Application
These Principles
shall be applied without discrimination of any kind such as on grounds of
disability, race, colour, sex, language, religion, political or other opinion,
national, ethnic or social origin, legal or social status, age, property or
birth.
Definitions
In these Principles:
"Counsel"
means a legal or other qualified representative;
"Independent
authority" means a competent and independent authority prescribed by
domestic law;
"Mental health
care" includes analysis and diagnosis of a person's mental condition, and
treatment, care and rehabilitation for a mental illness or suspected mental
illness;
"Mental health
facility'' means any establishment, or any unit of an establishment, which as
its primary function provides mental health care;
"Mental health
practitioner'' means a medical doctor, clinical psychologist, nurse, social
worker or other appropriately trained and qualified person with specific skills
relevant to mental health care;
"Patient"
means a person receiving mental health care and includes all persons who are
admitted to a mental health facility;
"Personal
representative" means a person charged by law with the duty of
representing a patient's interests in any specified respect or of exercising
specified rights on the patient's behalf, and includes the parent or legal
guardian of a minor unless otherwise provided by domestic law;
"The review
body" means the body established in accordance with Principle 17 to review
the involuntary admission or retention of a patient in a mental health
facility.
General limitation
clause
The exercise of the
rights set forth in these Principles may be subject only to such limitations as
are prescribed by law and are necessary to protect the health or safety of the
person concerned or of others, or otherwise to protect public safety, order,
health or morals or the fundamental rights and freedoms of others.
Principle 1
Fundamental
freedoms and basic rights
1. All persons have
the right to the best available mental health care, which shall be part of the
health and social care system.
2. All persons with a
mental illness, or who are being treated as such persons, shall be treated with
humanity and respect for the inherent dignity of the human person.
3. All persons with a
mental illness, or who are being treated as such persons, have the right to
protection from economic, sexual and other forms of exploitation, physical or
other abuse and degrading treatment.
4. There shall be no
discrimination on the grounds of mental illness. "Discrimination"
means any distinction, exclusion or preference that has the effect of nullifying
or impairing equal enjoyment of rights. Special measures solely to protect the
rights, or secure the advancement, of persons with mental illness shall not be
deemed to be discriminatory. Discrimination does not include any distinction,
exclusion or preference undertaken in accordance with the provisions of these
Principles and necessary to protect the human rights of a person with a mental
illness or of other individuals.
5. Every person with
a mental illness shall have the right to exercise all civil, political,
economic, social and cultural rights as recognized in the Universal Declaration
of Human Rights, the International Covenant on Economic, Social and Cultural
Rights, the International Covenant on Civil and Political Rights, and in other
relevant instruments, such as the Declaration on the Rights of Disabled Persons
and the Body of Principles for the Protection of All Persons under Any Form of
Detention or Imprisonment.
6. Any decision that,
by reason of his or her mental illness, a person lacks legal capacity, and any
decision that, in consequence of such incapacity, a personal representative
shall be appointed, shall be made only after a fair hearing by an independent
and impartial tribunal established by domestic law. The person whose capacity
is at issue shall be entitled to be represented by a counsel. If the person
whose capacity is at issue does not himself or herself secure such
representation, it shall be made available without payment by that person to
the extent that he or she does not have sufficient means to pay for it. The
counsel shall not in the same proceedings represent a mental health facility or
its personnel and shall not also represent a member of the family of the person
whose capacity is at issue unless the tribunal is satisfied that there is no
conflict of interest. Decisions regarding capacity and the need for a personal
representative shall be reviewed at reasonable intervals prescribed by domestic
law. The person whose capacity is at issue, his or her personal representative,
if any, and any other interested person shall have the right to appeal to a
higher court against any such decision.
7. Where a court or
other competent tribunal finds that a person with mental illness is unable to
manage his or her own affairs, measures shall be taken, so far as is necessary
and appropriate to that person's condition, to ensure the protection of his or
her interest.
Principle 2
Protection of
minors
Special care should
be given within the purposes of these Principles and within the context of
domestic law relating to the protection of minors to protect the rights of
minors, including, if necessary, the appointment of a personal representative
other than a family member.
Principle 3
Life in the
community
Every person with a
mental illness shall have the right to live and work, as far as possible, in
the community.
Principle 4
Determination of
mental illness
1. A determination
that a person has a mental illness shall be made in accordance with
internationally accepted medical standards.
2. A determination of
mental illness shall never be made on the basis of political, economic or
social status, or membership of a cultural, racial or religious group, or any
other reason not directly relevant to mental health status.
