'People like that': realising the social model in mental capacity jurisprudence.

United Nations Convention on the Rights of Persons with Disabilities and its implications for compulsory treatment and mental health nursing

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) was the first legally binding instrument explicitly focused on how human rights apply to people with disability. Amongst their obligations, consistent with the social model of disability, the Convention requires signatory nations to recognise that “…persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and mandates signatory nations to develop “…appropriate measures to provide access by persons with disability to the support they may require in exercising their legal capacity”. The Convention promotes supported decision-making as one such measure. Although Australia ratified the UNCRPD in 2008, it retains an interpretative declaration in relation to Article 12 (2, 3, 4), allowing for the use of substituted decision-making in situations where a person is assessed as having no or limited decision-making capacity. Such an outcome is common for people with severe or profound intellectual disability because the assessments they are subjected to are focused on their cognition and generally fail to take into account the interdependent nature of human decision-making. This paper argues that Australia’s interpretative declaration is not in the spirit of the Convention nor the social model of disability on which it is based. It starts from the premise that the intention of Article 12 is to be inclusive of all signatory nations’ citizens, including those with severe or profound cognitive disability. From this premise, arises a practical need to understand how supported decision-making can be used with this group. Drawing from evidence from an empirical study with five people with severe or profound intellectual disability, this paper provides a rare glimpse on what supported decision-making can look like for people with severe or profound intellectual disability. Additionally, it describes the importance of supporters having positive assumptions of decision-making capacity as a factor affecting supported decision-making. This commentary aims to give a focus for practice and policy efforts for ensuring people with severe or profound cognitive disability receive appropriate support in decision-making, a clear obligation of signatory nations of the UNCRPD. A focus on changing supporter attitudes rather than placing the onus of change on people with disability is consistent with the social model of disability, a key driver of the UNCRPD.

Byline: Afzal. Javed, M. Amering The concept of human rights increasingly defines the discourse on ethical, moral, and legal frameworks of nations as well as international organizations. Their international and universal character was set out in the 1948 Universal Declaration of Human Rights and reinforced consistently ever since. At the same time, discussions on differences regarding their interpretation and application involve all of us on a daily basis on a political, professional, and personal level. Although human rights are promoted in a wider perspective and all population groups fall under their protection, there are on-going discourses around the world over the human rights needs of individuals diagnosed with psychiatric disorders and those experiencing mental health problems. Reports have confirmed the severity of human rights violations among this group almost in all cultures and countries though there are variations in frequency, intensity or severity. The practices and policies to follow human rights also change from one country to another with a number of concerns for disparities. Recent Historic Firsts In recent years, several historic firsts occurred, which have a strong bearing on the current developments in mental health and human rights: *For the first time in history, the human rights for persons with disabilities were specifically formulated in the 2006 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). This was deemed necessary because persons with disabilities have been denied their human rights on many levels and in all cultures and societies despite the fact that all prior human rights legislation, of course, applies to persons with disabilities in the same way as to every human being. This process of assessing the human rights situation of a particular group of people responding to the documented need for extra attention can be understood in analogy with the formulation of the UN-Convention on the Elimination of All Forms of Discrimination against Women in 1979 or the UN-Convention on the Rights of the Child in 1989 *For the first time in history persons with a lived experience of disability were part of the negotiating process at the United Nations. This brought about a plethora of novel experiences and “New Diplomacy” strategies with remarkable successes and only partly overcome stumble blocks [sup][1] *For the first time in history persons with a lived experience of disabilities from mental health problems (psychosocial disabilities) joined the movement of disability activists and were equal partners in the process of drafting the UN-CRPD. As a result, the convention obliges states to involve persons with disabilities in policy development. Therefore, from now on, people with a lived experience background will as rights-holders be part of the activities of international and national monitoring bodies with regard to UN-CRPD as well as all negotiating processes of international, national or local policies that concern their care and their lives in their communities. Furthermore, the UN-CRPD has a place in history with an exceptionally fast ratification process. By June 2016, 165 States Parties have ratified the UN-CRPD, thereby making it applicable in their countries. The consequent changes in policy and practice of mental health care concern high-as well as low- and middle-income countries.[sup][2] As a majority of people will be experiencing some form of disability either personally or as a family carer or friend at some point in time in their lives and disabilities from mental health problems affect millions of people all around the globe the significance of the claims and consequences of a successful meeting of the obligations of this particular UN-Convention can hardly be overestimated. The Un-Convention on the Rights of Persons With Disabilities The UN-CRPD includes freedom rights, such as the right to be free from exploitation, violence and abuse and requests nondiscrimination in terms of capacity and equal recognition before the law. …

