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Chapter 1 Context of mental health legislation 1 1. Introduction 1 2. The interface between mental health law and mental health policy 2 3. Protecting, promoting and improving rights through mental health legislation 3 3.1 Discrimination and mental health 3 3.2 Violations of human rights 4 3.3 Autonomy and liberty 5 3.4 Rights for mentally ill offenders 5 3.5 Promoting access to mental health care and community integration 6 4. Separate versus integrated legislation on mental health 7 5. Regulations, service orders, ministerial decrees 7 6. Key international and regional human rights instruments related to the rights of people with mental disorders 8 6.1 International and regional human rights instruments 8 6.1.1 International Bill of Rights 9 6.1.2 Other international conventions related to mental health 11 7. Major human rights standards applicable to mental health 13 7.1 UN Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (MI Principles, 1991) 13 7.2 Standard Rules on the Equalization of Opportunities for Persons with Disabilities (Standard Rules, 1993) 14 8. Technical standards 15 8.1 Declaration of Caracas (1990) 15 8.2 Declaration of Madrid (1996) 15 8.3 WHO technical standards 15 8.4 The Salamanca Statement and Framework for Action on Special Needs Education (1994) 16 9. Limitation of rights 16 Chapter 2 Content of mental health legislation 19 1. Introduction 19 2. Preamble and objectives 19 3. Definitions 20 3.1 Mental illness and mental disorder 20 3.2 Mental disability 22 3.3 Mental incapacity 23 3.4 Unsoundness of mind 23 3.5 Definitions of other terms 26 4. Access to mental health care 27 4.1 Financial resources for mental health care 27 4.2 Mental health in primary care 28 4.3 Allocating resources for underserved populations 29 4.4 Access to medications and psychosocial interventions 29 4.5 Access to health (and other) insurance 29 4.6 Promoting community care and deinstitutionalization 30 5., Rights of users of mental health services 3 5.1 Confidentiali ty' 5.2 Access to inforrmationr 53: 1 : Eirnment 5.3.2 Privacy 3' 5.3.3 Communication , 3 5.3.4 Labour 30 5.4 Notice of rights 3 6. Rights of families and carws of persons ith menta did 7. Competence, capacity and guardian shipt 7.1 Definitions 3 7.2 Assessment of incapacity 40 7.2.1 Capacity to make treatment decision, 4 7.2.2 Capacity to select a substitute decision-maker,4 7.2.3 Capacity to make a financial decision- 7.3 Determining incapacity and incompetence 41 7.4 Guardianship 41 8. Voluntary and involuntary mental health care 43 8.1 Voluntary admission and voluntary treatment3 8.2 "Non-protestlng patlents 4,1 8.3 In nt admission and invountateatnt 8.3.1 Combined versus a separate approach to Siinvo untary adm ission and invo untary treatm n 47 ....... .3.t2Orted frlnvolUntary admWissJr 49 .. .8..3 . 0 4Pr 6 dureforinvoldntso a1 1 misi on 8.3.4 CrWerfinvoluntary,troatment (wherproceo. . . . for admission and treatment, are separate) 8.3.5 Procedure for invointsrytreatmen of admitted personsd53 Sza.6 Prpxy Consentifr treatmert... 8.3.7 1nvoluntary treatment in community settings 57 S8.4; E- m ergency s tuation s 0 . S4.t 1Pr cedure for involuntary adnilssi o ahd treatment in emergency situations 60 9. Staff *uirements for doterm,ing mental disorder ,1 9.1 L skills 1 9.2 Professional groups : . Spicial treatments ' 0. Sp. 10,J M6J&r nedlcka 6nd surgical procedures;I" 102 Psychosurgery and other irreversible teatments 10.3 Electroc6nvslsive therapy (ECT) 4 11. Seclusion and restraint 12 Clinical and xperlmrntarnesOarch... 13.1 Judiciaf t quasHudlcial oversifht of invok0ntary adtlss&io/tra.aftent and other restrictionsof rish. . . . 8 13141 compositionh 132 gu n d oVersght body 9 *112 Z Additional powers 7 ....133 *omplitai ndremedMs 70a 113 Proceuraln sfeg'ad" em .. 14, Police resp onsibilitis with respect to persons with monta disorders i 14.1 Powersof the polic . 72 14.2 Responding, to catl for assistance 73 * '**. 14.:'; inl , nt p r m^ ^'^ .' 14.3: Protections for persons with mental disordars.. . .73 14.3.1 Place of safety * 14.3.2 Treatmt options 14.3.3 06tentlon period 74. 14,3.4 Prompt notification, 74 14 . .. .. Review of record ........ .. Legislativ. provisions relatingo to mentally iN offenders& 7 18.1 The pre-trial stages in the criminal ju4tica system 7$ 15j The decision t prosecute 7 15.2 The trial stage in the c, minI justice syI...teft7 A 5. Fitnessto stand trial S', :r ': 1531 P;d c nity treatnt . 1&1.2 Hospital orderas 7 S*The post'sene ong (serv6ing sentence i pri n) stag .. for....... .55 FaciiItir-off6n 7 ... .Additli. .ubtingve provisions affecting me S i-discrfi minatlon legislation 1&2S General health care 81 1.3. Housing, ! 18.4 Eloptymsnt 8$ ... 5 votel 16 mem 1. o Minors 80 17.2 Worr b4ef 6;. Offonces0rw&pthale. 86 Chapter 3 Process: drafting, adopting and imple nting . Introduction ..89 ^2.1 Identifying mental disaorder an bardersto mental he alth care O 22 Mapping of mental-health-related 2 2.3 Studying international ventions and standards 93 24 Reviewing mental health legislation in other co6tntrlei 9$ 130 1&l;ng consensus and negotia.tlng for ch.. .. 2.6 Jbucatingt6 puic on issuet concerning mentai health and 3. raftinag merntal health legislation96 .*........3Ž 1The drafting process 9' $:'3 Inviting consultation. . 9 3.4 Process and 'procedure for consultatlon 99 3.5. ntguage legislation 102 4. Aloption of legi4slation 10 4.1 Legislative procews 103 4..K 1 Responsibility for adopting legisaton 103 4.1.2 Debate of draft legislation and its adoptionr 104, 4.1.3 Sanction, promulgation and publication of new legislation 104 4.2 Key actions during adoption of legislation 105 4.2.1 Mobilizing public opinion 105 4.2.2 Lobbying members of the executive branch of government and the legislature 105 5. Implementing mental health legislation 106 5.1 Importance and role of bodies responsible for implementation 106 5.2 Dissemination and training 108 5.2.1 Public education and awareness 108 5.2.2 Users, families and advocacy organizations 108 5.2.3 Mental health, health and other professionals 109 5.2.4 Developing information and guidance materials 110 5.3 Financial and human resources 110