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Introduction - A “Paradigm Shift” in Mental Health Care

Published online by Cambridge University Press:  20 August 2021

Michael Ashley Stein
Affiliation:
Harvard Law School
Faraaz Mahomed
Affiliation:
Wits University
Vikram Patel
Affiliation:
Harvard Medical School
Charlene Sunkel
Affiliation:
Global Mental Health Peer Network
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Summary

The passage of the United Nations Convention on the Rights of Persons with Disabilities (CRPD or the Convention) has been hailed as the culmination of a “paradigm shift” from the biomedical model of disability to the social and human rights-oriented model. The CRPD’s assertion of equal recognition before the law applying to all persons with disability, including mental health and psychosocial disability, and thus amounting to universal legal capacity, in Article 12 and in the subsequent General Comment, Number 1 on Article 12 issued by the Committee on the Rights of Persons with Disabilities (CRPD Committee), has been the subject of considerable debate. While many have argued that this is a long overdue protection and a manifestation of nondiscrimination and freedom from coercion on the basis of disability, some have raised concerns based on perceived impracticality or risk. Among the obligations of States parties to the Convention is the mandate to shift from coercion, in the form of substitute decision-making models, to supported decision-making regimes, relying on a “will and preference” standard rather than a “best interests” standard. Even while debate around the exact nature and scope of Article 12 and General Comment 1 continues, efforts to end coercion in mental health and to promote supported decision-making have been gaining momentum in laws, policies, and practices around the world.

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Publisher: Cambridge University Press
Print publication year: 2021

