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The CRPD and Mental Health Law: The Conflict About Abolition, the Practical Dilemmas of Implementation and the Untapped Potential

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Disability Law and Human Rights

Abstract

The implementation of the CRPD in the mental health context has been stymied by fierce conflict about whether it requires the abolition of mental health law which permits the involuntary detention and psychiatric treatment of persons with severe mental impairments. In this chapter I provide a brief overview of the conflict and explore some of the mental health specific problems and dilemmas. By rejecting abolition, are States Parties simply seeking to ‘oppress’ persons with mental impairment? Or, might the abolition of mental health law make the lives of some persons with mental impairment worse, or violate their other human rights? And, to what extent has the conflict overshadowed other less ambitious, but important, mental health reforms which could unleash the potential of the CRPD?

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Notes

  1. 1.

    The terminology which refers to persons with mental impairments has always been problematic and contentious. By persons with mental impairment I mean persons with psychiatric conditions including schizophrenia, bipolar disorder, depression, anxiety disorders, eating disorders, obsessive–compulsive disorder and post-traumatic stress disorder which may be treatable by psychiatric intervention, rather than persons with cognitive impairments such as intellectual disability, autism and dementia. While I have no difficulty with the idea that society can disable persons, ‘persons with disabilities’ seems too general. I have instead chosen ‘mental impairment’ as opposed to ‘mental illness’ or ‘psycho-social’ disability, in this paper because it is the term used in the Convention on the Rights of Persons with Disabilities, open for signature 30 March 2007, UNTS 2515, (entered into force 3 May 2008), Art 1 (‘CRPD’).

  2. 2.

    While the term ‘mental health law’ applies to all laws that relate to mental health, this chapter is particularly concerned about legal provisions which permit the involuntary detention and psychiatric treatment of persons with mental impairment, whether contained in a stand-alone Mental Health Act or dispersed within other legislation.

  3. 3.

    See for example Dhanda (2016) and Minkowitz (2017).

  4. 4.

    For example, MacQuarrie and Laurin-Bowie (2013) and Duffy and Kelly (2017, 28).

  5. 5.

    I am not aware of any material which spells it out as comprehensively as my Ph.D. dissertation which has recently been published as a book called Mental Health Law: Abolish or Reform? (Oxford University Press, 2021), especially Chapters 2 and 3.

  6. 6.

    Re E (Medical Treatment Anorexia) [2012] EWHC 1639 (COP).

  7. 7.

    Nottinghamshire Healthcare NHS Trust (Applicant) v RC (Respondent) [2014] EWHC 1317 (COP), 7 and 37.

  8. 8.

    For example, Committee on Rights of Persons with Disabilities. 2013. Concluding observations on the initial report of Australia, adopted by the Committee at its tenth session CRPD/C/AUS/CO/1 [34], and more recently, Committee on Rights of Persons with Disabilities. 2017. Concluding observations on the United Kingdom CRPD/C/GBR/CO/1) [31] and [55]. George Szmukler (2015, 260) reports that the CRPD Committee has called for the abolition of all substitute decision-making regimes in over 20 state reports.

  9. 9.

    See Committee on the Rights of Persons with Disabilities ‘General Comment No. 1 (2014) Article 12: Equal Recognition before the Law’ (11 April 2014) UN Doc CRPD/C/GC/1 [26].

  10. 10.

    See CRPD Committee. 2015. Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities: The Right to Liberty and Security of Persons. 14th Session: [6] and [10].

  11. 11.

    CRPD Committee. 2018. General Comment 6: Equality and Non-discrimination (Article 5), [30].

  12. 12.

    Committee on the Rights of Persons with Disabilities ‘General Comment No. 1 (2014) Article 12: Equal Recognition before the Law’ (11 April 2014) UN Doc CRPD/C/GC/1, [24].

  13. 13.

    CRPD, declarations and reservations, http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-15&chapter=4&lang=en. Accessed 27 March 2020.

  14. 14.

    General Comment 1, above n 5, [38].

  15. 15.

    UNHCR. 2013. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez A/HRC/22/53, [89(b)], available at https://www.ohchr.org/_layouts/15/WopiFrame.aspx?sourcedoc=/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf&action=default&DefaultItemOpen=1. Accessed 27 March 2020.

  16. 16.

    UNHRC. 2017. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. A/HRC/35/21, [63]–[66].

  17. 17.

    Ibid., [66].

  18. 18.

    UN Human Rights Committee. 2014. General Comment 35 Article 9 (Liberty and Security of the Person) CCPR/C/GC/35.

  19. 19.

    Subcommittee on Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. 2016. Approach of the Subcommittee on Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment regarding the rights of persons institutionalized and treated medically without informed consent CAT/OP/27/2 [14]–[15].

  20. 20.

    D v United Kingdom (1997) 24 EHRR 423.

  21. 21.

    Article 5(e), European Convention on Human Rights, opened for signature 1950 (entered into force 1 June 2010).

  22. 22.

    N v Romania Application No. 59132/08 decision of 28 November 2017, [141]–[147].

  23. 23.

    Committee on the Rights of Persons with Disabilities ‘General Comment No. 1 (2014) Article 12: Equal Recognition before the Law’ (11 April 2014) UN Doc CRPD/C/GC/1, [7], [13], [15], [32], [33].

  24. 24.

    Ibid., [41].

  25. 25.

    Committee on the Rights of Persons with Disabilities ‘General Comment No. 1 (2014) Article 12: Equal Recognition before the Law’ (11 April 2014) UN Doc CRPD/C/GC/1 [19].

  26. 26.

    For example, Royal Commission into Victoria’s Mental Health System, Interim Report, November 2019 (no. 87, 2018–2019); Productivity Commission, Mental Health Draft Report, October 2019.

  27. 27.

    Mental Health Act 2013 (Tas); Mental Health Act 2014 (Vic); Mental Health Act 2014 (WA); Mental Health Act 2015 (ACT); Mental Health Act 2016 (Qld); Mental Health Amendment (Statutory Review Act) 2014 (NSW); Mental Health (Review) Amendment Act (SA).

  28. 28.

    Independent Review of the MHA 1983. 2018. Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion. UK Government, Final Report.

  29. 29.

    Mental Capacity Act 2016 (Northern Ireland).

  30. 30.

    Assisted Decision-Making (Capacity) Act 2015 (Ireland).

  31. 31.

    For example, X NHS Trust v B [2015] EWCOP 60.

  32. 32.

    Royal Commission into Victoria’s Mental Health System, Interim Report, November 2019 (no. 87, 2018–2019).

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Wilson, K. (2022). The CRPD and Mental Health Law: The Conflict About Abolition, the Practical Dilemmas of Implementation and the Untapped Potential. In: Felder, F., Davy, L., Kayess, R. (eds) Disability Law and Human Rights. Palgrave Studies in Disability and International Development. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-86545-0_9

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