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Developing a Council of Europe legal and

ethical tool for mental health

Pĕtr Nawka,Piotr Mierzewski

COUNCIL OF EUROPE

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COUNCIL OF EUROPEFoundedin 1949

47 member states

800 mln Europeans

Seat:Strasbourg,

France

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HUMAN RIGHTSPALACE

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FOUR P’s…

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

scopeLack of adaptation to society,

as such, not a mental disorder

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Overview of Rec (2004)10

General provisionsRegulation of involuntary

measuresPlacement of incapacitated

non-objecting patientsSpecific situationsCriminal justice systemQuality 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