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References

Arstein-Kerslake, A & Flynn, A. (2016). The General Comment on Article 12 of the Convention on the Rights of Persons with Disabilities: a roadmap for equality before the law. The International Journal of Human Rights, 20(4), 471–90.Google Scholar
Appelbaum, PS. (2016). Protecting the rights of people with disabilities: an international convention and its problems. Psychiatric Services, 67(4), 366.CrossRefGoogle ScholarPubMed
Appelbaum, PS. (2019). Saving the UN Convention on the Rights of Persons with Disabilities – from itself. World Psychiatry, 18(1), 12.Google Scholar
Asemblea Legilativa de la Republica Costa Rica. (2016). Ley Para La Promocion de la Autonomia Personal de las Personas con Discapacidad, No. 9379. www.tse.go.cr/pdf/normativa/promocionautonomiapersonal.pdfGoogle Scholar
Australian Law Reform Commission. (2017). Equality, Capacity and Disability in Commonwealth Laws. www.alrc.gov.au/publication/equality-capacity-and-disability-in-commonwealth-laws-ip-44/Google Scholar
Autistic Self-Advocacy Network (ASAN). (2016). The right to make choices: International Laws and Decision-Making by People with Disabilities. http://autisticadvocacy.org/wp-content/uploads/2016/02/Easy-Read-OSF-5-Guardianship-and-SDM-Laws-v3.pdfGoogle Scholar
Bartlett, P (2014). Implementing a paradigm shift: implementing the CRPD in the context of mental disability law. In Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture’s 2013 Thematic Report. Washington: Centre for Human Rights and Humanitarian Law, American University Washington College of Law, 169–80.Google Scholar
Bennewith, O, Amos, T, Lewis, G, Katsakou, C, Wykes, T, Morriss, R, Priebe, S. (2010). Ethnicity and coercion among involuntarily detained psychiatric in-patients. BJPsych, 196(1), 75–6.Google Scholar
Bergström, T, et al. (2018). The family-oriented open dialogue approach in the treatment of first-episode psychosis: nineteen–year outcomes. Psychiatry Research, 270, 168–75.CrossRefGoogle ScholarPubMed
Bilchitz, D. (2016). Dignity, fundamental rights and legal capacity: moving beyond the paradigm set by the General Comment on Article 12 of the Convention on the Rights of Persons with Disabilities. South African Journal on Human Rights, 3, 410.CrossRefGoogle Scholar
Browning, M, Bigby, C & Douglas, J. (2014). Supported decision making: understanding how its conceptual link to legal capacity is influencing the development of practice. Research and Practice in Intellectual and Developmental Disabilities, 1(1), 3445.Google Scholar
Callaghan, S, Ryan, C & Kerridge, I. (2013). Risk of suicide is insufficient warrant for coercive treatment for mental illness. International Journal of Law and Psychiatry, 36, 5–6, 374–85.Google Scholar
Carney, T & Fleur, Beaupart (2013). Public and private bricolage: challenges balancing law, services and civil society in advancing the CRPD supported decision making. University of New South Wales Law Journal 36(1), 175201.Google Scholar
Craigie, J, et al. (2019). Legal capacity, mental capacity and supported decision-making: Report from a panel event. International Journal of Law and Psychiatry, 62, 160168.Google Scholar
Davis, JK. (2008). How to justify enforcing a Ulysses contract when Ulysses is competent to refuse. Kennedy Institute of Ethics Journal, 18(1), 87106.CrossRefGoogle ScholarPubMed
Dawson, J. (2015). A realistic approach to assessing mental health laws’ compliance with the UNCRPD. International Journal of Law and Psychiatry, 40, 70.Google Scholar
Deacon, BJ. (2013). The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33, 846.Google Scholar
De Bhailis, C & Flynn, E. (2017). Recognising legal capacity: commentary and analysis of Article 12 CRPD. International Journal of Law in Context, 13(1), 6.CrossRefGoogle Scholar
Department of Justice and Equality, Ireland. (2013). Assisted Decision-Making (Capacity) Bill, 2013. www.oireachtas.ie/documents/bills28/bills/2013/8313/b8313d.pdfGoogle Scholar
Dhanda, A. (2006). Legal capacity in the Disability Rights Convention: stranglehold of the past or lodestar for the future. Syracuse Journal of International and Comparative Law, 34, 429.Google Scholar
Dhanda, A. (2017). Conversations between the proponents of the new paradigm of legal capacity. International Journal of Law in Context, 13(1), 87.Google Scholar
Disability Rights Fund. (2012). Law No. 29973, Peru, General Law on Persons with Disabilities. http://disabilityrightsfund.org/resources/law-no-29973-peru-general-law-on-persons-with-disabilities/Google Scholar
Drack-Schonenberger, T, Bleiker, M, Lengler, S, et al. (2016). Crisis cards for the prevention of compulsory hospitalization: signs of a crisis, treatment-specific demands and coping strategies from the patients’ perspective. Psychiatrische Praxis, 43, 5, 253.Google Scholar
Dunn, MC, Clare, ICH, Holland, AJ & Gunn, MJ. (2007). Constructing and reconstructing ‘best interests’: an interpretative examination of substitute decision-making under the Mental Capacity Act 2005. Journal of Social Welfare and Family Law, 29(2), 117.Google Scholar
El Congreso de Colombia. (2019). Ley 1996: Por Medio de la Cual se Establece el Regimen Para el Egercicio de la Capacidad Legal de las Personas con Discapacidad Mayores de Edad. https://dapre.presidencia.gov.co/normativa/normativa/LEY%201996%20DEL%2026%20DE%20AGOSTO%20DE%202019.pdfGoogle Scholar
