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Strasbourg, 6 September 2024 CDBIO(2024)7REV
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STEERING COMMITTEE FOR HUMAN RIGHTS
IN THE FIELDS OF BIOMEDICINE AND HEALTH (CDBIO)
Draft Recommendation on respect for autonomy in mental healthcare
revised taking into account the comments made orally and in writing
at the 5th CDBIO meeting (11-13 June 2024)
Draft Recommendation on respect for autonomy in mental healthcare
Preamble
The Committee of Ministers, under the terms of Article 15.b of the Statute of the Council of Europe,
Considering that the aim of the Council of Europe is to achieve a greater unity between its member States, inter alia, by promoting common standards and developing actions in the field of human rights;
Recalling the Convention for the Protection of Human Rights and Fundamental Freedoms (ETS No 005) and the Convention on Human Rights and Biomedicine (Oviedo Convention) (ETS No 164);
Recalling the Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (ETS No 126);
Recalling relevant international standards including the UN Convention on the Rights of Persons with Disabilities;
Having regard to the relevant case law of the European Court of Human Rights;
Having regard to the work of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment;
Recalling the principles of the Recommendation Rec(2004)10 of the Committee of Ministers to member States concerning the protection of the human rights and dignity of persons with mental disorder;
Building on the Compendium Report of good practices in the Council of Europe to promote voluntary measures in mental health services;
Having regard to the World Health Organization’s QualityRights Initiative;
Affirming the importance of the principles from the Oviedo Convention concerning the protection of human dignity, the primacy of the human being and non-discrimination;
Emphasising the principles of free and informed consent, of equitable access to healthcare and of professional standards set out in that Convention;
Stressing that respect for autonomy is central to upholding human dignity;
Recommends that Governments of member States:
a) demonstrate leadership in embedding respect for autonomy in mental healthcare by ensuring that the guidelines contained in this Recommendation are reflected in national law, policy and practice;
b) take appropriate measures to ensure that adequate resources are allocated to mental healthcare so that these guidelines can be realised;
c) examine, within the Committee of Ministers, the implementation of this recommendation no later than five years from its adoption, and every five years thereafter.
GUIDELINES
Chapter I – Object and scope
Article 1 – Object
This recommendation aims to ensure respect for the autonomy of persons receiving mental healthcare and to prevent the use of coercion in the provision of such care.
Article 2 – Scope
This Recommendation applies to persons receiving mental healthcare (hereafter “persons concerned”) in all settings in which the care is delivered.
Chapter II – General principles
Article 3 – General rule
1. Mental healthcare should only be provided with the free and informed consent of the person concerned or, where, according to law, the person does not have the capacity to consent, by respecting their will and preferences.
2. Any exception to the general rule laid down in paragraph 1 should be subject to strict legal safeguards respecting human dignity.
Article 4 – Access to mental healthcare
Persons with mental health problems should have equitable access to mental healthcare, including community-based care.They should have access to mental healthcare as early as possible.
Chapter III – Policies and practices
Article 5 – Guiding principles
Policies and practices should reflect the goal of ensuring respect for the autonomy of the persons concerned in mental healthcare. Responsibilities for achieving this goal should be defined at all levels.
Article 6 – Involvement of persons with lived experience
Persons with lived experience of mental healthcare should be involved individually or via representative organisations in developing laws, policies and practices relevant to mental health and in their monitoring and evaluation. Their involvement should be appropriately resourced.
Chapter IV – Mental healthcare
Article 7 – Information on and exercise of rights
Persons concerned should be individually informed of their rights in respect of mental healthcare and have access to assistance to enable them to understand and exercise such rights, including to express their will and preferences and make decisions about their care.
Article 8 – Advance care planning
Persons concerned should be encouraged to express their will and preferences for their future care and these should be documented.
Article 9 – Environment of mental healthcare facilities
The physical and social environment of mental healthcare facilities should be reviewed, and if necessary adapted, taking into account the need to respect the autonomy of the persons concerned.
Article 10 – Service networks
Mental healthcare services should have close links with other services that can contribute to the promotion and respect of autonomy of the persons concerned.
Article 11 – Family and social networks
Subject to respecting the confidentiality, privacy and autonomy of the person concerned, the potential benefits of involving the person’s family and social network in their care should be taken into account.
Article 12 – Complaints procedure
1. Persons concerned should have effective access to a complaints procedure. They should be informed of the procedure and should receive an appropriate and timely response to any complaint.
2. Information from complaints should be used to improve care in the future.
3. Such information should be made available, subject to appropriate protection of the privacy and confidentiality of the person concerned, to bodies responsible for quality assurance and monitoring.
Chapter V – Public understanding and prevention of stigma
Article 13 – Public understanding
Public understanding should be promoted in relation to:
i. the importance of respect for autonomy as a human rights principle,
ii. the prevention and care of mental health problems, and the potential for recovery, and
iii. the benefits of early access to mental healthcare.
Article 14 – Addressing stigma and discrimination
Measures should be taken to address stigma and prejudice around mental health problems, and to prevent and eliminate discrimination against persons with such problems and to promote their inclusion in society.
Chapter VI – Education and training
Article 15 – Education and training
1. All staff involved in mental healthcare and others who, in their professional capacity, come into contact with persons with mental health problems, should receive, as appropriate to their role:
- education on respect for autonomy as a human rights principle, and
- training in practices that respect the autonomy of such persons.
2. Healthcare professionals in primary care should receive appropriate training in early identification of mental health problems and initiation of appropriate care that respects autonomy.
Chapter VII – Research and sharing of good practice
Article 16 – Research
Research aiming to promote respect for autonomy in mental healthcare should be supported.
Article 17 – Sharing of good practice
Mental health care services should share good practice in order to ensure respect for autonomy in mental healthcare.
Chapter VIII – Review and monitoring
Article 18 – Review of practices
Those providing mental healthcare should regularly review their practice, with a view to ensuring respect for the autonomy of the persons concerned.
Article 19 – Monitoring
1. There should be systems for monitoring compliance with the principles set out in this recommendation.
2. The results of such monitoring should be made publicly available.