Mental disabilities and the human right to the highest attainable standard of health

Human Rights Quarterly

Volumn 28, Issue 2, 2006, Pages 332-356

  Hunt, Paul ^a,b   Mesquita, Judith ^a  

^a UNIVERSITY OF ESSEX   (United Kingdom)

^b UNIVERSITY OF WAIKATO   (New Zealand)

Author keywords

[No Author keywords available]

Indexed keywords

DISABILITY; HEALTH CARE; HEALTH POLICY; HEALTH SERVICES; HUMAN RIGHTS; MENTAL HEALTH; UNITED NATIONS;

EID: 33745053200     PISSN: 02750392     EISSN: None     Source Type: Journal    
DOI: 10.1353/hrq.2006.0019     Document Type: Article

References (141)

1. For convenience, throughout this article, we use the shorthand right to health or right to the highest attainable standard of health to refer to the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. World Health Organization (WHO), The World Health Report 2001: Mental Health: New Understanding, New Hope 1 (2001) [hereinafter World Health Report 2001].
3. Id. at 19.
4. Id. at x.
5. Id. at 3.
6. Id.
7. Id.
8. WHO, WHO Resource Book on Mental Health, Human Rights and Legislation 1 (2005).
9. See, e.g., European Committee for the Prevention of Torture and Inhuman or Degrading Treatment (CPT), The CPT Standards: "Substantive" Sections of the CPT's General Reports 55 (2004), Doc. No. CPT/Inf/E (2002) 1-Rev. 2004.
10. See Mental Disability Rights International (MDRI) & Asociación Pro Derechos Humanos, Human Rights and Mental Health in Peru 12-14 (2004);
11. Mental Disability Advocacy Centre, Cage Beds: Inhuman and Degrading Treatment in Four EU Accession Countries (2003);
12. Amnesty International, Romania: Memorandum to the Government Concerning Inpatient Psychiatric Treatment (2004).
13. Karin Raye, Mental Disability Rights Int'l, Violence, Women and Mental Disability (1999).
14. See, e.g., Lawrence Gostin & Lance Gable, The Human Rights of Persons with Mental Disabilities: A Global Perspective on the Application of Human Rights Principles to Mental Health, 63 Md. L. Rev. 20, 98 (2004);
15. Claire Breen, The Right to Education of Persons with Disabilities: Disabled in Interpretation and Application, 21 Netherlands Q. Hum. Rts. 7 (2003);
16. Purohit and Moore v. Gambia, African Comm'n. on Hum. and Peoples' Rts., Comm. No. 241/2001 (2003);
17. European Committee of Social Rights, Autism-Europe v. France, Complaint No. 13/2002, Decision on the Merits transmitted to the Committee of Ministers on 22 May 2003.
18. Montreal Declaration on Intellectual Disability, adopted 6 Oct. 2004 (Pan-American Health Organization/World Health Organization Conference on Intellectual Disability), available at http://www.aamr.org/pdf/ DeclarationMTL.pdf [hereinafter Montreal Declaration].
19. See, e.g., Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, U.N. ESCOR, Comm'n on Hum. Rts., 61 st Sess., Agenda Item 10, U.N. Doc. E/CN.4/2005/51 (2005) [hereinafter Report of the Special Rapporteur 2005];
20. Report of the Special Rapporteur on The Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, U.N. ESCOR, Comm'n on Hum. Rts., 60th Sess. U.N. Doc. E/CN.4/ 2004/49 (2004).
21. The Right to the Highest Attainable Standard of Health, General Comment No. 14, U.N. ESCOR, Comm. On Econ., Soc. & Cult. Rts., 22nd Sess., U.N. Doc. E/C.12/2000/4 (2000) [hereinafter General Comment No. 14].
22. See WHO, International Classification of Functioning, Disability and Health (ICF) (2001).
23. Id.
24. See Gerard Quinn & Theresia Degener, Human Rights and Disability, the Current Use and Future Potential of Human Rights Instruments in the Context of Disability (2002) (U.N. Doc. HR/PUB/02/1).
25. Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (MI Principles), G.A. Res. 46/119, U.N. GAOR, U.N. Doc A/RES/46/119 (1991).
26. See id princ. 7(1);
27. see also Eric Rosenthal & Leonard Rubenstein, International Human Rights Advocacy under the Principles for the Protection of Persons with Mental Illness, 16 Int'l J. L. & Psychiatry 257 (1993).