Federal Republic of Germany. (2014). German Statement on the Draft General Comment on Article 12 CRPD, Committee on the Rights of Persons with Disabilities.Google Scholar
Gooding, P. (2015). Navigating the “flashing amber lights” of the right to legal capacity in the United Nations Convention on the Rights of Persons with Disabilities: responding to major concerns. Human Rights Law Review, 15(1), 45.Google Scholar
Gooding, P, McSherry, B, Roper, C, Grey, F. (2018). Alternatives to Coercion in Mental Health Settings: A Literature Review. Melbourne: University of Melbourne. https://socialequity.unimelb.edu.au/__data/assets/pdf_file/0012/2898525/Alternatives-to-Coercion-Literature-Review-Melbourne-Social-Equity-Institute.pdfGoogle Scholar
Government of Norway. (2014). Draft General Comment No. 1 on Article 12 of the Convention on the Rights of Persons with Disabilities – submission by the Norwegian Government, Committee on the Rights of Persons with Disabilities.Google Scholar
Health Rights Advocacy Forum. (2019). Civil society submission to the Parliament of Kenya on the Mental Health Amendment Bill of 2018.Google Scholar
Henderson, C, Swanson, JW, Szmukler, G. (2008). A typology of advance statements in mental health care. Psychiatric Services, 59(1), 63.Google Scholar
Hoffman, I & Konczei, G. (2010). Legal regulations relating to the passive and active legal capacity of persons with intellectual and psychosocial disabilities in light of the Convention on the Rights of Persons with Disabilities and the impending reform of the Hungarian Civil Code. Loyola of Los Angeles International and Comparative Law Review, 33, 143.Google Scholar
Human Rights Watch. (2017). Mexico: Mental Health Bill Undermines Disability Rights. www.refworld.org/docid/59e5f7d84.htmlGoogle Scholar
Kenya National Commission on Human Rights. (2018). The Many Faces of Mental Health in Kenya. www.knchr.org/DesktopModules/EasyDNNNews/DocumentDownload.ashx?portalid=0&moduleid=2432&articleid=1086&documentid=18Google Scholar
Kogstad, RE. (2009). Protecting mental health clients’ dignity – the importance of legal control. International Journal of Law and Psychiatry, 32(6), 383.Google Scholar
Kroll, J & Bachrach, B. (1984). Sin and mental illness in the Middle Ages. Psychological Medicine, 14, 507514.Google Scholar
Lewis, O & Callard, F. (2017). The World Psychiatric Association’s ‘Bill of Rights’: A curious contribution to human rights. International Journal of Mental Health, 46(3), 157.CrossRefGoogle Scholar
Mahomed, F, Stein, MA & Patel, V. (2019). Involuntary mental health treatment in the era of the United Nations Convention on the Rights of Persons with Disabilities. PLoS Med, 15(10). https://doi.org/10.1371/journal.pmed.1002679Google Scholar
Ministry of Law and Justice, India. (2017). The Mental Health Care Act, No. 10 of 2017. www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdfGoogle Scholar
Ministry of Foreign Affairs of Denmark. (2014). Response from the Government of Denmark with regards to Draft General Comment on Article 12 of the Convention – Equal Recognition before the Law, Committee on the Rights of Persons with Disabilities.Google Scholar
Minkowitz, T. (2006). The United Nations Convention on the Rights of Persons with Disabilities and the right to be free from nonconsensual psychiatric interventions. Syracuse Journal of International and Comparative Law, 34, 405.Google Scholar
Minkowitz, T. (2012). CRPD advocacy by the World Network of Users and Survivors of Psychiatry: the emergence of a user/survivor perspective in human rights. http://dx.doi.org/10.2139/ssrn.2326668CrossRefGoogle Scholar
Minkowitz, T. (2017). New UN report: steps forward, but no end to impunity. Mad in America. www.madinamerica.com/2017/05/steps-forward-but-no-end-to-impunity/Google Scholar
Minkowitz, T. (2018). Peruvian legal capacity reform – celebration and analysis. Mad in America. www.madinamerica.com/2018/10/peruvian-legal-capacity-reform-celebration-and-analysis/Google Scholar
Morse, JM. (1995). The significance of saturation. Qualitative Health Research, 5(2), 147.Google Scholar
National Board of Health and Welfare of Sweden. (2008). A New Profession Is Born: Personligt ombud, PO. www.personligtombud.se/publikationer/pdf/A%20New%20Proffession%20is%20Born.pdfGoogle Scholar
Newton-Howes, G, Pickering, N & Young, G. (2019). Authentic decision-making capacity in hard medical cases. Clinical Ethics, 14(4), 173–7.Google Scholar
Northern Ireland Human Rights Commission/Equality Commission for Northern Ireland. (2017). Disability Rights in Northern Ireland. www.equalityhumanrights.com/sites/default/files/northern_ireland_supplementary_submission_to_crpd_uk_loi_-_ecni_nihrc.pdfGoogle Scholar
Ossa-Richardson, A. (2013). Possession or insanity? Two views from the Victorian lunatic asylum. Journal of the History of Ideas, 74(4), 553–75.CrossRefGoogle Scholar
Pathare, S & Shields, LS. (2012). Supported decision-making for persons with mental illness: a review. Public Health Reviews, 34, 15.CrossRefGoogle Scholar
Pearl, AL. (2013). Article 12 of the United Nations Convention on the Rights of Persons with Disabilities and the Legal Capacity of Disabled People: the way forward? Leeds Journal of Law and Criminology, 1(1), 1.Google Scholar
Perlin, M. (1992). On sanism. SMU Law Review, 46, 373–93.Google Scholar