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is the first international treaty to provide a basis for standards for the rights of persons with disabilities. It also represents the first human rights convention formally ratified by the European Union. In 2008, the UNCRPD was ratified by the majority of EU and EEA member states. Article 30 of the Convention specifically addresses the right to participate in cultural life, recreation, leisure, and sport is referenced and addressed in the UNCRPD States Parties reports submitted by all EU and EEA countries, as well as the United Kingdom. Research Question: How is sport represented in the State Party reports submitted under the UNCRPD? Methods: Data were collected from the UN Treaty Body Database. When multiple States Parties reports were available for a country, both reports were included for analysis. Results: Thematic analysis of 31 UNCRPD States Parties reports from EU, EEA, and UK countries revealed six key themes: General Factors, Sport in Article 30, Types of Support, Entities, Assistive Technologies, and Assistive Technologies in Sport. Sport was mentioned in all reports, with 90.3% referencing recreational sport and 83.9% elite-level sport. Funding and programmes were the most frequently cited supports for inclusive sport. Nearly half of the countries reported dedicated entities overseeing disability sport. Assistive technology was widely referenced across multiple UNCRPD articles, but only 16.1% of countries discussed its use specifically in sport. Countries differ significantly in their implementation of the UNCRPD in the context of sports. While some nations are advancing toward full inclusion, where disability does not affect an individual’s ability to participate in sports, others remain in the early stages of addressing participation in sport. These countries often rely on targeted programs specifically designed to facilitate the participation of persons with disabilities. Discussion: The analysis reveals significant disparities in how countries report and implement sport-related provisions under the UNCRPD. Ambiguities in categorizing elite versus recreational sport, underreporting of existing programs and entities, and limited references to strategic frameworks like the Kazan Action Plan highlight inconsistencies in reporting. Assistive technology (AT), while widely acknowledged across UNCRPD articles, is rarely linked to sport, despite its critical role in facilitating access and participation. These gaps suggest a need for clearer guidelines and more comprehensive reporting to ensure inclusive and equitable sport opportunities for persons with disabilities. Conclusions: There are notable disparities among countries’ reports in terms of mentioning participation for people with disability in sport, with some mentioning greater emphasis in integration and accessibility than others. To advance the UNCRPD rights through sport, clearer guidelines, standardized terminology, and more comprehensive reporting practices are essential.

This chapter begins with the historical developments that put mental health and capacity law into context, then moves on to the relationship to other areas of law. It describes the principles, and the roles of professionals and relatives. It goes on to explain the procedures for using civil powers, and civil admission for treatment. Consent to treatment, leave from hospital, civil community treatment, and after-care. The chapter then details police powers under mental health law, court-ordered pre-sentence assessment and sentence of treatment, alongside other court orders. Transfer from prison to treatment is included, with restriction orders, then appeals against treatment and detention is outlined. The subsequent section outlines human rights law, the European Convention of Human Rights, misuse of mental health law, and finishes with mental capacity laws.

Background: People with disabilities have experienced heightened social risks in the context of the pandemic, resulting in higher rates of infection and mortality. They have also borne elevated burdens associated with public health measures. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) obliges its 184 state parties to eliminate discrimination and ensure equality and inclusion for persons with disabilities, including protection and safety in situations of emergency. It remains unclear to what extent national COVID-19 policies have aligned with these commitments under the UNCRPD. Our objective in this exploratory study was to assess alignment between the UNCRPD indicators and COVID-19 policies from 14 countries with the goal of informing policy development that is inclusive of persons with disabilities and responsive to rights under the UNCRPD.Methods: We identified COVID-19 policy documents from 14 purposively selected countries. Country selection considered diversity based on geographic regions and national income levels, with restriction to those countries that had ratified the UNCRPD and had English or French as an official language. We used a computational text mining approach and developed a complex multilevel dictionary or categorization model based on the UNCRPD Bridging the Gap indicators proposed by the Office of the High Commissioner on Human Rights (OHCHR). This dictionary was used to assess the extent to which indicators across the entirety of the UNCRPD were represented in the selected policies. We analyzed frequency of associations with UNCRPD, as well as conducting ‘key word in context’ analyses to identify themes. Results: We identified 764 COVID-19 national policy documents from the period of January 2020 to June 2021. When analyzed in relation to the Articles of the UNCRPD, the most frequently identified were Articles 11 (risk and humanitarian emergencies), 23 (home and family), 24 (education), and 19 (community living). Six countries produced 27 policies that were specifically focused on disability. Common themes within these documents included continuation of services, intersectionality and equity, and disability considerations in regulations and public health measures.Conclusion: Analyzing country policies in light of the UNCRPD offers important insights about how these policies do and do not align with states’ commitments. As new policies are developed and existing ones revised, more comprehensive approaches to addressing the rights of persons with disabilities are urgently needed.