3. Family or
professional conflict, or non-conformity with moral, social, cultural or
political values or religious beliefs prevailing in a person's community, shall
never be a determining factor in diagnosing mental illness.
4. A background of
past treatment or hospitalization as a patient shall not of itself justify any
present or future determination of mental illness.
5. No person or
authority shall classify a person as having, or otherwise indicate that a
person has, a mental illness except for purposes directly relating to mental
illness or the consequences of mental illness.
Principle 5
Medical
examination
No person shall be
compelled to undergo medical examination with a view to determining whether or
not he or she has a mental illness except in accordance with a procedure
authorized by domestic law.
Principle 6
Confidentiality
The right of
confidentiality of information concerning all persons to whom these Principles
apply shall be respected.
Principle 7
Role of community
and culture
1. Every patient
shall have the right to be treated and cared for, as far as possible, in the
community in which he or she lives.
2. Where treatment
takes place in a mental health facility, a patient shall have the right,
whenever possible, to be treated near his or her home or the home of his or her
relatives or friends and shall have the right to return to the community as
soon as possible.
3. Every patient
shall have the right to treatment suited to his or her cultural background.
Principle 8
Standards of care
1. Every patient
shall have the right to receive such health and social care as is appropriate
to his or her health needs, and is entitled to care and treatment in accordance
with the same standards as other ill persons.
2. Every patient
shall be protected from harm, including unjustified medication, abuse by other
patients, staff or others or other acts causing mental distress or physical
discomfort.
Principle 9
Treatment
1. Every patient
shall have the right to be treated in the least restrictive environment and
with the least restrictive or intrusive treatment appropriate to the patient's
health needs and the need to protect the physical safety of others.
2. The treatment and
care of every patient shall be based on an individually prescribed plan, discussed
with the patient, reviewed regularly, revised as necessary and provided by
qualified professional staff.
3. Mental health care
shall always be provided in accordance with applicable standards of ethics for
mental health practitioners, including internationally accepted standards such
as the Principles of Medical Ethics adopted by the United Nations General
Assembly. Mental health knowledge and skills shall never be abused.
4. The treatment of
every patient shall be directed towards preserving and enhancing personal
autonomy.
Principle 10
Medication
1. Medication shall
meet the best health needs of the patient, shall be given to a patient only for
therapeutic or diagnostic purposes and shall never be administered as a
punishment or for the convenience of others. Subject to the provisions of
paragraph 15 of Principle 11, mental health practitioners shall only administer
medication of known or demonstrated efficacy.
2. All medication
shall be prescribed by a mental health practitioner authorized by law and shall
be recorded in the patient's records.
Principle 11
Consent to
treatment
1. No treatment shall
be given to a patient without his or her informed consent, except as provided
for in paragraphs 6, 7, 8, 13 and 15 below.
2. Informed consent
is consent obtained freely, without threats or improper inducements, after
appropriate disclosure to the patient of adequate and understandable
information in a form and language understood by the patient on:
(a) The diagnostic
assessment;
(b) The purpose, method,
Likely duration and expected benefit of the proposed treatment;
(c) Alternative modes
of treatment, including those less intrusive; and
(d) Possible pain or
discomfort, risks and side-effects of the proposed treatment.
3. A patient may
request the presence of a person or persons of the patient's choosing during
the procedure for granting consent.
4. A patient has the
right to refuse or stop treatment, except as provided for in paragraphs 6, 7,
8, 13 and 15 below. The consequences of refusing or stopping treatment must be
explained to the patient.
5. A patient shall
never be invited or induced to waive the right to informed consent. If the
patient should seek to do so, it shall be explained to the patient that the
treatment cannot be given without informed consent.
6. Except as provided
in paragraphs 7, 8, 12, 13, 14 and 15 below, a proposed plan of treatment may
be given to a patient without a patient's informed consent if the following
conditions are satisfied:
(a) The patient is,
at the relevant time, held as an involuntary patient;
(b) An independent
authority, having in its possession all relevant information, including the
information specified in paragraph 2 above, is satisfied that, at the relevant
time, the patient lacks the capacity to give or withhold informed consent to
the proposed plan of treatment or, if domestic legislation so provides, that,
having regard to the patient's own safety or the safety of others, the patient
unreasonably withholds such consent; and
(c) The independent authority
is satisfied that the proposed plan of treatment is in the best interest of the
patient's health needs.
