[DRAFT] Standards For Persons With Mental Illness

[Walfo]

Part 1 of 2 for Mental Health legislation, part 2 is here. Feel free to comment and help this proposal go through the drafting process. Thank you!

Standards For The Mentally Ill

Category: Civil Rights

Strength: Significant

Proposed by: Walfo

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The World Assembly,

Ashamed of the way mentally ill persons are treated,

Aware of the importance for mentally ill people to receive care to move toward personal autonomy,

Seeking to create a standard for the treatment and rights of mentally ill people,

Hereby,

1. For the purposes of this resolution defines:

1. "mental health care" as the analysis and diagnosis of a person's mental condition, and treatment, care and rehabilitation for a mental illness or suspected mental illness,
2. "health practitioner" as a doctor, psychologist, nurse, social worker, or another appropriately trained and qualified person with specific skills relevant to mental health care,
3. "patient" as a person receiving mental healthcare, and all persons who are admitted to a mental health facility,
4. "personal representative" as a person that is charged with the duty of representing the patient’s interests which include a parent or legal guardian for a minor;

2. Requires that:

1. all persons have the right to the best available mental health care, which is to be part of a nations health and social care system,
2. all persons with mental illness, or being treated like one, is to be treated with humanity and respect for the inherent dignity of a human being,
3. all persons with a mental illness, or who are being treated as such persons, have the right to protection from economic, sexual, and other forms of exploitation, physical or other abuse, and degrading treatment,
4. all persons with a mental illness has the right to exercise all civil, political, economic, social, and cultural rights recognized in their nation,
5. when a court finds that a person with mental illness is unable to manage his or her own affairs, measures are taken, to ensure the protection of his or her interests;

3. Additionally requires that:

1. all persons with mental illness have the right to live and work in their communities unless deemed unfit,
2. every patient is to have the right treatment suited to their cultural background,
3. every patient has the right to receive health and social care to their health needs in accordance with the same standards as other ill persons;

4. Demands that:

1. every patient shall have the right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to the patient's health needs and to protect the physical safety of others,
2. the treatment and care of every patient shall be based on an individually prescribed plan, that is discussed with the patient and reviewed and revised regularly by a health practitioner,
3. the treatment of every patient shall be directed towards preserving and enhancing personal autonomy,
4. health practitioners only administer medication that has been demonstrated to be efficient and never as a punishment or for the convenience of others,
5. medications prescribed by a health practitioner are to be recorded in that patient’s records;

5. Additionally demands that:

1. patients cannot receive treatment without their informed consent, except if an independent authority is satisfied that the treatment is in the best interest of the patient, the patient lacks the capacity to give consent, or if the treatment is done to prevent immediate or imminent harm to the patient or another person,
2. a patient may request the presence of a person or persons of the patient's choosing during the procedure for granting consent,
3. a patient has the right to refuse or stop treatment, except for if the exceptions in 5a. The consequences of refusing or stopping treatment must be explained to the patient,
4. sterilization is never carried out as a treatment for mental illness,
5. clinical trials and experimental treatment are to never be carried out on any patient without informed consent.

Draft I

[Walfo]

Future drafts will be placed here:

[Xanthorrhoea]

IC: The people of Xanthorrhoea can only assume that such a hastily written proposal could only be written by a person to whom clause 1c applies. In it's current state, we heartily oppose this legislation, as it would cripple the abilities of our fine health system to effectively treat our citizens.

OOC: There are a lot of loophholes and unintended consequences here.

First of all, calling someone a "mentally ill person" in the title/preamble is a bit insensitive. Mental illness is something you have, not something you are. Use the phrasing you use in the rest of the proposal and say "persons with mental illness."

Second, in 1d you've defined a "personal representative," but never used the term again. Either drop the definition, or include it where you meant to put it (Clause 5?).

2. Requires that: [...]
d. all persons with a mental illness has the right to exercise all civil, political, economic, social, and cultural rights recognized in their nation,

ALL rights? Um, no, not in a million years. The way this is written, a person in acute psychosis has the right to vote, to freedom of movement, refuse treatment, have guns (if that's a right in your country) etc. Some conditions, whether temporarily or permanently, impair your ability to interact with society. If you are acutely psychotic and think your neighbour is the devil, you shouldn't be voting, and you shouldn't have a gun. Same goes for dementia and driving, financial independencec etc. I get the intent, but this is a disaster of a clause. Might I suggest adding caveats for treatment/safety/reasonableness to this clause. At the moment this clause effectively forbids any and all involuntary treatments.

when a court finds that a person with mental illness is unable to manage his or her own affairs, measures are taken, to ensure the protection of his or her interests

Well intentioned, but what about cases of acute psychosis/suicidality/homicidality? You don't have time for a court order, that person is going to go home and kill themselves/their reputation/someone else long before their case goes near a courtroom. I'd suggest including specific clauses addressing involuntary patients that take into acccount the realities of managing them. Also, what "measures" should be taken? Measures is too vague for my taste. Might be a good spot to make use of that "personal representative" definition from earlier...

all persons with mental illness have the right to live and work in their communities unless deemed unfit

What's to stop the authorities from declaring that anyone with a mental illness is automatically "unfit"? Maybe change it to something about "unless this prevents effective treatment/is unsafe etc" instead.

the treatment of every patient shall be directed towards preserving and enhancing personal autonomy

