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

2. 2 Founded in 1949 47 member states 800 mln Europeans Seat: Strasbourg, France

3. 3 HUMAN RIGHTS PALACE

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

5. 5 2006 - 2007 COMMITTEE OF EXPERTS ON DEVELOPING A COUNCIL OF EUROPE MENTAL HEALTH REFERENCE TOOL

6. 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. 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. 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. 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. 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. 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)

12. 12

13. 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. 14 Recommendation R(2004)10 on the protection of the human rights and dignity of persons with mental disorder

15. 15 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

16. 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. 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. 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. 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. 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. 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. 22 PARTICIPATION: - Parliamentary Assembly -Council of Europe Commissioner for Human Rights -European Commission -World Health Organisation

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

24. 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. 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. 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. 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. 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