Chapter 1 : Rights, Principles and Standards

Rights, Principles and Standards
UN Declaration - Rights of Disabled Persons
UN Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care
NSW Department of Health Charter for Mental Health Care in NSW
National Standards for Mental Health Services
National Statement of Rights and Responsibilities of Consumers of Mental Health Services
Rights
Responsibilities
A word on the Third National Mental Health Plan 2003-2008

UN Declaration - Rights of Disabled Persons

The Declaration of the Rights of Disabled Persons was adopted by the United Nations in 1975. It defines ‘disabled person’ to mean ‘any person unable to ensure by himself or herself, wholly or partly, the necessities of normal individual and/or social life, as a result of deficiency, whether congenital or not, in his or her physical or mental capacities’.

This definition includes people with a mental illness, whether or not they also have other disabilities. The UN Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care specifically recognise the applicability of the Declaration to people with a mental illness.

The Declaration recognises that people with disabilities are entitled to:

The inherent right to respect for their human dignity;
The same fundamental human rights as other citizens, whatever the origin nature and seriousness of their handicaps and disabilities, including the right to a decent life - as normal and full as possible;
The right to legal safeguards against abuse of any limitation of rights made necessary by the severity of a person’s handicap, including regular review and the right of appeal;
The right to any necessary treatment, rehabilitation, education, training and other services to help develop their skills and capabilities to the maximum;
The right to economic and social security and the right, according to their capabilities, to secure and retain productive employment and to join trade unions;
The right to have their needs considered in economic and social planning;
The right to family life, the right to participate in all social, recreational and creative activities and the right not to be subjected to more restrictive conditions of residence than necessary;
The right to protection against exploitation or discriminatory, abusive or degrading treatment; and
The right to qualified legal assistance to protect their rights, and to have their condition taken fully into account in any legal proceedings.

UN Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care

Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care were adopted by the UN General Assembly in 1991. The Mental Illness Principles focus mainly on human rights in relation to the mental health system but they also say:

Every person with mental illness has the same rights as every other person, including the rights in the International Covenant on Civil and Political Rights and the rights recognised in the Declaration on the Rights of Disabled Persons;
Every person with a mental illness has the right to live and work, as far as possible, in the community; and
People being treated for a mental illness must be accorded the right to recognition as a person before the law.

The Principles reaffirm that individuals who have experienced mental illness have the right to protection from exploitation – economic, sexual or in other terms, abuse – physical or in other forms, or degrading treatment.

In relation to mental health care, the principles deal with abuses and the means to prevent them, as well as recognising the right of everyone in the community to have access to mental health care when necessary. The principles provide:

All persons have the right to the best available health care, which shall be part of the health and social care system and that;
Every patient shall have the right to receive such health and social care as is appropriate according to his or her health needs, and is entitled to care and treatment in accordance with the same standards as other ill persons.

The Principles emphasise that people with mental illness should not be stigmatised or disadvantaged in the care available because of the nature of the illness. There should not be a lower standard for mental health care than for the rest of the health system. They require that mental health facilities be inspected by competent authorities often enough to ensure that conditions, treatment and care of patients comply with the Principles.

The Principles emphasise the concept of ‘least restrictive alternative’ in relation to treatment; the right to be treated and cared for, as far as possible, in the community in a way suitable to the individual’s cultural background; special protection for children; and directing treatment towards enhancing personal autonomy, including respect for patients’ rights to privacy and opportunities for education and vocational training.

There are detailed requirements for informed consent. To ensure that such rights are effectively monitored, the Principles also require that States shall ensure that appropriate mechanisms are in place 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 the patient.

NSW Department of Health Charter for Mental Health Care in NSW

The NSW Department of Health’s Charter for Mental Health Care in NSW states that every person has the right to mental health services that:

Respect human rights;
Are compassionate and sensitive to the needs of the individuals they serve;
Foster positive attitudes to mental health in the larger community;
Promote positive mental health;
Encourage true consumer involvement at all levels of service delivery and policy development;
Provide effective treatment and care across the lifespan;
Are widely accessible to people with mental health needs;
Provide care in the least restrictive environment, consistent with treatment requirements;
Provide effective and comprehensive prevention programs across one's lifespan;
Promote ‘living well’ with mental illness;
Address quality of life issues such as accommodation, education, work and income, leisure and sport, home and family and other relationships;
Use language that reduces stigma, discrimination, or negativity for those affected and their families;
Respect and are responsive to diversity in lifestyle, sexuality and sexual preference;
Are culturally sensitive and appropriate to the needs of the individuals they serve; and
Encourage and support self-help.

National Standards for Mental Health Services

The National Standards for Mental Health Services outlines the national standards that should apply to all mental health services across Australia. This is a 45 page document available from the following website or address:

http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/mental-pubs

Mental Health Branch, Health Services Division, Commonwealth Department of Health and Aging Phone:(02) 6289 1555.

These standards were endorsed by the Australian Health Ministers Advisory Council’s National Mental Health Working Group. They are intended to be a blueprint for new and existing services and a tool for consumers and carers as a checklist for service quality and to assist them to participate in service planning, development and evaluation.