I would suggest that the treatment of every patient should be directed towards managing their mental illness. Maximising autonomy is great, but only within the limits of reasonableness (see the above dementia example). This basiccally seems like a re-tread of clause 4a, but singling out autonomy. I would suggest similar caveats for appropriateness/safety to the ones you have there. While I'm on it, "physical safety" in 4a seems needlessly restrictive. Emotional/mental/cultural safety is also important, drop the "physical," and just say "safety". Considering the patient's safety as well as other's safety might be nice too.

health practitioners only administer medication that has been demonstrated to be efficient and never as a punishment or for the convenience of others

Do you mean "effective" here instead of "efficient"? Seems an odd way to phrase things. Also, "never as punishment" = great! "or for the convenienec of others" = less great. While dosing someone up with midazolam so they lie in bed and don't ccause trouble should rightly be outlawed, convenience can occcur alongside legitimate reasons. I personally would find it convenient as an inpatient if my neighbour wasn't wandering into my room, or hitting me/staff. Pharmacological restraint (and physical restraint) should always be a last resort, but they need to be available if needed. I feel that stating "only for the convenience..." would help with this and not harm the intended effect of the clause.

medications prescribed by a health practitioner are to be recorded in that patient’s records

"...prescribed and administered by..." Prescription =/= giving meds, and what's actually given matters more.

patients cannot receive treatment without their informed consent, except if an independent authority is satisfied that the treatment is in the best interest of the patient, the patient lacks the capacity to give consent, or if the treatment is done to prevent immediate or imminent harm to the patient or another person,

I agree with the sentiment, but I'd argue you should drop the "best interests" section. People have the right to make bad decisions, unless they lack the capacity to make those decisions. This contradicts thhe principle of autonamy you set up in clause 4c. If they have capacity, they have the right to make decisions against their own interest. And before anyone says it, a suicidal person does not have capacity to decide to die. That's not a loophole this would open up.

a patient may request the presence of a person or persons of the patient's choosing during the procedure for granting consent

A patient may request a block of chocolate. It doesn't mean they'll get it. Maybe add on something like "... and all reasonable efforts must be made to accomodate this request" This might also be another spot to make use of your "personal representative."



Sorry if I sound a bit harsh. Overall, there are good bones here, and apart from what I noted above and some phrasing/language consistency issues, I think this has the makings of a great proposal. Mental illness is poorly treated and stigmatised the world over IRL. Having some protections for people living with it in NS is certainly a noble cause.

[Imperium Anglorum]

See Patients Rights Act and Institutional Psychiatry Act.

[Walfo]

See Patients Rights Act and Institutional Psychiatry Act.

Seen! Somebody is drafting a repeal for the IPA, so this would replace it. Working on edits now from above.

[Abacathea]

The World Assembly,

Ashamed of the way mentally ill persons are treated,

I'd reword this or strike it entirely, it's a blanket statement that doesn't recognize how well some persons are treated in nations. Unless that is what you're ashamed of?

Aware of the importance for mentally ill people to receive care to move toward personal autonomy,

I'm not sure I agree with this or at least that it is the case with all persons suffering from Mental Health issues

Hereby,

1. For the purposes of this resolution defines:

1. "mental health care" as the analysis and diagnosis of a person's mental condition, and treatment, care and rehabilitation for a mental illness or suspected mental illness,
2. "health practitioner" as a doctor, psychologist, nurse, social worker, or another appropriately trained and qualified person with specific skills relevant to mental health care,
3. "patient" as a person receiving mental healthcare, and all persons who are admitted to a mental health facility,
4. "personal representative" as a person that is charged with the duty of representing the patient’s interests which include a parent or legal guardian for a minor;

No issues with these definitions, they appear pretty comprehensive.

all persons with mental illness, or being treated like one, is to be treated with humanity and respect for the inherent dignity of a human being,

or being treated like one, doesn't make sense to me, I think you're intending something there, but it's not coming across. Additionally, human centric, won't fly with the Pythons and Bears of this Assembly.

all persons with a mental illness, or who are being treated as such persons, have the right to protection from economic, sexual, and other forms of exploitation, physical or other abuse, and degrading treatment,

Without going looking indepth, I sense there's already legislation that governs this without making a distinction of mental health or otherwise.

all persons with a mental illness has the right to exercise all civil, political, economic, social, and cultural rights recognized in their nation,

Have instead of has the right.

when a court finds that a person with mental illness is unable to manage his or her own affairs, measures are taken, to ensure the protection of his or her interests;[/list]

This feels.... awkwardly thrown in, like an afterthought, I'm not fond of the wording, "measures are taken" feels generic and broad

persons with mental illness have the right to live and work in their communities unless deemed unfit,
every patient is to have the right treatment suited to their cultural background,
every patient has the right to receive health and social care to their health needs in accordance with the same standards as other ill persons;

As I read this I formed my position overall, and I'll address it in my conclusion. I do take exception to the cultural background though because that might not necessarily BE the right treatment and enforcing this legislation could be mandating that doctors also have an extensive cultural knowledge in addition to medical knowledge

I'm not going to lie, I stopped critiquing any further by the time I got to the demands and mandates. By the end of reading this, I was actually a bit fatigued of the same thought constantly popping up in my head, any developed nation that cares remotely about Mental Health and in the case of some of your requirements general medical health would already be complying with these requirements.

I think a lot of this is well intended, but while I can see a rational and a purpose it also seems to me that some of it was included because it sounds or feels the right thing to have included. The wording by and large seems clunky to me, forced at times even. There are some human-centric issues that I think are prevalent throughout. Needs a lot more refining I think.

[Bears Armed]

when a court finds that a person with mental illness is unable to manage his or her own affairs, measures are taken, to ensure the protection of his or her interests;

See G.A. Res.#299 'Legal Competence', especially clause 3: This point is already covered.