Developing a Council of Europe legal and ethical tool for mental health

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Developing a Council of Europe legal and
ethical tool for mental health

• Petr Nawka,
• Piotr Mierzewski

COUNCIL OF EUROPE
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COUNCIL OF EUROPE

• Founded
• in 1949
• 47 member states
• 800 mln Europeans
• Seat
• Strasbourg, France

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HUMAN RIGHTSPALACE

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FOUR Ps

• Principles - COE
• Policy - WHO
• Politics - EU
• Practice - Countries

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2006 - 2007

• COMMITTEE OF EXPERTS ON DEVELOPING A COUNCIL OF
  EUROPE MENTAL HEALTH REFERENCE TOOL

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Make an analytical inventory of the range of
existing policy measures related to mental
health, as contained in the Council of Europe
binding and non binding documents
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Determine the essential basket of the
human/patients rights, ethical and social
cohesion components in national mental health
policies, to be used for developing a humane
mental health country profile
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Propose a model framework leading to the
development of an integrate policy tool in each
country, which shall contain in particular - a
practical compendium based on the already
existing Council of Europe texts, with emphasis
on ethical and human rights issues in the area of
prevention and promotion of mental health policy
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Propose a model framework leading to the
development of an integrate policy tool in each
country, which shall contain in particular
ethical framework for a patient-oriented mental
health policy to be agreed upon as a European
reference tool for decision-making and priority
setting.
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The European Health Committee has confirmed the
nomination of experts coming from the following
countries Austria, France, Finland, FYROM,
Georgia, Germany, Russian Federation, Slovak
Republic and Spain.
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PARTICIPATION The Steering Committee on
Bioethics (CDBI) and the European Committee for
the Prevention of Torture and Inhuman or
Degrading Treatment or Punishment (CPT)
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Work of CDBI

• Convention on Human Rights and Biomedicine (1997)
  and its Protocols on
• Cloning of human beings (1998)
• Transplantation of organs tissues (2002)
• Biomedical research (2005)
• Human Genetics (under development)
• Recent recommendations on
• Xenotransplantation, research on human tissue,
  protection of persons with mental disorder

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Recommendation R(2004)10on the protection of the
human rights and dignity of persons with mental
disorder
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Background

• 1983 Recommendation R(83)2
• 1994 Parliamentary Assembly Recommendation 1235
• 1996 Working Party set up
• 1997 Convention on Human Rights and Biomedicine
• 2000 White Paper issued for public
  consultation
• 2004 Recommendation Rec (2004)10 adopted

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Convention on Human Rights and Biomedicine (1997)

• Article 7
• Covers serious mental disorder treatment without
  consent to prevent serious harm to health must
  have supervisory, control and appeal procedures
• Article 26 exceptions
• Public safety, crime prevention, public health
  protection, protection of rights and freedoms of
  others

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Implications of Rec (2004)10

• Recommendations are NOT legally binding but have
  moral force
• EM is a guide to interpretation
• Aims to promote good medical practice, beyond
  specific legal regulation
• No general mechanism for monitoring or
  enforcement but CPT likely to use it in
  monitoring involuntary placement.

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The broader context

• Rec (2004)10 not comprehensive persons with
  mental disorder have, in general, the same rights
  as others (in particular ECHR rights)
• CPT Standards
• General work also relevant e.g.
• R(99)4 on legally incapacitated persons
• R(98)7 on health care in prisons.

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Scope of Rec (2004)10

• All persons with mental disorder
• Mental disorder defined in accordance with
  international standards e.g. ICD-10
• Therefore mental handicap within scope
• Lack of adaptation to society, as such, not a
  mental disorder

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Overview of Rec (2004)10

• General provisions
• Regulation of involuntary measures
• Placement of incapacitated non-objecting patients
• Specific situations
• Criminal justice system
• Quality assurance monitoring

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Specific situations

• Regulations concerning
• Seclusion and restraint (Art. 27)
• Certain non-irreversible but intrusive treatments
  (Art. 28.1)
• Irreversible treatments (Art 28.2)
• Minors
• Procreation

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• PARTICIPATION
• - Parliamentary Assembly
• Council of Europe Commissioner for Human Rights
• European Commission
• World Health Organisation

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Observers - Europe-wide organisation of mental
health patients
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WORKING METHODS - an electronic network of
national correspondents- a Web-based public
consultation of its draft document- hearings
and written consultations- pilot national or
regional seminars bringing together
policy-makers, professionals and representatives
of academia and civil society- links with
European institutions and competent experts in
the field.
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Council of Europe

• Questions for discussion
• Collect and assess existing CoE documents-the
  secretariat will produce a list of documents,
  what framework/methodology will be used?
• Essential basket of key components-What should be
  in the essential basket of human rights, ethical
  and social cohesion components to help countries
  produce a humane mental health country profile?

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Council of Europe

• An assessment of the perception of the CoE and
  the utility of published documents-we could
  invite interested parties to submit their views
  to us, using a pro-forma, or hold hearings
• The reference tool-early thoughts on its
  component parts

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Council of Europe

• Other considerations
• Outcomes-a practical, helpful framework which
  enables countries to develop costed action plans
• Communications-via a website, but do we want to
  consult/hold hearings to help shape our thinking
  and do we wish to consult on our draft framework?
  
• Absent friends-who else should we be talking
  to/consulting with on this project?

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Council of Europe

• Conclusions
• A major opportunity to improve the care and
  treatment, social inclusion and human rights of
  people with mental health problems