Sat, Jun 24, 2017

White Paper on the protection of the human rights and dignity of people suffering from mental disorder

Helsinki, October 31, 2000

To:Secretariat of the Council of Europe
Steering Committee on Bioethics (CDBI)
67075 Strassbourg / cedex
France

Email: carlos.desola@coe.int

Ref.: Remarks and suggestions to the "White Paper" on the protection of the human rights and dignity of people suffering from mental disorder, especially those placed as involuntary patients in a psychiatric establishment

Dear Sir,

The European Federation of Professional Psychologists Associations (EFPPA) is formed by 31 European Member Associations representing 130.000 psychologists. At least fifty percent of these professionals are fully dedicated to the diagnostic, treatment and reinsertion of persons suffering mental health problems.

We consider the Council of Europe initiative to draw up rules for its member states with the aim of protecting the human rights of mental patients to be extremely positive, especially with respect to its contents, which not only include the situation of those placed involuntarily but also deal specifically with that of people treated involuntarily.

Nevertheless, EFPPA highly regrets that the Steering Committee or whomever might have been responsible for co-ordinating the project and its contents never required the opinion of our Organisation or the opinion and expertise of psychologists.

In some European Countries there exists adequate legislation regulating involuntary admissions (though in practice it is frequently not respected), but there are no such regulations or norms on involuntary treatment, and it is this fact that lends great relevance and importance to the Council of Europe's initiative.

We acknowledged the existence of the "White Papers" informally and extremely late. For that reason we only have had the time to analyse and respond to the first seven points of the aforementioned document.

POINT 1. EXTENT OF THE APPLICATION OF THE NEW LEGAL INSTRUMENT

The three proposals are appropriate, especially the first, inasmuch as it appears to introduce the idea of involuntary outpatient treatment, which we consider necessary and pertinent, though this idea is not made sufficiently explicit in Point 6 (Specific considerations on involuntary treatment).

 

POINT 3. CRITERIA FOR INVOLUNTARY ADMISSION TO PSYCHIATRIC INSTITUTIONS AND FOR INVOLUNTARY TREATMENT

In the second paragraph it should be specified more clearly that involuntary admission, as a health measure aimed at improving the patientâ??s mental disorder, is not exempt from the need for informed consent, nor from the need to provide information that must apply to any therapeutic intervention.

The distinction between involuntary admission and treatment is correct, as are the criteria to be fulfilled before either takes place.

In Section (b) it would appear more appropriate to use the concept of risk than that of danger, given the negative connotations of associating danger with mental illness.

POINT 4. PROCEDURES FOR MAKING A DECISION ON INVOLUNTARY ADMISSION AND INVOLUNTARY TREATMENT

In Section 2 it is stated that: "The Working Group expressed its opinion that it was necessary for the patient to be examined by a psychiatrist or medical doctor with the requisite experience and competence before making a decision on the need for and/or extension of involuntary admission and/or treatment".

In this section we propose the exclusion of the possibility that any medical doctor â??with the requisite experience and competenceâ? may decide on the need for and/or extension of involuntary admission and/or treatment, given the difficulties involved in demonstrating and verifying both experience and competence. In our opinion, both the assessment of the patient and the decision about such measures should be the responsibility of specialised professionals in the field of mental health (psychiatrists and clinical psychologists).

In Section 3, the most appropriate â??pertinent and independent authorityâ? would appear to be that of the judicial authorities, as is usually the case in European legislation. In a democratic society, the judge is the maximum guarantor of freedom, an essential right in all situations of involuntary admission.

POINT 5. PROCEDURES FOR INVOLUNTARY ADMISSION AND TREATMENT IN CASES OF EMERGENCY

Section 2 should include more specific details of the procedure by which the â??pertinent authorityâ? proceeds to give the appropriate authorisation for involuntary admission and/or treatment and of the control mechanisms involved. The details proposed in the legislation of many European countries on involuntary admission could be employed.

POINT 6. SPECIFIC CONSIDERATIONS ON INVOLUNTARY TREATMENT

All appear adequate. Mention should perhaps be made of involuntary outpatient treatment.

POINT 7. SPECIAL TREATMENTS

The Working Group supports electroconvulsive therapy as long as it is administered with anaesthetics and muscle relaxants, and points out that it can be applied in certain circumstances in the absence of the patientâ??s consent or against his or her will. In these cases it should be indicated who will give consent and/or added that the decision to administer treatment should be confirmed by a committee such as that proposed for the case of psychosurgery. This procedure introduces more objective criteria in decision-making and offers better guarantees and security for mental patients subjected to this type of treatment.

In general, the Federation believes that the approach of this document is based on an excessively medical perspective with regard to the professionals that are considered appropriate for assessing, evaluating and treating both involuntary admission and treatment, with clinical psychologists being excluded from such functions. This approach represents a step backwards with respect to the existing legislation in some European countries, and would have negative implications for patients treated by clinical psychologists in the public Mental Health Service context.

On behalf of the Executive Council of the EFPPA

Tuomo Tikkanen

President, EFPPA

European Federation of Professional Psychologists' Associations