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) took effect in 2008. This paper discusses a number of flashpoints where the CRPD will require real and significant reconsideration of English mental health and mental capacity law. The CRPD introduces a new paradigm into international disability law, relying on the social model of disability. While that is no doubt a good thing, there is as yet no clear sense as to how that is to be implemented. After providing an introduction to the Convention, the paper considers four specific areas: mental capacity law (focussing on the provisions of the Mental Capacity Act 2005), psychiatric treatment without consent, civil detention of people with mental disabilities, and mental disability in the criminal system (fitness to plead, insanity and diminished responsibility).

Persons with disabilities have a right to effective access to justice under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). This article provides insights on the parameters of that right, including a close examination of the history and text of Article 13, which directly addresses access to justice and other relevant UNCRPD provisions. In addition to the UNCRPD, this article discusses implementation guidance from the Committee on the Rights of Persons with Disabilities, including its guidelines for State Party reports and jurisprudence. The initial reports by eleven States Parties — Argentina, Azerbaijan, China, Costa Rica, Croatia, Dominican Republic, Ecuador, Hungary, Mexico, Peru and Turkmenistan — are also considered. The Committee’s feedback regarding implementation of Article 13 by these eleven States parties is critiqued for being limited and inconsistent. This article then attempts to clarify what effective access to justice actually requires. It does so by focusing on the insights that can be drawn from implementation of Article 13 since the UNCRPD was adopted as well as implementation guidance from the Conference of States Parties, the International Disability Alliance, the World Network of Users and Survivors of Psychiatry and the National Center for Access to Justice. This article concludes with recommendations on how the Committee can improve its guidance on access to justice to help ensure that equal rights will not be illusory for persons with disabilities.

Background: Amid global shifts from institutional to family-centric models in child protection systems, children with disabilities (CWD) remain marginalized from social systems. Despite the existence of legislative and policy initiatives, fragmented implementation and social stigma continue to leave CWD behind. This study investigated the policy and practical disparities hindering CWD inclusion in Sri Lanka and explored rights-based strategies aligned with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Method: This study consists of two linked articles: a scoping review and an expert interview analysis, contributing to policy recommendations. The review examined 242 academic and policy documents to assess Sri Lanka's alignment with the UNCRPD and included a comparison with international practices. The second article involved semistructured interviews with 11 experts from NGOs, government entities, and institutions. Thematic analysis of the interviews identified key challenges and practical suggestions across policy and implementation. Results: The scoping review revealed major gaps in accessibility, inter-agency coordination, public awareness, legal infrastructure, and data availability. Expert interviews confirmed these gaps and highlighted cultural stigma, incoherent services, and the absence of a cohesive regulatory system. Compared to global standards, Sri Lanka continues to face challenges in establishing a unified, disability-inclusive child protection model with measurable outcomes. Conclusions: To strengthen CWD protection in Sri Lanka, actionable strategies aligned with the UNCRPD are vital. Recommendations include reinforcing legal frameworks, enhancing stakeholder coordination, launching national awareness campaigns, and promoting legal literacy. This study emphasizes the urgent need for a comprehensive regulatory structure to protect CWD rights and address societal attitudes toward disability, ensuring effective policy implementation.