7. Paragraph 6 above
does not apply to a patient with a personal representative empowered by law to
consent to treatment for the patient; but, except as provided in paragraphs 12,
13, 14 and 15 below, treatment may be given to such a patient without his or
her informed consent if the personal representative, having been given the
information described in paragraph 2 above, consents on the patient's behalf.
8. Except as provided
in paragraphs 12, 13, 14 and 15 below, treatment may also be given to any
patient without the patient's informed consent if a qualified mental health
practitioner authorized by law determines that it is urgently necessary in
order to prevent immediate or imminent harm to the patient or to other persons.
Such treatment shall not be prolonged beyond the period that is strictly
necessary for this purpose.
9. Where any
treatment is authorized without the patient's informed consent, every effort
shall nevertheless be made to inform the patient about the nature of the
treatment and any possible alternatives and to involve the patient as far as
practicable in the development of the treatment plan.
10. All treatment
shall be immediately recorded in the patient's medical records, with an
indication of whether involuntary or voluntary.
11. Physical
restraint or involuntary seclusion of a patient shall not be employed except in
accordance with the officially approved procedures of the mental health
facility and only when it is the only means available to prevent immediate or
imminent harm to the patient or others. It shall not be prolonged beyond the
period which is strictly necessary for this purpose. All instances of physical
restraint or involuntary seclusion, the reasons for them and their nature and
extent shall be recorded in the patient's medical record. A patient who is
restrained or secluded shall be kept under humane conditions and be under the
care and close and regular supervision of qualified members of the staff. A
personal representative, if any and if relevant, shall be given prompt notice
of any physical restraint or involuntary seclusion of the patient.
12. Sterilization
shall never be carried out as a treatment for mental illness.
13. A major medical
or surgical procedure may be carried out on a person with mental illness only
where it is permitted by domestic law, where it is considered that it would
best serve the health needs of the patient and where the patient gives informed
consent, except that, where the patient is unable to give informed consent, the
procedure shall be authorized only after independent review.
14. Psychosurgery and
other intrusive and irreversible treatments for mental illness shall never be
carried out on a patient who is an involuntary patient in a mental health
facility and, to the extent that domestic law permits them to be carried out,
they may be carried out on any other patient only where the patient has given
informed consent and an independent external body has satisfied itself that
there is genuine informed consent and that the treatment best serves the health
needs of the patient.
15. Clinical trials
and experimental treatment shall never be carried out on any patient without
informed consent, except that a patient who is unable to give informed consent
may be admitted to a clinical trial or given experimental treatment, but only
with the approval of a competent, independent review body specifically
constituted for this purpose.
16. In the cases
specified in paragraphs 6, 7, 8, 13, 14 and 15 above, the patient or his or her
personal representative, or any interested person, shall have the right to
appeal to a judicial or other independent authority concerning any treatment
given to him or her.
Principle 12
Notice of rights
1. A patient in a
mental health facility shall be informed as soon as possible after admission,
in a form and a language which the patient understands, of all his or her
rights in accordance with these Principles and under domestic law, which
information shall include an explanation of those rights and how to exercise
them.
2. If and for so long
as a patient is unable to understand such information, the rights of the
patient shall be communicated to the personal representative, if any and if
appropriate, and to the person or persons best able to represent the patient's
interests and willing to do so.
3. A patient who has
the necessary capacity has the right to nominate a person who should be
informed on his or her behalf, as well as a person to represent his or her
interests to the authorities of the facility.
Principle 13
Rights and
conditions in mental health facilities
1. Every patient in a
mental health facility shall, in particular, have the right to full respect for
his or her:
(a) Recognition
everywhere as a person before the law;
(b) Privacy;
(c) Freedom of
communication, which includes freedom to communicate with other persons in the
facility; freedom to send and receive uncensored private communications;
freedom to receive, in private, visits from a counsel or personal
representative and, at all reasonable times, from other visitors; and freedom
of access to postal and telephone services and to newspapers, radio and
television;
(d) Freedom of religion
or belief.
2. The environment
and living conditions in mental health facilities shall be as close as possible
to those of the normal life of persons of similar age and in particular shall
include:
(a) Facilities for
recreational and leisure activities;
(b) Facilities for
education;
(c) Facilities to
purchase or receive items for daily living, recreation and communication;
(d) Facilities, and
encouragement to use such facilities, for a patient's engagement in active
occupation suited to his or her social and cultural background, and for
appropriate vocational rehabilitation measures to promote reintegration in the
community. These measures should include vocational guidance, vocational
training and placement services to enable patients to secure or retain
employment in the community.