28. See Standard Rules for the Equalization of Opportunities for Persons with Disabilities, G.A. Res. 48/96, R. 14(2), U.N. GAOR, 85th plen. mtg., U.N. Doc A/Res/48/96 (1993) [hereinafter Standard Rules].
29. Montreal Declaration, supra note 13.
30. A recent and welcome contribution to the literature is The Human Rights of Persons with Intellectual Disabilities: Different but Equal (Stanley S. Herr, Lawrence O. Gostin, & Harold Hongju Koh eds., 2003).
31. Adopted respectively by: World Programme of Action Concerning Disabled Persons, G.A. Res. 37/51, adopted 3 Dec. 1982, U.N. GAOR, 37th Sess., Supp. No. 51, U.N. Doc. A/37/51 (1982) [hereinafter World Programme of Action Concerning Disabled Persons]; Declaration of Caracas on the Restructuring of Psychiatric Care in Latin America (Regional Conference on the Restructuring of Psychiatric Care in Latin America, convened by PAHO/WHO, 11-14 Nov. 1990) [hereinafter Declaration of Caracas];
32. EUR. Parl. Ass. 10th Sitting, Rec. No. 1235 (12 Apr. 1994);
33. Comm. Of Ministers, 896th Meeting, Rec. No (2004) 10 (22 Sept. 2004).
34. See, e.g., World Network of Users and Survivors of Psychiatry, Position Paper on the Principles for the Protection of Persons with Mental Illness, available at www.wnusp.org/wnusp%20evas/Dokumenter/ positionpaper.html.
35. See Draft Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, Working Group (New York, 5-26 Jan. 2004), U.N. Doc. A/AC.265/2004/WG.1 (2004).
36. Progress of Efforts to Ensure the Full Recognition and Enjoyment of the Human Rights of Persons with Disabilities: Report of the Secretary General, U.N. GAOR, 58th Sess., Agenda Item 119(b), ¶ 43, 24, U.N. Doc. A/58/181 (2003).
37. Persons with Disabilities, General Comment No. 5, U.N. ESCOR, Comm. on Econ., Soc. & Cult. Rts., 11th Sess., ¶ ¶ 7(b), 34, U.N. Doc. E/C.12/ 1994/13 (1994) [hereinafter General Comment No. 5].
38. For a fuller discussion of the European Court's jurisprudence see, among others, Gostin & Gable, supra note 12;
39. O. Lewis, Protecting the Rights of People with Mental Disabilities: The European Court of Human Rights, 9 Eur. J. Health L. 293 (2002).
40. For an overview of the approaches of the European Court and the Inter-American Commission, see Lawrence O. Gostin, International Human Rights Law and Mental Disability, Hastings Center Rep., Mar.-Apr. 2004, at 11, 12.
41. Aerts v. Belgium, App. No. 25357/94, Eur. Ct. H.R. (1998), ¶ 46. The Court held that there must be some relationship between the ground of permitted deprivation of liberty relied on and the place and conditions of detention. In principle, the "detention" of a person as a mental health patient will only be "lawful" for the purposes of subparagraph (e) of paragraph 1 if effected in a hospital, clinic or other appropriate institution.
42. Keenan v. United Kingdom, App. No. 27229/95, Eur. Ct. H.R. (2001).
43. Varbanov v. Bulgaria, App. No. 31365/96, Eur. Ct. H.R. (2000).
44. Rosario Congo v. Ecuador, Case No. 11.427, Inter-Am. C.H.R., Report No. 63/99, OEA/Ser.L/V/II.102, doc. 6 rev. (1998).
45. Id.
46. See also American Convention on Human Rights, signed 22 Nov. 1969, O.A.S.T.S. No. 36, O.A.S. Off. Rec. OEA/Ser.L/V/II.23, doc. 21, rev. 6 (1979) (entered into force 18 July 1978), reprinted in 9 I.L.M. 673 (1970).
47. Mental Disability Rights International, Historic Settlement Reached to Deinstitutionalize Mental Health System in Paraguay, available at www.mdri.org
48. Purohit and Moore v. Gambia, supra note 12.
49. International Covenant on Economic, Social and Cultural Rights [hereinafter ICESCR], adopted 19 Dec. 1966, G.A. Res. 2200 (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, art. 12, U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3 (entered into force 3 Jan. 1976).