INTRODUCTION On August 8, 2016, the Mental Health Care (MHC) Bill, 2016 was passed in the Rajya Sabha. If the Bill is passed in the Lok Sabha, then it repeals the Mental Health Act, 1987. The Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2007.[1] The Convention requires the laws of the country to align with the Convention. The new Bill was introduced as the existing Mental Health Act, 1987 does not fulfill the obligations of the UNCRPD.[2] The preamble of the MHC Bill, 2016 clearly depicts that this legislation is to protect, promote, and fulfill the rights of such persons during delivery of MHC and services.[3] The Bill is progressive and rights based in nature. The whole dedicated Chapter (v) on "Rights of the persons with mental illness" is the heart and soul of this legislation. However, the Bill mainly focuses on the rights of the persons with mental illness only during treatment in hospital and it is completely silent about the care of the persons with mental illness in community.[3] MHC priorities need to be shifted from psychotic disorders to common mental disorders and from mental hospitals to primary health centers. Increase in invisible mental problems such as suicidal attempts, aggression and violence, widespread use of substances, and increasing marital discord and divorce rates emphasizes the need to prioritize and make a paradigm shift in the strategies to promote and provide appropriate mental health services in the community.[4] There are several significant positive developments in the new Bill. First, there is a mention of decriminalization of attempted suicide. It is specifically stated that there is a presumption of severe stress in person with attempted suicide and such person shall not be tried and punished under the said code. Moreover, it is highlighted that the appropriate Government will be bound not only to provide care, treatment, and rehabilitation of such persons but also to take measures to reduce its recurrence. This is an important and progressive step which will have positive implication throughout the country.[5] Second, there is a detailed description on "Rights of person with mental illness." This is highly significant step to make the Bill as patient-centric. There is a mention of the right to access MHC and treatment at affordable cost, good quality which is acceptable to person with mental illness, their family members, and caregivers. The onus will be on appropriate Government to make such provisions for range of services including outpatient and inpatient services, half-way homes, sheltered accommodation, supported accommodation, hospital- and community-based rehabilitation, free cost of medicines, specialized services of child and adolescent, and old age mental health. The appropriate Government will ensure necessary budgetary provisions for effective implementation along with integration of mental health services into general health care at all levels of health. Every person with mental health illness will have right to protection from cruel, inhuman, and degrading treatment. Third, the key feature in this new Bill is the provision for medical insurance for treatment of mental illness at par with physical illness by all insurers. Mental health insurance has remained a neglected area for long. This new feature will have huge and significant impact for the persons with mental illness, family, and caregivers.[6] Fourth, the new Bill clearly describes the "Duties of appropriate Government." This is a unique feature as the appropriate Government will have responsibility to plan, design, and implement programs for mental health such activities related to promotion, prevention, reduction of suicide, stigma. The important aspect will also to address the human resource needs which include training of medical officers and other persons. There are many other favorable aspects of this new Bill, which are beyond the scope of description here. In general, there are several features which may be seen as welcome step by persons with mental illness, their family, caregivers, professionals, care providers, and significant others. However, it seems ambitious and poses a huge responsibility and challenge to all stakeholders for its effective implementation. The new Bill tries to be overinclusive in its approach stretching beyond its legislative limit, and despite noble intentions behind it, it would be a challenge for the stakeholders whether the contents of the Bill are legislation, program, policy, or even a treatment guideline. There are highly qualified and accountable bodies to design a program or to recommend the treatment guidelines. There is a need to draw a distinction between the act and the rules, while the former is stable and constant over the years and latter are subject to change. The major task would be to effectively formulate the Rules which take into the account the opinions of all stakeholders and in the best interest of the person with mental illness. On a closer look, this Bill premises on a hypothesis that the MHC providers and family members are the main violators of the rights of the persons with mental illness, which is unfortunate. On the other hand, the Bill does not take into account of family members' significant contribution, caregivers' burden, isolation, frustration, and violence they undergo because of persons with mental illness.[7] The Bill is silent on the role and contribution of family members in providing care. Unlike the West, in India, family is the key resource in the care of patients with mental illness.[7] Families assume the role of primary caregivers for two reasons. First, it is because of the Indian tradition of interdependence and concern for near and dear ones in adversities. Second, there is a paucity of trained mental health professionals required to cater to the vast majority of the population;[8] hence, the clinicians depend on the family. Thus, having an adequate family support is the need of the patient, clinician, and the healthcare administrators.[7] Unfortunately, that Bill does not foster the need to support the family members in providing care. The Mental Health Act, 1987 legislation focused on admission and treatment of persons with severe mental illness in mental hospitals[9] when they were detained against their will.[1] However, the MHC Bill, 2016 tries to regulate almost all the MHC establishments. This could be avoided by legislation focusing on MHC institutes, where patients are admitted against their will for treatment. The Mental Health Act, 1987 was not implemented across the country because of severe shortage of resources;[9] however, a new MHC Bill, 2016 has been introduced without addressing the issues which haunted the Mental Health Act, 1987.[10] Although there are many positive aspects of the MHC Bill, 2016, the negative aspects have severe and negative impact of the MHC in India. This article focuses on the shortcomings of the MHC Bill, 2016. MENTAL HEALTH CARE BILL, 2016: CHALLENGES AND REMEDIES Definition of mental health establishment National Mental Health Programme (NMHP) (National policy) advocates integration of mental health into general and primary health care.[11] However, the Bill mandates all the establishments to take license for treating patients; this may come in the way of integrating mental health into general health and, thus, the implementation of the policy. Many private hospitals and nursing homes may refuse to treat patients with mental illness reporting that they do not have license to do so. Hence, the proposed Bill should be in line with the NMHP (Mental health policy). To encourage treatment in general hospitals, they need to keep those establishments out of the purview of licensing.[1] The proposed Bill enthusiastically moves forward (without acknowledging the available meager resources) to protect and promote human rights of persons with mental illness by mandating licensing of the mental health establishments. There are many hostels, prisons, jails, juvenile home, child protection centers, reception centers, centers for destitute, beggars' home, religious places such as temples, churches, and dargahs, and faith healers need to take license to keep persons with mental illness. This will defeat the purpose of the Bill and will invite "license raj" of harassing the MHC providers. It would be prudent to keep the general hospital psychiatry units and nontreatment providing centers to be kept out of the purview of licensing.[1] Capacity to make mental health care and treatment decisions This issue of capacity to make MHC and treatment decisions is inadequate and may have dangerous consequences because person with mental illness may refuse treatment due to (a) absent insight, (b) severe mood symptoms, and (c) his/her symptoms are coming in the way of decision-making. Family members usually find it difficult to manage individuals with serious mental illnesses, who have no insight, and usually, they refuse admission and treatment. This clause by default considers that everyone has capacity and one has to prove that person with mental illness lacks capacity before initiating involuntary treatment. One has to approach the mental health board to take permission to initiate involuntary treatment. There is no scope to take guardians' consent to initiate involuntary treatment under the new Bill. This will add an enormous burden to family members and MHC providers in treating involuntary patients with severe mental disorders.[12] This clause is either to be deleted or to be considered informed consent from the parents and family members, or two doctors (preferably one of them is a psychiatrist) opinion is taken to initiate involuntary treatment. This can help the patient and also the family members in providing timely care. The Supreme Court of Canada has dealt similar issue in a well-known celebrity case referred as "Canada's Beautiful Mind" that a law that allows a person with a mental illness to be incarcerated indefinitely in a "hospital" because needed psychiatric treatment cannot, by law, be provided is not justifiable in a caring democratic jurisdiction.[13] Hence, the new Bill needs to make provision for treatment (involuntary) in all supported (involuntary) admissions through informed consent from the parents and/or by family members to restore liberty by treatment. It has been stated very rightly that in the regulation of involuntary treatment, a balance must be found between duties of care and protection and the right to self-determination.[14] Advance directives Person with mental illness may revoke, amend, or cancel advanced directives many times in a day, and family members will be finding difficult to handle such situations. Only the mental health board has powers to amend or overrule the advance directive. This needs to be done in very short time to enable the treatment (24–48 h). If patient has written costly treatment or private/corporate hospital (which family cannot afford) in advance directives, then who will bear the cost of costly treatment. Considering the available human resources (Medical and Judicial), economic constraint, and our collective community efforts in treating patients with mental illness, our Indian population is not ready for such advanced directives. Above all these, research studies data do not support the use of advance directives in person with mental illness (Cochrane review). It would be prudent to do more research in this area in our population before to introduce this advance directive.[15] This advance directive operates on the basic premise that "if a person develops mental illness" Which mental illness? If multiple illnesses occur? If it becomes comorbid with physical illness? What severity? Under what circumstances? Above issues are wide open and threaten each individual. If an MHC provider writes an advance directive, he/she need to write for each disorder "if I develop mania," "If I develop schizophrenia," like a textbook, how he/she should be care or not to be cared. This advance directive will welcome more litigations and heavy burden on family members. It is advisable that advance directive needs to be kept out of the purview of the Bill.[16] The Cochrane database of systematic review on advance treatment directives for people with severe mental illness reported that there are too few data available to make definitive recommendations to introduce it.[17] Even in the West, this has certainly not had its intended benefit. For the Indian reality, to be rushing in with legislation on this count is rather hasty and ill conceived.