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This article was written by Yanyan Huang. Yanyan is currently a master student of the International Human Rights Law programme at Lund University. She graduated from Macau University of Science and Technology with a bachelor’s degree. Her fields of interest include disability law as well as women’s rights.
Discussions about ending involuntary hospitalization and treatment raise questions about the rights and care of individuals with mental health conditions and psychosocial disabilities. Some find it easy to recognize their mental illness and actively engage in treatment, while others question their diagnosis and see treatment as coercion. Hospitalization has been a treatment for mental health issues, but it involves voluntary and involuntary decisions. Does involuntary admission violate the rights of those affected? And should this choice be abolished?
Involuntary Admission
In addition to cases of public security incidents or criminal cases that deprive citizens of their personal freedom, involuntary admission is considered a special situation that deprives citizens of their personal freedom in accordance with health laws. Patients who meet the treatment conditions may be required to be involuntarily admitted to the hospital. However, institutions that make such decisions can create situations where such a right is misjudged or abused to the detriment of patients’ human rights. In the OConnor v. Donaldson case in 1975, Donaldson voluntarily entered a mental hospital in Florida after diagnosis, but later sought to be discharged. However, the hospital Fortsätter to hold him involuntarily. Eligibility for compulsory admission has always been an issue that has been debated by the legal and medical academia. In this case, the applicant eventually appealed to the Supreme Court. The court ultimately upheld Donaldson on the grounds that the patient could be constitutionally imposed only if he posed a danger to himself or others, or if he was mentally disabled from meeting basic survival needs. This ruling sets an important precedent in recognizing and protecting the rights of people with mental illness. It emphasizes that involuntary admission should be based on clear necessity and not simply because the patient has a mental health conditions or psychosocial disabilities.
International Human Rights Law Perspective
From an international human rights law perspective, provisions on involuntary hospitalization are mainly advocated to abolish this provision. Article 12 of the UN Convention on the Rights of Persons with Disabilities (CRPD) serves as the core article of the discussion. It requires States to recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life and to provide support for persons with disabilities to exercise their legal capacity. Besides, Article 25 requires health professionals to provide care on the basis of free and informed consent. In addition, the CRPD Committee elaborates on the issue in General Comment No. 1 on Article 12 Equal recognition before the law. This commentary, while not legally binding, holds authority as an interpretation of the law. It directly indicates that “these practices must be abolished in order to ensure that full legal capacity is restored to persons with disabilities on an equal basis with others.” The most recent document regarding this issue is Mental health, human rights and legislation: Guidance and practice, published by OHCHR and WHO on October 9 2023. The Prohibition of involuntary hospitalization and treatment is clearly stated in Article 2.3.4. Mexico’s General Health Law is cited as an example to point out the inevitable trend of repeal.
It can be seen that both the relevant provisions of the Convention and the Committee’s interpretation take a negative position on involuntary admission. It is worth noting that the position of total abolition does not imply the abandonment of persons with mental health conditions and psychosocial disabilities or the denial of medical treatment and any support. Instead, it favours autonomous decision-making, which must not be imposed in a compulsory manner.
However, some medical scholars argue that an overemphasis on autonomy could lead to abuse of their disadvantage. They are also concerned about whether the patients could receive appropriate treatment on time, as well as the potential cost that may arise. Therefore, they oppose the complete abolition of involuntary treatment.
Conclusion
To conclude, the legal regulations concerning involuntary admission for people with mental health conditions and psychosocial disabilities need improvement through the mental health laws of each country. Despite the ongoing debate on the existence of involuntary admission, it is of utmost importance to respect the autonomy of people with mental disabilities to the greatest extent. This involves avoiding involuntary hospitalization and treatment as much as possible and expanding non-compulsory service models with voluntary and supportive decision-making.
Sources:
United Nations General Assembly. (2006). Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
Committee on the Rights of Persons with Disabilities, Convention on the Rights of Persons with Disabilities. General comment No.1 (2014), Article 12: Equal recognition before the law Committee on the Rights of Persons with Disabilities
Mental health, human rights and legislation: guidance and practice. Geneva: World Health Organization and the United Nations (represented by the Office of the United Nations High Commissioner for Human Rights); 2023.
O’Connor v. Donaldson, 422 U.S. 563 (1975)
Szmukler G, Daw R, Callard F. Mental health law and the UN Convention on the rights of Persons with Disabilities. Int J Law Psychiatry. 2014;37(3):245-252. doi:10.1016/j.ijlp.2013.11.024
Melinda Jones, Can international law improve mental health? Some thoughts on the proposed convention on the rights of people with disabilities, International Journal of Law and Psychiatry,
Vol.28(2):183-205.
Sundram, C. J. (1998). In harm’s way: research subjects who are decisionally impaired. Journal of Health Care Law & Policy, 1(1), 36-65.
Jennifer Brown, The changing purpose of mental health law: From medicalism to legalism to new legalism, International Journal of Law and Psychiatry, Vol.47(2016):1-9
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