50. Convention on the Rights of the Child, adopted 20 Nov. 1989, G.A. Res. 44/25, U.N. GAOR, 44th Sess., Supp. No. 49, art. 24, U.N. Doc. A/44/49 (1989) (entered into force 2 Sept. 1990), reprinted in 28 I.L.M. 1448 (1989);
51. Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights, Protocol of San Salvador, adopted 17 Nov. 1988, General Assembly of the Organization of American States, art. 10;
52. African Charter on Human and Peoples' Rights, adopted 27 June 1981, O.A.U. Doc. CAB/LEG/67/3 Rev. 5 (entered into force 21 Oct. 1986), reprinted in 21 I.L.M. 58 (1982). For national constitutional protections of the right to health,
53. see Eleanor Kinney & Brian A. Clark, Provisions for Health and Health Care in the Constitutions of the Countries of the World, 37 Cornell Int'l L.J. 285 (2004).
54. See Paul Hunt, Reclaiming Social Rights (1996);
55. Health and Human Rights: A Reader (Jonathan M. Mann et al. eds., 1999).
56. Women and Health, General Comment No. 24, U.N. ESCOR, Comm. for Elim. of Discrim. against Women, 20th Sess., U.N. Doc. A/54/38/Rev. 1 (1999);
57. General Comment No. 14, supra note 15;
58. The Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, adopted 22 Apr. 2002, U.N. ESCOR, Comm'n on Hum. Rts., U.N. Doc. E/CN.4/RES/2002/31 (2002);
59. HIV/AIDS and the Rights of the Child, General Comment No. 3, U.N. ESCOR, Comm. on Rts. of the Child, 32nd Sess., U.N. Doc. CRC/GC/2003/3 (2003);
60. Adolescent Health and Development in the Context of the Convention on the Rights of the Child, General Comment No. 4, U.N. ESCOR, Comm. on Rts. of the Child, 33rd Sess., U.N. Doc. CRC/GC/2003/4 (2003) [hereinafter General Comment No. 4].
61. ICESCR, supra note 37, art. 2 (1).
62. General Comment No. 14, supra note 15, ¶ 8.
63. WHO, World Health Report 2001, supra note 2, at 112-15.
64. For an approach to right to health indicators and benchmarks, see Interim Report of the Special Rapporteur of the Commission on Human Rights on the Right of Everyone to Enjoy the Highest Attainable Standard of Physical and Mental Health, U.N. GAOR, 58th Sess., Agenda Item 117(c), U.N. Doc. No. A/58/427 (2003);
65. Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health [hereinafter Report of the Special Rapporteur 2004], U.N. GAOR, 59th Sess., Agenda Item 105(b), U.N. Doc. No. A/59/422 (2004).
66. See infra § II.B.4(f).
67. See Report of the Special Rapporteur 2005, supra note 14, ¶ 88.
68. See also MI Principles, supra note 19, princ. 11.
69. See also U.N. Doc. No. A/58/181, supra note 27, ¶ ¶ 34-42.
70. See European Convention for the Protection of Human Rights and Fundamental Freedoms, art. 50(1)(e), opened for signature 4 Nov. 1950, 213 U.N.T.S. 221, Europ. T.S. No. 5 (entered into force 3 Sept. 1953);
71. MI Principles, supra note 19, princ. 16.
72. MI Principles, supra note 19, princs. 3, 7(1).
73. See generally Winterwerp v. The Netherlands, App. No. 6301/73, Eur. Ct. H.R. (1979);
74. E. v. Norway, App. No. 11701/85, Eur. Ct. H.R. (1990);
75. Gostin & Gable, supra note 12;
76. Lawrence O. Gostin, Human Rights of Persons with Mental Disabilities: The European Convention of Human Rights, 23 Int'l J.L. & Psychiatry 125 (2000);
77. Lewis, supra note 29.
78. Varbanov v. Bulgaria, supra note 32, ¶ ¶ 47-53;
79. Purohit and Moore v. Gambia, supra note 12, ¶ ¶ 30, 45, 85;
80. Congo v. Ecuador, supra note 33, ¶ ¶ 55-59.
81. Standard Rules, supra note 21, R. 2-4.
82. Id. R. 2, ¶ 3.
83. See Declaration on the Rights of Disabled Persons, adopted 9 Dec. 1975, G.A. Res. 3447 (XXX), 30 U.N. GAOR Supp. (No. 34) at 88, ¶ 6, U.N. Doc A/10034 (1975);
84. World Programme of Action Concerning Disabled Persons, supra note 24, ¶ ¶ 95-107.
85. Standard Rules, supra note 21, R. 3.
86. Comm. on Econ., Soc. & Cult. Rts., General Comment 5, supra note 28, ¶ 34.
87. General Comment No. 14, supra note 15, ¶ 4.
88. Id. ¶ 12.
89. WHO, Improving Access and Use of Psychotropic Medicines (2004).
