
timely compliance with the medicines prescribed
 Taking the person to the hospital for follow-up as advised
 Infusing hope, faith and confidence in the mind of the
recovering person all the time that he/she can be
effectively treated, cured and can resume a normal life
like in any other illness
 Extending cooperation to the psychiatric social worker
during follow-up home visits.

IN TREATMENT SETTING
 No individual should be handcuffed or tied with
ropes while being brought to the hospital or as an
inpatient;
 There should be facilities for sedating disturbed
individuals in the outpatient (OPD) setting;
 The OPD should comprise a large hall with
sufficient number of chairs to seat persons seeking
consultation and accompanying family members;
 The OPD hall should be well lit and ventilated
with provision of potable water, toilet, newspaper
stand and a television;
 A hospital canteen should be available nearby as
waiting in the OPD may go up to 2 to 4 hrs
depending on the average turnout of patients and
the number of treating professionals available;

 At the OPD there should be sufficient number of
registration counters to cater to the needs of people
in different age groups (adults, adolescents, elderly
and the children) as also women and men
 The people at the registration counter should be
given orientation and training to be civil, courteous,
considerate to everyone seeking care, particularly
the elderly
 No mentally ill person or their caregivers should be
subjected to any abuse or offensive treatment or
treatment that borders on cruelty or torture; instead
they should be treated with utmost civility, courtesy
and consideration
 No person seeking help for mental distress or
illness should be refused examination at the OPD
on any ground whatsoever

 Similarly, no patient should be refused admission
as an inpatient if the same is considered absolutely
necessary by the physician examining him/her.
 Once a decision is taken that a patient requires
inpatient care, certain other rights accrue to the
admitted person such as:
Right to wholesome, sumptuous and nutritive food
according to certain prescribed scales
Right to potable water
Right to environmental sanitation including clean
toilets
Right to personal hygiene
Right to books, journals, periodicals and newspapers in
their language
Right to recreation (television in the room, dance,
drama, music, other cultural activities, games and
sports)
Right to food is further elaborated.

Right to Food:
This includes:
 Preparation of food in the kitchen in a neat,
orderly and tidy manner
 Serving food courteously
 Ensuring that the food is wholesome and
nutritious
 Making the hospital self-sufficient by
developing a farm/kitchen garden to
minimise dependence on market and ward
off scarcity.

SUPREME COURT
AND HUMAN
RIGHTS FOR
PERSONS WITH
MENTAL ILLNESS

 Admission of non-criminal mentally ill persons
in jails is illegal and unconstitutional
 All mentally ill persons kept in various central,
district and sub jails must be medically
examined immediately after admission
 Specialised psychiatric help must be made
available to all inmates who have been lodged
in various jails/sub jails
 Each and every patient must receive review or
revaluation of developing mental problems
 A mental health team comprising clinical
psychologists, psychiatric nurses and
psychiatric social workers must be in place in
every mental health hospital.’

 Right of a mentally ill person to food, water,
personal hygiene, sanitation and recreation
is an extension of the right to life as in Article
21 of the Constitution
 Quality norms and standards in mental
health are non-negotiable
 Treatment, teaching, training and research
must be integrated to produce the desired
results
 Obligation of the State in providing
undiluted care and attention to mentally ill
persons is fundamental to the recognition of
their human right and is irreversible.

ROLE AND
INTERVENTION OF
NHRC IN MENTAL
HEALTH AND
HUMAN RIGHTS

‘Quality Assurance in Mental Health’
emerged as the end product of this
marathon action research project with
the following outputs:
 Existing status of mental health
hospitals, failings and inadequacies
 Comprehensive recommendations to
achieve the object of ensuring quality
mental health care in the country.

The NIMHANS team took enormous
pains to visit and intensively review
the functioning of 37 mental health
hospitals all over the country. The
review ended with a series of
recommendations including steps to
improve physical facilities, treatment
and care of patients, occupational
therapy as a tool of rehabilitation,
training and research, and community
outreach programmes.

The recommendations in a capsule form are:
 Immediate abolition of cell admissions
 Gradual conversion of closed wards into
open wards
 Construction of new wards of shorter
capacity (not more than 20) for use as open
wards
 Streamlining admission and discharge
procedure in accordance with provisions of
the Mental Health Act, 1987
 Upgradation of investigation facilities
 In-service training of all staff members

Providing each patient a cot, mattress,
pillow, bed sheet and adequate clothing
for change
Improving supply of water and electricity
Ensuring supply of nutritive food of 3000
kilocalories per day to each patient
Developing occupational therapy
facilities
Improving recreational facilities
Developing rehabilitation facilities
including day care centres.

NURSING
IMPLICATIONS FOR
PROTECTING
PATIENTS RIGHTS.

NURSING IMPLICATIONS
To protect patient’s rights, the nurse should be
aware of these rights in the first place.
She should ensure that ward procedures &
policies should not violate patient’s rights.
Discussing these rights with the mental health
team & including these rights in the nursing care
plan is all part of her responsibility in protecting
the patient’s rights.

Human rights for mentally ill persons

Human rights for mentally ill persons

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