[1418] Nominated representative A person with mental illness may revoke his/her decision of nomination of a representative as he/she suffers by reason of severe mental illness coloring his/her perception, alter many times in a day too. (1) Only mental health board has powers to overrule the nominated representative. (2) This needs to be done in very short time to enable the treatment. (3) If nominated representative is requesting for costly treatment (which family cannot afford), then who will bear the cost of costly treatment: is it family? or nominated representative? or the State? (4) Considering the available human resources (Medical and Judicial), economic constraint, and our collective community efforts in treating patients with mental illness, our Indian population is not ready for such a departure from family as a caregiver to a patient chosen nominated representative. (5) This nominated representative breaks the Indian family system who cares and bears the brunt of patents unpleasant behavior and still willing to support his/her treatment.[7] Ultimately, family may disown the patient and which may have serious consequences in the form of abandoning the patient and wandering mentally ill at large, which defeats the very purpose of the Bill in protecting the patient. Family members are the true value and assets in the Indian context to provide community care for persons with mental illness. Hence, family members are the natural guardians until proven otherwise. This "Nominated Representative" breaks the very backbone and fabric of our society "the family." In all most, all the cases, family members are the caregivers this needs to be fostered and enhanced. This clause on Nominated Representative needs to be removed from the Bill.[16] Mental health review boards The district-level mental health review boards, which are quasi-judicial bodies overseeing the effective implementation of the MHC delivery system, could introduce new hurdles for treatment delivery and unnecessary delay. This could be simply because of nonavailability of judicial workforce and other resources to operate at every district levels. If these issues are not addressed, this may cause delay in initiating treatment, which may cause enormous amount of stress on the care providers. Delay in addressing the issue can defeat the purpose of the Bill. If these boards do not operate on day-to-day basis at each hospital level, then this can cause serious adversarial impact on the MHC of the person. Unfortunately, MHC is taking an ugly turn similar to western country where involuntary MHC is argued in the court of law. MHC is becoming a tedious, prolonged, and costly judicial proceeding. These mental health review boards need to have time limit (<72 h) to take decision, especially with regard to capacity to consent for treatment issues. The mainstream judicial system is incapable of handling such complaints because of lack of sensitivity and also being clogged with a huge pendendency of mainstream cases.[12] These boards need to move away from tardy judicial process/procedures. Alternatively, the first level of review could be independent hospital review board, which can address those contentious issues in a cost-effective and timely manner at the patient's doorsteps/hospital. Hence, it would be prudent to create consumer-friendly (independent) MHC hospital boards at every hospital using local resources. This MHC hospital board could be comprised of independent psychiatrist/mental health professionals, family caregivers, and recovered patient. Another alternative is to create a board of visitors at each hospital (along the lines of Mental Health Act, 1987) to perform similar functioning. Right to confidentiality The Bill also gives power to nominated representative to unlimited access to the records of the persons with mental illness. Mental health professionals have expressed reservations over sharing of information, describing it as "breach of confidentiality," as per the Medical Council Ethics, 2002.[19] However, according to the Bill, information regarding MHC needs to be shared with the nominated representative. This issue impinges on the fundamental rights – "right to privacy." Hence, there is a need to introduce a clause that information shared will be only with family members and will be in verbal form only. Written documents or medical records will be shared only with patients/legal authorities on obtaining a written request. Punishment for contravention of any of the provisions of the Bill/rule Punishments are too harsh and there is no provision for whether contravention is accidental or due to practical difficulties or deliberate. Medical personnel is already covered under various legislations such as Consumer Protection Act, MCI, and civil and criminal laws for any medical negligence. There are various other commissions such as Human Rights Commission, Women Commission, and Child Welfare Committee to protect the rights of the persons with mental illness. Unlike the other patients, behavior and responses of mentally ill are different, especially in patients with paranoid delusions. Such people are likely to complain against hospital/doctors or other personnel which he may feel true because of his/her illness but are not true. This litigation-based MHC can give rise to a defensive practice, and tendency to avoid care of such patients will only harm such patients and their family members. This will also increase the cost of MHC. There should be a provision for an independent expert committee/mental health board at hospital levels to review such complaints, and only complaints which have prima facie found to be true should be referred to the District Mental Health Board. Otherwise, there will be innumerable complaints making the hospital authorities/doctors and other personnel spend more time in the District Boards than in hospital treating patients. Discharge planning The psychiatrist is expected to be responsible for patient care and treatment in the future after discharge. This clause is idealistic but may not be possible in custodial care (involuntary patients), destitute patients, and voluntary admissions, wherein only the patient can be briefed or counseled regarding the future treatment. The ultimate decision of continuing treatment or not is the choice of the patient. Discharge planning should not be considered as negligence as it is not possible without active cooperation of the patient and family members. If the law makers are very serious about this issue of "the continuity of care," then they should enable the MHC providers and family members by introducing the Compulsory Community Treatment Order. Unfortunately, the Bill is silent on the much-needed community treatment order. Inclusion of compulsory community treatment orders may play a significant role in providing care for the chronically ill patients and also better the lives of the family members and caregivers. Availability of community treatment order to the family members and caregivers enables them to provide continuous care. The community treatment order brings relief to families of person with mental illness, encourages use of less restrictive forms of inpatient treatment, violence, unnecessary and brings to the lives of the mentally Hence, there is a need to have a community treatment order in The Compulsory community treatment order is and can be with our society and resources. of such law can in continuity of care after discharge. for research The Bill mandates Mental Health to permission for many and can or research in persons with mental illness. There is a need to this clause to permission for and to with per the of family members during admission and treatment The Bill the role of family members in providing care in hospital The Bill needs to make provisions that at one family needs to be with the patient during inpatient treatment. There is a need that family members need to be in the provision of the care. This not only patient's rights but also family members in active treatment such as and family to be and also in rehabilitation which huge in continuity and of the treatment.[7] If there are no family members, the medical board two mental health will of the of family Hence, there should be on such admissions along with their or to encourage family support during which physical support to the person with mental illness.[7] family members will the mental hospital to the of and Many such as and many other centers for across India have the of family during inpatient care. A clause needs to be introduced involuntary inpatient treatment is by default one family needs to and be with the persons with mental illness during inpatient treatment. The for inpatient for supported admission needs not when family members are in the and in treatment and A for admission with family members needs to be introduced and family support system to provide to the that have been beyond in Indian research across the of of persons with severe mental illness is completely and integration of mentally ill into the community and of their assets and are completely There is a need to have this issue of of of persons with severe mental illness to be in the proposed Bill. The treatment and need to be as per the guidelines. The board needs to take the bodies opinion in case of in treatment and is a form of treatment for patients with of suicidal and and patients. In treatment, is a form of treatment and in has been in the Bill. If this clause is not effective treatment will be to the patient can be is usually in ill patients. for the for in or is the much-needed treatment. psychiatrist needs to have the right to about treatment with the consent of family members. The Bill should not or on acceptable of resources The Bill is highly with the which is similar to the western society resources are in many than India. The issue in our society with regard to the of implementation of the MHC Bill is the of There have been serious about the of resources such as workforce and and also will for implementation of the Bill. The major is lack of especially in the and There are problems such as inadequate mental health for and of the available mental health resources to general health In lack of regarding mental health the and to the If mental health services are not available in the district where the patient then that such person is to access any other mental health in the district and the of treatment at such establishments in that district will be by the appropriate This based mental health issues can to and many of them of the existing meager resources. of the the Bill needs to and make provisions and a through and detailed in the Bill for mental health workforce on similar lines of Mental Health of in the The Bill needs to introduce for of workforce a time There is also an need to introduce at the level that every should to treat mental This responsibility needs to be to a for and the of workforce The need of the is in addressing major such as lack of mental health and which are the major to psychiatric services in the community.[4] of The Bill is silent and does not the to for of or district the workforce resource for the Bill is highly in the and also in the area of mental health treatment. Hence, training of workforce needs to be considered to the existing The Bill should provision of adequate resources for of these There has been a major shift from or custodial care as in the Indian Act, when the effective treatment was to the Mental Health of 1987 that mainly focused on the treatment and care of mentally ill with efforts to reduce and cater for their human to the MHC Bill of 2016 that focuses mainly on the human rights of persons with mental illness and their the care of the persons with mental illness. the Bill, there an of the and of mental ill patients along with that the It is prudent for the to account for the of the developments in the mental health the needs of the patients and family, make provisions to the treatment make provisions to the workforce resources and health in the of mental provide services, promote such patients, and make provisions for adequate and while making law of the The need of the is a law that can be implemented in that can cater to the health needs at all levels of and levels of while protecting the human rights of the mental health as as the and their support and of interest There are no of