3. In no
circumstances shall a patient be subject to forced labour. Within the limits
compatible with the needs of the patient and with the requirements of
institutional administration, a patient shall be able to choose the type of
work he or she wishes to perform.
4. The labour of a
patient in a mental health facility shall not be exploited. Every such patient
shall have the right to receive the same remuneration for any work which he or
she does as would, according to domestic law or custom, be paid for such work
to a non-patient. Every such patient shall, in any event, have the right to
receive a fair share of any remuneration which is paid to the mental health
facility for his or her work.
Principle 14
Resources for
mental health facilities
1. A mental health
facility shall have access to the same level of resources as any other health
establishment, and in particular:
(a) Qualified medical
and other appropriate professional staff in sufficient numbers and with adequate
space to provide each patient with privacy and a programme of appropriate and
active therapy;
(b) Diagnostic and
therapeutic equipment for the patient;
(c) Appropriate
professional care; and
(d) Adequate, regular
and comprehensive treatment, including supplies of medication.
2. Every mental
health facility shall be inspected by the competent authorities with sufficient
frequency to ensure that the conditions, treatment and care of patients comply
with these Principles.
Principle 15
Admission principles
1. Where a person
needs treatment in a mental health facility, every effort shall be made to
avoid involuntary admission.
2. Access to a mental
health facility shall be administered in the same way as access to any other
facility for any other illness.
3. Every patient not
admitted involuntarily shall have the right to leave the mental health facility
at any time unless the criteria for his or her retention as an involuntary
patient, as set forth in Principle 16, apply, and he or she shall be informed
of that right.
Principle 16
Involuntary
admission
1. A person may (a)
be admitted involuntarily to a mental health facility as a patient; or (b)
having already been admitted voluntarily as a patient, be retained as an
involuntary patient in the mental health facility if, and only if, a qualified
mental health practitioner authorized by law for that purpose determines, in
accordance with Principle 4, that person has a mental illness and considers:
(a) That, because of
that mental illness, there is a serious likelihood of immediate or imminent
harm to that person or to other persons; or
(b) That, in the case
of a person whose mental illness is severe and whose judgement is impaired,
failure to admit or retain that person is likely to lead to a serious
deterioration in his or her condition or will prevent the giving of appropriate
treatment that can only be given by admission to a mental health facility in
accordance with the principle of the least restrictive alternative.
In the case referred
to in subparagraph (b), a second such mental health practitioner, independent
of the first, should be consulted where possible. If such consultation takes
place, the involuntary admission or retention may not take place unless the
second mental health practitioner concurs.
2. Involuntary
admission or retention shall initially be for a short period as specified by
domestic law for observation and preliminary treatment pending review of the
admission or retention by the review body. The grounds of the admission shall
be communicated to the patient without delay and the fact of the admission and
the grounds for it shall also be communicated promptly and in detail to the
review body, to the patient's personal representative, if any, and, unless the
patient objects, to the patient's family.
3. A mental health
facility may receive involuntarily admitted patients only if the facility has
been designated to do so by a competent authority prescribed by domestic law.
Principle 17
Review body
1. The review body
shall be a judicial or other independent and impartial body established by
domestic law and functioning in accordance with procedures laid down by
domestic law. It shall, in formulating its decisions, have the assistance of
one or more qualified and independent mental health practitioners and take
their advice into account.
2. The review body's
initial review, as required by paragraph 2 of Principle 16, of a decision to
admit or retain a person as an involuntary patient shall take place as soon as
possible after that decision and shall be conducted in accordance with simple
and expeditious procedures as specified by domestic law.
3. The review body
shall periodically review the cases of involuntary patients at reasonable
intervals as specified by domestic law.
4. An involuntary
patient may apply to the review body for release or voluntary status, at
reasonable intervals as specified by domestic law.
5. At each review,
the review body shall consider whether the criteria for involuntary admission
set out in paragraph 1 of Principle 16 are still satisfied, and, if not, the
patient shall be discharged as an involuntary patient.
6. If at any time the
mental health practitioner responsible for the case is satisfied that the
conditions for the retention of a person as an involuntary patient are no
longer satisfied, he or she shall order the discharge of that person as such a
patient.
7. A patient or his
personal representative or any interested person shall have the right to appeal
to a higher court against a decision that the patient be admitted to, or be
retained in, a mental health facility.
Principle 18
Procedural
safeguards
1. The patient shall
be entitled to choose and appoint a counsel to represent the patient as such,
including representation in any complaint procedure or appeal. If the patient
does not secure such services, a counsel shall be made available without
payment by the patient to the extent that the patient lacks sufficient means to
pay.
