1 Developing a Council of Europe legal and ethical tool for mental health Pĕtr Nawka, Piotr Mierzewski COUNCIL OF EUROPE

2 Founded in member states 800 mln Europeans Seat: Strasbourg, France

3 HUMAN RIGHTS PALACE

4 FOUR P’s… P rinciples - COE P olicy - WHO P olitics - EU P ractice - Countries

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

6 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

7 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”;

8 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;

9 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.

10 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.

11 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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13 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

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

15 Background 1983 – Recommendation R(83) – Parliamentary Assembly Recommendation – Working Party set up 1997 – Convention on Human Rights and Biomedicine 2000 – “White Paper” issued for public consultation 2004 – Recommendation Rec (2004)10 adopted

16 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

17 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.

18 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.

19 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

20 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

21 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

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

23 Observers: - Europe-wide organisation of mental health patients

24 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.

25 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?

26 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

27 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?

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