Background:Employability prospects for persons with mental illness (PMIs) in India remain limited. E.g, new job opportunities and accommodation in already existing frameworks are scarce, and public action to reduce stigma for these persons is scarce too. Although India ratified The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) on 01 Oct 2007, there are discriminatory and unlawful national policies which have provisions in contradiction to those of UNCRPD related to employability of PMIs.Aim:This study aims to assess employability prospects of PMIs in India as per current legislation and policies, using UNCRPD as a guideline.Materials and Methods:This paper is a review of national laws and policies in India, on employability prospects of PMIs, using UNCRPD as a guideline. This study looks mainly into Article 27 of UNCRPD (‘work and employment’ rights of persons with disabilities) in relation to the Rights of persons with Disability (RPWD) Act, 2016 in India.Findings:RPWD act 2016, has various loopholes utilizing which, Government as well as private sectors continue discriminatory practices with regards to PMIs. Provision of exemption from various sections on the matter of work and employment of disabled persons (including PMIs) in the Act is a potential area for discriminatory practices. This does not gel very well with ethos of UNCRPD on the matter of work and employment.Conclusion:Persons with psychosocial disability have to deal with various challenges such as critical and stigmatizing attitude at workplace. When top-down approach is non-discriminatory, it improves attitude of general public too, towards persons with mental illness and their capability to work.