2. The patient shall
also be entitled to the assistance, if necessary, of the services of an
interpreter. Where such services are necessary and the patient does not secure
them, they shall be made available without payment by the patient to the extent
that the patient lacks sufficient means to pay.
3. The patient and
the patient's counsel may request and produce at any hearing an independent
mental health report and any other reports and oral, written and other evidence
that are relevant and admissible.
4. Copies of the
patient's records and any reports and documents to be submitted shall be given
to the patient and to the patient's counsel, except in special cases where it
is determined that a specific disclosure to the patient would cause serious
harm to the patient's health or put at risk the safety of others. As domestic
law may provide, any document not given to the patient should, when this can be
done in confidence, be given to the patient's personal representative and
counsel. When any part of a document is withheld from a patient, the patient or
the patient's counsel, if any, shall receive notice of the withholding and the
reasons for it and shall be subject to judicial review.
5. The patient and
the patient's personal representative and counsel shall be entitled to attend,
participate and be heard personally in any hearing.
6. If the patient or
the patient's personal representative or counsel requests that a particular
person be present at a hearing, that person shall be admitted unless it is
determined that the person's presence could cause serious harm to the patient's
health or put at risk the safety of others.
7. Any decision
whether the hearing or any part of it shall be in public or in private and may
be publicly reported shall give full consideration to the patient's own wishes,
to the need to respect the privacy of the patient and of other persons and to
the need to prevent serious harm to the patient's health or to avoid putting at
risk the safety of others.
8. The decision
arising out of the hearing and the reasons for it shall be expressed in writing.
Copies shall be given to the patient and his or her personal representative and
counsel. In deciding whether the decision shall be published in whole or in
part, full consideration shall be given to the patient's own wishes, to the
need to respect his or her privacy and that of other persons, to the public
interest in the open administration of justice and to the need to prevent
serious harm to the patient's health or to avoid putting at risk the safety of
others.
Principle 19
Access to
information
1. A patient (which
term in this Principle includes a former patient) shall be entitled to have
access to the information concerning the patient in his or her health and
personal records maintained by a mental health facility. This right may be
subject to restrictions in order to prevent serious harm to the patient's
health and avoid putting at risk the safety of others. As domestic law may
provide, any such information not given to the patient should, when this can be
done in confidence, be given to the patient's personal representative and
counsel. When any of the information is withheld from a patient, the patient or
the patient's counsel, if any, shall receive notice of the withholding and the
reasons for it and it shall be subject to judicial review.
2. Any written
comments by the patient or the patient's personal representative or counsel
shall, on request, be inserted in the patient's file.
Principle 20
Criminal offenders
1. This Principle
applies to persons serving sentences of imprisonment for criminal offences, or
who are otherwise detained in the course of criminal proceedings or
investigations against them, and who are determined to have a mental illness or
who it is believed may have such an illness.
2. All such persons
should receive the best available mental health care as provided in Principle
1. These Principles shall apply to them to the fullest extent possible, with
only such limited modifications and exceptions as are necessary in the
circumstances. No such modifications and exceptions shall prejudice the
persons' rights under the instruments noted in paragraph 5 of Principle 1.
3. Domestic law may
authorize a court or other competent authority, acting on the basis of
competent and independent medical advice, to order that such persons be
admitted to a mental health facility.
4. Treatment of
persons determined to have a mental illness shall in all circumstances be
consistent with Principle 11.
Principle 21
Complaints
Every patient and
former patient shall have the right to make a complaint through procedures as
specified by domestic law.
Principle 22
Monitoring and
remedies
States shall ensure
that appropriate mechanisms are in force to promote compliance with these
Principles, for the inspection of mental health facilities, for the submission,
investigation and resolution of complaints and for the institution of
appropriate disciplinary or judicial proceedings for professional misconduct or
violation of the rights of a patient.
Principle 23
Implementation
1. States should
implement these Principles through appropriate legislative, judicial,
administrative, educational and other measures, which they shall review
periodically.
2. States shall make
these Principles widely known by appropriate and active means.
Principle 24
Scope of
principles relating to mental health facilities
These Principles
apply to all persons who are admitted to a mental health facility.
Principle 25
Saving of existing
rights
There shall be no
restriction upon or derogation from any existing rights of patients, including
rights recognized in applicable international or domestic law, on the pretext
that these Principles do not recognize such rights or that they recognize them
to a lesser extent.
©
Copyright 1997 - 2000
Office of the United Nations High Commissioner for Human Rights
Geneva, Switzerland