published in worked-over form in: Current Opinion in Psychiatry, Vol. 12 (1999), No. 1, pp. 6-7
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To:
WHO
Dr. J.M. Bertolote
Mental Disorders Control
CH-1211 Geneve 27

April 24, 1997

Comment to: Quality Assurance in Mental Health Care, "Draft. Human Rights of People with Mental Disorders", WHO 1997

All fat-printed words and sentences should be added resp. changed. This would optimize the quality assurance in the psychiatric/psychosocial field.

National Legislation

1. There is national legislation concerning the respect of human rights of people with mental disorders and their relatives. The national organizations of (ex-)users/survivors of psychiatry should be invited to hearings before laws are passed.

5. There is legal mechanism whereby any decision involving involuntary treatment of hospitalization is automatic and periodically reviewed by a competent body. No decision should be made without the consent of the national organizations of (ex-)users/survivors of psychiatry.

7. Every person with a mental disorder or who is said to have a mental disorder has the right to exercise all civil, political, economic, social and cultural rights recognized in the Universal Declaration of Human Rights and other UN documents.

Monitoring Bodies

8. There is an ombudsman/ombudswoman who should be an (ex-)user/survivor of psychiatry at the national level.

9. There is a body including (ex-)user/survivors of psychiatry specifically charged, at the national level, with monitoring the respect of human rights of people with mental disorders or who are said to have mental disorders. The task of this body should include the registration of new treatment measures and decisions of ethics' comissions in research fields.

11. The national psychiatric association (college/board) has a section particularly dedicated to human rights. No decision should be made without the consent of the national organizations of (ex-)users/survivors of psychiatry.

12. The national association (college/board) of psychologists has a section particularly dedicated to human rights. No decision should be made without the consent of the national organizations of (ex-)users/survivors of psychiatry.

13. The national association (college/board) of nurses has a section particularly dedicated to human rights. No decision should be made without the consent of the national organizations of (ex-)users/survivors of psychiatry.

14. The national association (college/board) of social workers has a section particularly dedicated to human rights. No decision should be made without the consent of the national organizations of (ex-)users/survivors of psychiatry.

15. The national association (college/board) of occupational therapists has a section particularly dedicated to human rights. No decision should be made without the consent of the national organizations of (ex-)users/survivors of psychiatry.

15a. As a form of monitoring (ex-)users/survivors of psychiatry have to be involved in the education (including the boards of examiners) of psychiatrists, physicians, psychologists, nurses, social workers, occupational therapists on a well-payed level.

Equity and Access to Treatment

18. At least 20% of all psychiatric beds are located in general hospitals. For every psychiatric bed there should be one bed in an anti- or nonpsychiatric run-away-house. Each second psychiatric bed has to be placed in a Soteria-like institution.

21. Sterilization, abortion or any treatment that can be harmful for the patients' (future) children are never carried out on people with mental disorders or who are said to have mental disorders against their will.

22. Psychosurgery and other intrusive and irreversible treatments such as psychiatric drugs, electro- and insulinshock for mental disorders are never carried out on an involuntary patient and without informed consent. To make declarations-in-advance safe they should be acknowledged explicitly. Treatment agreements should be possible too. Psychiatrists who treat without informed consent should lose their medical approbation.

23. Clinical trials and experimental treatments are never carried out on an involuntary patient without informed. The institutions and persons carrying out these measures are obliged to prove that possible damages are not due to these measures.

24. Essential psychiatric drugs are easily and quickly available to all those who want them.

26. There are written guidelines/norms on quality assurance of mental health care. These guidelines/norms require the consent of the national organizations of (ex-) users/survivors of psychiatry.

Specific Facilities

27. There are appropriate facilities for the treatment of criminal offenders with mental disorders or who are said to have mental disorders. Treatment should include nonpharmacological measures such as psychotherapy.

28. There are appropriate facilities/services for the treatment of children/adolescents with mental disorders or who are said to have mental disorders. Treatment should include nonpharmacological measures such as psychotherapy.

29. There are appropriate facilities for the treatment of the elderly with mental disorders or who are said to have mental disorders. Treatment should include nonpharmacological measures such as psychotherapy.

30. At any given facililty, the space (treat & recr) is sufficient for the number of inmates/patients admitted. There should be phones-boxes for inmates/patients in each psychiatric ward. There should be easily visible coin-operated telephones at the entrance halls of each psychiatric institution. In each psychiatric ward should be an easily visible notice, that inmates/patients can get writing-paper, envelopes and stamps if wanted. There are notice-boards in every ward, on which local, regional and national organisations of (ex-)users and survivors of psychiatry can put up uncensored information. For each inmate/patient there should be the offer to have a daily walk in the open air for at least one hour. On each ward should be a kitchen where inmates/patients can prepare food and drinks around the clock. The nonsmokers' right to have good air to breathe is guaranteed. The smokers' right to smoke as long as they want is guaranteed too.

32. Meals served to inmates/patients meet recommended minimum nutritional requirements. The needs of people who want special diets have to be met.

33. Staff speak frequently to inmates/patients and always in a friendly, positive and courteous manner. On request staff should remain silent and leave inmates/patients alone.

34. Written records are appropriately maintained for all inmates/patients, who are entitled to access their own records at any time and without justification. Copies of records should be available. Inmates/patients should have the right to revise records or to add commentaries.

38. Help and support are made available by staff to family members who want them.

For the European Network of (ex-) Users and Survivors of Psychiatry
Peter Lehmann