The viewpoint explores challenges and opportunities for Persons With Disabilities (PWDs) in accessing public institutions in line with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in Zimbabwe. The study is based on the social model of disability, reinforced by the human rights perspective, which seek to meaningfully address issues bedevilling PWDs in their quest to be accorded the rightful place in the society, particularly in their access to public spaces. It further explains attitudinal, environmental and institutional barriers. Qualitative research method was used, coupled with a few key informant interviews. The target population for this study were first and foremost PWDs. The study also targeted councillors, urban planners as well as administrators. Two subcategories of visually and physically impaired persons were carefully selected. The study findings indicated that attitudes and inadequate knowledge on disability by some community members and duty bearers also contribute to exclusion of Persons With Disabilities in public spaces. The study also found out that there are unfriendly facilities available. Additionally, the negative attitudes of stakeholders and administrative complications have deprived Persons With Disabilities from obtaining the benefits of available entitlements. Inadequate legislation, policy and lack of political will have also been established to be some of the factors leading to the side-lining of PWDs. The research recommends for creation of specific services in public spaces to support the needs of this group, integration of new technologies, and the domestication of the UNCRPD as well as the implementation of the disability policy, including best practices in disability inclusion, Specific policies should be supported by the allocation of funds and rigorous monitoring.&#x0D; &#x0D; Read the full article in accessible html-format here.