The National Standards for Mental Health Services detail standards related to:

Standard 1 – Rights
Standard 2 – Safety
Standard 3 – Consumer and Carer participation
Standard 4 – Promoting Community Acceptance
Standard 5 – Privacy and Confidentiality
Standard 6 – Prevention and Mental Health Promotion
Standard 7 – Cultural Awareness
Standard 8 – Integration
Standard 9 – Service Development
Standard 10 – Documentation
Standard 11 – Delivery of Care

National Statement of Rights and Responsibilities of Consumers of Mental Health Services

Consumers of a Mental Health Service have rights and responsibilities under the Australian Health Ministers Statement of Rights and Responsibilities (1991) and the United Nations General Assembly Resolution on the “Protection of Persons with Mental Illness and the Improvement of Mental Health Care” (1992).

Rights

Consumers are entitled to a standard of care consistent with National Standards for Mental Health Services and principles contained within the National Mental Health Plans. A Person who uses Mental Health Services has a right to:

Make decisions about their own health care;
Receive professional assistance – without discrimination due to age, social status, sex, sexual preference, culture, religion or political beliefs;
Know the identity, professional status and the qualifications of the staff member who is working with them;
Be informed of tests, management or treatment options available, including risks, side effects or long term effects, before treatments or investigations;
Have their condition, or illness and plans for management explained in words they can understand;
Have a support person (a relative, friend or other person) involved in all aspects of their care and help in expressing their needs if they would like them to;
Have their privacy and confidentiality respected;
Inform the health service if something is wrong or if the service can be improved;
Accept or refuse advice, treatment or care at any time, except as required by the NSW Mental Health Act or the Guardianship Act;
Ask for a different health professional to coordinate their care, if this is required;
Ask for, and be offered an interpreter if required;
Ask for assistance and advice on how to get a second opinion about their diagnosis and treatment;
See their medical record (file) in the presence of a health care professional, add information or comments to their records, and have a copy; and
Make a complaint about any aspect of treatment or care they are not satisfied with.

Responsibilities

A consumer of Mental Health Services is encouraged to work with mental health professionals and support their own health and wellbeing by:

Answering questions about their health as openly as possible;
Being sure to keep their appointments;
Letting the health worker know if they cannot attend an appointment or will be late;
Following treatment or management agreed to, and informing the health care worker if they decide not to continue with their treatment;
Accepting the consequences of their own informed decisions;
Letting their health care worker know if they are seeing another doctor or health care worker about the same problem;
Respecting the rights of mental health professionals to be safe at work; and
Voicing their thoughts and opinions without violence.

A word on the Third ational Mental Health Plan 2003-2008

The National Mental Health Plan (NMHP) 2003-2008 is the third in a series of National Mental Health Plans. The first was released in 1992 and covered the five year period to 1997. It concentrated on reform to specialist mental health services, increased the emphasis on community based care, decreased reliance on institutional care and mainstreamed acute beds into general hospitals. Its major focus was the low prevalence mental illnesses such as psychosis and bipolar disorder. The second NMHP released in 1997 consolidated the reform activities of the first plan and increased the emphasis on promotion and prevention, the development of cross sector partnerships in service reform, and quality and effectiveness in service delivery. It extended its focus to include high prevalence disorders such as depression and anxiety disorders. The third NMHP (2003-2008) has service responsiveness, quality care, research, innovation and sustainability as its priority themes articulated within the population health approach.

Prior to the National Mental Health Plans, medical and nursing students were educated to believe that ‘mental illness’ occurred in equal degree across all socio-economic groups, that a diagnosis of mental illness was a life sentence and that there was no such thing as recovery. The National Mental Health Plans have taken a new approach that situates psychiatry in both a biomedical model and a socio economic and cultural framework that promotes recovery and understands psychiatry and its treatment modalities as the circuit breaker in a causal chain.

The foreword to the third NMHP (2003-2008) states there has been considerable development in emphasis in mental health care "from a focus on treatment to consideration of prevention, early intervention, rehabilitation and recovery". Reference is made to housing, education, welfare, justice and employment as important considerations in preventing the development of mental health problems and in promoting recovery from mental illness. The NMHP 2003-2008 asserts that mental health should be understood within a population health framework that "takes into account the complex influences on mental health, encourages a holistic approach to improving mental health and well being and develops evidence based interventions that meet the identified needs of population groups...." The population health model is comprehensively presented in the Australian National Mental Health Strategy document ‘Promotion, Prevention and Early Intervention for Mental Health’ (PPEI). This document, published in 2000, is the theoretical basis upon which much of the NMHP 2003-2008 is premised. It identifies the determinants of health as translating into either risk factors or preventative factors. In the context of mental health, risk factors increase the likelihood that mental illness will develop while protective factors provide people with resilience and moderate the impact of stress thereby reducing the likelihood of mental health problems. Examples given of risk factors include: poverty; family discord; physical, sexual or emotional abuse; and poor schooling. Examples of protective factors include: good nutrition; small family size; and a sense of connectedness to others.

The Third National Mental Health Plan 2003-2008 demonstrates an understanding of the importance of the role played by NGOs in further developing a population health approach. It promotes NGOs as working beyond the mental health services in providing access to support services that are essential to recovery and community participation. The NMHP recognises the high demand placed on NGOs and acknowledges that their funding base remains limited given their key role in mental health promotion and support. The Third National Mental Health Plan 2003-2008 can be accessed in full at: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/mental-pubs/$FILE/nmhp0308.pdf

Mental Health Coordinating Council