Perlin, M. (2015). “God said to Abraham/kill me a son”: why the insanity defense and the incompetency status are compatible with and required by the Convention on the Rights of Persons with Disabilities and basic principles of therapeutic jurisprudence. Paper delivered at the 5th International Therapeutic jurisprudence Conference at the University of Auckland, New Zealand. www.researchgate.net/publication/286775785_God_Said_to_AbrahamKill_Me_a_Son_Why_the_Insanity_Defense_and_the_Incompetency_Status_Are_Compatible_with_and_Required_by_the_Convention_on_the_Rights_of_Persons_with_Disabilities_and_Basic_PrinciplesGoogle Scholar
Quinn, G & Arstein-Kerslake, A. (2010). Restoring the “human” in “human rights”: personhood and doctrinal innovation in the UN disability convention. In Gearty, C & Douzinas, C (eds.) The Cambridge Companion to Human Rights Law. Cambridge: Cambridge University Press, 36–55.Google Scholar
Republique Francaise. (2014). Commentaire de la France sur le projet d’observations générales du Comité des droits des personnes handicapées, relative à l’article 12 de la Convention relative aux droit des personnes handicapées, Committee on the Rights of Persons with Disabilities.Google Scholar
Scholten, M & Gather, J. (2017). Adverse consequences of article 12 of the UN Convention on the Rights of Persons with Disabilities for persons with mental disabilities and an alternative way forward. J Med Ethics, 0, 18, https://doi.org/10.1136/medethics-2017-104414.Google Scholar
Seikkula, J, Aaltonen, J, Alakare, B, et al. (2006). Five-year experience of first episode nonaffective psychosis in open-dialogue approach: treatment principles, follow-up outcomes and two case studies. Psychotherapy Research, 16, 2, 214.Google Scholar
Series, L. (2017). Relationships, autonomy and legal capacity: mental capacity and support paradigms. International Journal of Law and Psychiatry, 40, 80.Google Scholar
Shakespeare, T. (2006). The Social Model of Disability. In Davis, LJ (ed.) The Disability Studies Reader. New York: Routledge, 195203.Google Scholar
Slobogin, C. (2015). Eliminating mental disability as a legal criterion in deprivation of liberty cases: the impact of the Convention on the Rights of Persons With Disabilities on the insanity defense, civil commitment, and competency law. International Journal of Law and Psychiatry, 40, 36.Google Scholar
Spandler, H, Anderson, J & Sapey, B. (2015). Advancing the rights of users and survivors of psychiatry using the UN Convention on the Rights of Persons with Disabilities. In Spandler, H, Anderson, J & Sapey, B (eds.) Madness, Distress and the Politics of Disablement. Bristol: Policy Press, 171–82.Google Scholar
Stein, MA. (2007). Disability human rights. California Law Review, 95, 75121.Google Scholar
Stein, MA & Lord, JE. (2010). Monitoring the Convention on the Rights of Persons with Disabilities: innovations, lost opportunities, and future potential. Human Rights Quarterly, 32, 689.Google Scholar
Szmukler, G, Daw, R & Dawson, J. (2010). A model law fusing incapacity and mental health legislation. Journal of Mental Health Law, 20, 11.Google Scholar
Szmukler, G, Daw, R & Callard, F. (2014). Mental health law and the UN Convention on the Rights of Persons with Disabilities. International Journal of Law and Psychiatry, 37, 245252.Google Scholar
United Nations Committee on the Rights of Persons with Disabilities. (2014). General comment No. 1: Article 12, Equal recognition before the law. 11th session, March 31–April 11, 2014. www.ohchr.org/EN/HRBodies/CRPD/Pages/DGCArticles12And9.aspxGoogle Scholar
United Nations Convention on the Rights of People with Disabilities. (2007). General Assembly resolution 61/106 of 24 January 2007.Google Scholar
United Nations General Assembly. (2013). Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez. UN Doc A/HRC/22/53. www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdfGoogle Scholar
United Nations General Assembly. (2017a). Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN Doc A/HRC/35/21. https://documents-dds-ny.un.org/doc/UNDOC/GEN/G17/076/04/PDF/G1707604.pdf?OpenElementGoogle Scholar
United Nations General Assembly. (2017b). Report of the Special Rapporteur on the rights of persons with disabilities. UN Doc A/HRC/37/56. www.un.org/en/ga/search/view_doc.asp?symbol=A/HRC/37/56Google Scholar
Ward, A. (2011). Adults with incapacity: freedom and liberty, rights and status: Part 1. Scots Law Times, 5, 21.Google Scholar
Weich, S. (2017). The Maudsley Debate: Has the Mental Health Act had its day? No. BMJ, 359. https://doi.org/10.1136/bmj.j5248Google Scholar
World Health Organization. (2017). Protecting the Right to Legal Capacity in Mental Health and Related Services – WHO QualityRights Training to Act, Unite and Empower for Mental Health (Pilot Version). WHO/MSD/MHP/17.5, Licence: CC BY-NC-SA 3.0 IGO. Geneva: World Health Organization.Google Scholar
World Network of Users and Survivors of Psychiatry. (2001). Human Rights Position Paper of the World Network of Users and Survivors of Psychiatry. https://d3gqux9sl0z33u.cloudfront.net/AA/AG/chrusp-biz/downloads/256093/wnusp_mexico_statement.docGoogle Scholar
World Psychiatric Association. (2020). Implementing alternatives to coercion in mental health care. Discussion Paper from the World Psychiatric Association Task Force.Google Scholar
Zelle, H, Kemp, K & Bonnie, RJ. (2015). Advance directives for mental health care: innovation in law, policy and practice. Psychiatric Services, 66(1), 7.Google Scholar

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