90. Declaration of Caracas, supra note 24.
91. Inter-American Convention on the Elimination of All Forms of Discrimination Against Persons with Disabilities, adopted 7 June 1999, OAS Doc. AG/Res. 1608 (1999).
92. MI Principles, supra note 19, princs. 3, 7(1), 7(2).
93. WHO, World Health Report 2001, supra note 2, at 89-91.
94. Report of the Special Rapporteur of the Commission for Social Development on Monitoring the Implementation of the Standard Rules on the Equalization of Opportunities for Persons with Mental Disabilities on his Third Mandate, 2000-2002, U.N. ESCOR, Comm'n for Soc. Dev., 40th Sess., Agenda Item 3(b), ¶ 28, U.N. Doc. E/CN.5/2002/4 (2002) [hereinafter Report of the Special Rapporteur of the Commission for Social Development].
95. Marcia Rioux, On Second Thought, in Human Rights of Persons with Intellectual Disabilities, supra note 23, at 287.
96. Report of the Special Rapporteur of the Commission for Social Development, supra note 63, ¶ 30.
97. MI Principles, supra note 19, princ. 7(3).
98. General Comment No. 14, supra note 15, ¶ 33.
99. Congo v. Ecuador, supra note 33, ¶ ¶ 82, 84.
100. ICESCR, supra note 37, art. 2, ¶ 1;
101. General Comment No. 14, supra note 15, ¶ 36.
102. WHO, Mental Health Policy, Plains and Programmes (2004).
103. See WHO, WHO Resource Book on Mental Health, Human Rights and Legislation, supra note 8.
104. General Comment No. 14, supra note 15, ¶ 36;
105. Standard Rules, supra note 21, R.5(b);
106. MI Principles, supra note 19, princ. 12.
107. See General Comment No. 14, supra note 15, ¶ ¶ 18-21.
108. Comm. on Econ., Soc. & Cult. Rts., General Comment 5, supra note 28, ¶ 15;
109. Purohit and Moore v. Gambia, supra note 12, ¶ 30.
110. General Comment No. 14, supra note 15, ¶ 44(d).
111. General Comment No. 5, supra note 28, ¶ 34;
112. Purohit and Moore v. Gambia, supra note 12, ¶ 81.
113. General Comment No. 4, supra note 40, ¶ 22.
114. Id. ¶ 35(c);
115. Standard Rules, supra note 21, R. 9(2).
116. General Comment No. 14, supra note 15, ¶ 19.
117. Id. ¶ 11.
118. supra note 21, R. 14, 18;
119. Montreal Declaration, supra note 13, ¶ 6.
120. Standard Rules, supra note 21, R. 14(2), 18;
121. Montreal Declaration, supra note 13, ¶ 9(d).
122. WHO, Mental Health Policy and Service Guidance Package: Advocacy for Mental Health 5 (2003).
123. See Report of the Special Rapporteur 2004, supra note 44, ¶ ¶ 32-35, 42-46;
124. Standard Rules, supra note 21, R. 21, 22 (on International Cooperation).
125. General Comment No. 14, supra note 15, ¶ ¶ 38-45.
126. See, e.g., MDRI, Not on the Agenda: Human Rights of People with Mental Disabilities in Kosovo (2002).
127. Eric Rosenthal et al., Implementing the Right to Community Integration for Children with Disabilities in Russia: A Human Rights Framework for International Action, 4 Health & Hum. Rts.: Int'l J. 83 (1999).
128. See, e.g., National Council on Disability, Foreign Policy and Disability (2003).
129. See Consolidated Appropriations Act, H.R. 4818, 108th Cong. §579(d) (2005).
130. WHO has also recently published many useful resources. See, e.g., WHO, supra note 8;
131. Eric Rosenthal & Clarence J. Sundram, The Role of International Human Rights in National Mental Health Legislation (2004).
132. For some comments on accountability, see Report of the Special Rapporteur 2004, supra note 44, ¶ ¶ 36-46.
133. MI Principles, supra note 19, princ. 22.
134. Id. princ. 17.
135. Id. princs. 11, 18.
136. Principles Relating to the Status of National Institutions, adopted 20 Dec. 1993, G.A. Res. 48/134, U.N. GAOR, 48th Sess., annex, U.N. Doc A/48/ 49 (1993) (Paris Principles).
137. See Quinn & Degener, supra note 18.
138. Id. at 1.
139. See, e.g., Human Rights of Persons with Disabilities, Res. 2000/51, adopted 25 Apr. 2000, U.N. ESCOR, Comm'n on Hum. Rts., ¶ 11, U.N. Doc. E/CN.4/Res/2000/51 (2000).
140. Id.;
141. Quinn & Degener, supra note 18, at 4-5.