Apparently some people upon coming across [Down Syndrome dolls] were offended. […] Still, it’s curious, and telling, what gives offense. Was it the shock of seeing a doll not modeled on the normative form that caused such offense? Or the assumption that any representation of Down Syndrome must naturally intend ridicule? Either way, it would seem that we might benefit from an examination of such reactions—especially as they relate to instances of the idealisation of the human form that dolls […] represent. (Faulkner)

This article argues the New Zealand Government's current approach to compulsory psychiatric treatment is unjustifiable in a human rights context. Under s 59 of the Mental Health (Compulsory Assessment and Treatment) Act 1992, clinicians are empowered to administer compulsory psychiatric treatment to individuals without, or contrary to, their consent. This article analyses s 59, and its underlying justifications, in light of the New Zealand Government's commitments under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Further, it analyses the approach for compulsory psychiatric treatment advocated by the UNCRPD in light of Aotearoa New Zealand's mental health context to evaluate whether this approach would be more desirable than the current approach under s 59. The article then advocates for a more balanced approach to compulsory psychatric treatment which puts the rights of disabled individuals at the forefront and also ensures there are limits to these rights which are justifiable within a human rights context.

The island of Ireland is partitioned into Northern Ireland and the Republic of Ireland. In both jurisdictions, there have been important developments in mental health and mental capacity law, and associated policies and services. This includes an emphasis on developing more comprehensive approaches to collecting data on outcomes and so there is an opportunity to align these processes to enable comparison and shared learning across the border. This article explores: legal and policy developments; international approaches to mental health outcomes; and the type of data that would be helpful to collect to better understand the use of mental health and mental capacity laws. It is argued that an inclusive strategy to developing a comprehensive, integrated and aligned approach to collecting and analysing data would benefit citizens, policy makers and professionals.