Strasbourg, 28 September 2022                                                                           CDBIO(2022)28

STEERING COMMITTEE FOR HUMAN RIGHTS

IN THE FIELDS OF BIOMEDICINE AND HEALTH (CDBIO)

Outline of draft Recommendation promoting the use of voluntary measures

in mental healthcare services

Proposal from the Bureau

on the basis of a document prepared by Dr Elaine Gadd, Consultant

Preamble

·         Recalling the ECHR and the Convention on Human Rights and Biomedicine;

·         Recalling relevant international work including the UNCRPD;

·         Having regard to the caselaw of the European Court of Human Rights on the protection of persons with mental disorders;

·         Having regard to the work of the CPT;

·         Recalling Rec(2004)10 [and draft Additional Protocol with regard to involuntary placement and treatment within mental healthcare services];

·         Emphasising key relevant principles from the Convention on Human Rights and Biomedicine including:

§  Non-discrimination

§  Consent

§  Professional standards

§  Equitable access to healthcare

·         Stressing that the use of involuntary measures should always be a last resort and therefore

·         Recommending that governments of member states implement the guidelines in this Recommendation.

Article 1 – Object

·         to promote the use of voluntary measures in mental healthcare services.

Article 2 – Scope and definitions

Scope – making clear mental healthcare services covers all environments in which persons receive mental healthcare.

Definitions – as required, based on definitions used in the draft Additional Protocol.

Article 3 – Commitment to the use of voluntary measures

·         Member states should make an explicit commitment to promote the use of voluntary measures;

·         That commitment should be affirmed at all levels of responsibility for mental healthcare services[1].

Article 4 – Leadership

·         Member states should demonstrate leadership in promoting the use of voluntary measures by ensuring national law and policy reflects this goal;

·         Those responsible for mental healthcare services should ensure that practices within the service for which they are responsible reflect this goal.[2]

Article 5 – Participation of persons with lived experience

·         Member states should promote the involvement of persons with lived experience of mental healthcare services or with relevant psychosocial disabilities in developing policies and practices that promote the use of voluntary measures.

·         Member states should ensure that the involvement of persons with lived experience of mental healthcare services or of relevant psychosocial disabilities is appropriately resourced.

Article 6 – Promotion of early access to services[3]

·         Member states should promote public understanding of prevention, recognition and treatment of mental disorders and of the benefits of early access to mental health care services.

Article 7 – Appropriate mental healthcare

·         Member states should, taking into account available resources, ensure that equitable access is provided to a range of mental healthcare services of appropriate quality that promote the use of voluntary measures.

Article 8 – Complementary services

·         Mental health care services should have appropriate links with other services that can contribute to a reduction in use of involuntary measures.[4]

Article 9 – Research

·         Member states should promote research to increase the use of voluntary measures in mental healthcare and should ensure that such research is appropriately resourced.[5]

Article 10 – Appropriate environment

·         The physical and social environment of mental health facilities should be reviewed and, taking into account available resources, if necessary adapted to minimise the potential need for involuntary measures.

Article 11 – Public understanding

·         Member states should promote public understanding of the importance of decreasing the use of involuntary measures as a matter of human rights[6].

Article 12 – Education and training

·         All staff[7] involved in mental healthcare services should have sufficient training to understand the importance of promoting autonomy and avoiding the use of involuntary measures as a matter of human rights;

·         Healthcare professionals in mental healthcare services should receive appropriate training in practices promoting autonomy.

·         Primary care healthcare professionals should receive appropriate training in early identification of mental health problems and initiation of appropriate care that promotes autonomy.

Article 13 – Delivery of care

·         Mental healthcare services should be delivered in a manner that minimises the use of involuntary measures.

·         Subject to the confidentiality of the person concerned, the potential benefits of involving the person’s social network in his or her care should be considered.[8]

·         Where appropriate, persons receiving mental health care services should be encouraged to express their preferences and wishes for care in advance of a future crisis or deterioration in mental health.

Article 14 – Review

·         The use of any involuntary measure should be reviewed locally, on the basis of appropriate documentation, to consider the need for changes to practice in order to prevent such a measure being required in the future.[9]

Article 15 – Complaints

·         Mental healthcare services should have a complaints procedure.[10] Information from such complaints that could contribute to increasing the use of voluntary measures should be made available.

Article 16 – Monitoring

·         Documentation concerning complaints and the use of involuntary measures should be made available to bodies responsible for quality assurance and monitoring[11];

·         Such bodies should be encouraged to produce reports that can contribute to the goal of increasing the use of voluntary measures.

Article 17- Accountability and reporting

·         Those at all levels of responsibility for mental healthcare services should be accountable for progress towards increasing the use of voluntary measures;

·         Reports on progress should be provided at appropriate intervals and made widely available.

[Seclusion and restraint

CDBIO may wish to consider whether this topic should be explicitly covered. It is covered extensively in the draft Protocol. In this draft Recommendation, one could consider provisions on training on decreasing the use of seclusion and restraint, on review of all instances of the use of restraint and seclusion, and on learning from such reviews and from complaints as particularly relevant. An alternative would be to refer to seclusion and restraint in the EM to the general articles on those topics.]