[Draft] Psychiatric Care Act

[Morover]

A continuation of the old version, which Jedinsto handed over to me, and intended to be the followup to my repeal of GAR#140, Institutional Psychiatry Act.

The World Assembly,

Recognizing the fundamental rights to treatment and care that people with mental illness possess, and the high quality needed in order to administer this care effectively,

And believing that these rights ought to be upheld by the World Assembly,

Enacts the following provisions into law:

1. Gender identity, sexual orientation, political alignment, political beliefs, or any other reductive or arbitrary characteristics shall not be considered mental illness, nor shall any individual possessing these qualities be diagnosed with a mental illness on the basis of these characteristics.
2. Individuals with mental illness may not be persecuted on the basis of them having said mental illness.
3. Individuals with mental illness shall not be denied access to qualified and appropriate psychiatric care, and any care that they receive shall be free of abuse and exploitation.
4. Those with mental illness may refuse all care and treatment including but not limited to confinement to a mental health facility, unless they pose a direct and imminent threat to themselves or others.
5. The following rights are guaranteed to patients in mental health facilities, and shall be upheld in all member-states:
   
   1. Uncensored communication (and uncensored receiving of communication) from within mental health facilities so long as all recipients (including the patient) agree to be contacted.
   2. Uncensored and daily allowance of visitation, as long as;
      
      1. The visitor(s) are not determined to pose an immediate threat to the safety of the patient,
      2. The patient being visited is not determined to pose an immediate threat to the safety of the visitor(s), and
      3. The patient and visitor(s) both freely consent to the visit.
   3. Patients may have their visits monitored by appropriately equipped facility staff at the patient's request or their visitor's request.
   4. Patients released from the mental health facility as soon as it is safe to do so for the patient as well as society, and with the patient consenting. Proper psychiatric help will continue to be offered so long as the former patient still requests or requires.
   5. Provisions and rights guaranteed within this clause do not necessarily apply to individuals charged with criminal offenses.
6. All feasible steps to ensure an enjoyable and pleasant atmosphere, including a diversity of activities for both leisure and personal enrichment for all patients, will be taken within all mental health facilities.
7. Patients are not permitted to be transferred outside of the jurisdiction of the World Assembly for the purposes of bypassing this resolution.

Co-author: Jedinsto

[Apatosaurus]

Edit time! ^-^

The World Assembly,

Recognizing the fundamental rights to treatment and care that people with mental illness possess, and the high quality needed in order to administer this care effectively,

And believing that these rights ought to be upheld by the World Assembly,

The following provisions are enacted into World Assembly law: Hereby enacts the following. // "The World Assembly, recognising stuff and believing other stuff, the following provisions are enacted into World Assembly law" is incredibly poor grammar.

1. Individuals shall not be considered to be mentally ill based on their gender Gender identity (or a lack thereof), sexual orientation Might as well put (or a lack thereof) here too, though maybe not since it may be redundant, political alignment, political beliefs, and or any other reductive or arbitrary characteristics What is "reductive or arbitrary"? shall not be considered mental illness.
2. Individuals with mental illness may not be persecuted on the basis of them having said mental illness.
3. Individuals with mental illness shall not be denied access to qualified and appropriate psychiatric care, and any care that they receive shall be free of abuse and exploitation.
4. Those with mental illness may refuse all care and treatment including but not limited to confinement to a mental health facility, unless they pose a direct and imminent threat to the life, health, safety or property of themselves or others.
5. The following rights are guaranteed to patients in mental health facilities, and shall be upheld in all member-states:
   
   1. Uncensored communication (and uncensored receiving of communication) from within mental health facilities so long as all recipients (including the patient) agree to be contacted.
   2. Uncensored and daily allowance of visitation, as long as;
      
      1. The visitor(s) are not determined to pose an immediate threat to the safety of the patient,
      2. The patient being visited is not determined to pose an immediate threat to the safety of the visitor(s), and
      3. The patient and visitor(s) both freely consent to the visit.
   3. Patients may have their visits monitored by appropriately equipped facility staff at the patient's request or a their visitor's request.
   4. BeingPatients shall be released from the mental health facility as soon as it is safe to do so for the patient as well as society, and with the patient consenting. Proper psychiatric help will continue to be offered so long as the former patient still requests or requires.
   5. Provisions and rights guaranteed within this clause do not necessarily apply to individuals charged with criminal offenses.
6. All feasible steps to ensure a reasonably enjoyable "reasonably" is not a standard. What a conservative nation thinks is "reasonably enjoyable" will be different to what a libertarian nation thinks is. atmosphere, including a diversity of activities for both leisure and personal enrichment for all patients, will be taken within all mental health facilities.
7. Patients are not permitted to be transferred outside of the jurisdiction of the World Assembly for the purposes of bypassing this resolution.

Co-author: Jedinsto I'm fairly sure you can't credit CTE authors anymore? Since Jedinsto is CTE now

[Morover]

Edit time! ^-^

The World Assembly,

Recognizing the fundamental rights to treatment and care that people with mental illness possess, and the high quality needed in order to administer this care effectively,

And believing that these rights ought to be upheld by the World Assembly,

The following provisions are enacted into World Assembly law: Hereby enacts the following. // "The World Assembly, recognising stuff and believing other stuff, the following provisions are enacted into World Assembly law" is incredibly poor grammar.

1. Individuals shall not be considered to be mentally ill based on their gender Gender identity (or a lack thereof), sexual orientation Might as well put (or a lack thereof) here too, though maybe not since it may be redundant, political alignment, political beliefs, and or any other reductive or arbitrary characteristics What is "reductive or arbitrary"? shall not be considered mental illness.
2. Individuals with mental illness may not be persecuted on the basis of them having said mental illness.
3. Individuals with mental illness shall not be denied access to qualified and appropriate psychiatric care, and any care that they receive shall be free of abuse and exploitation.
4. Those with mental illness may refuse all care and treatment including but not limited to confinement to a mental health facility, unless they pose a direct and imminent threat to the life, health, safety or property of themselves or others.
5. The following rights are guaranteed to patients in mental health facilities, and shall be upheld in all member-states:
   
   1. Uncensored communication (and uncensored receiving of communication) from within mental health facilities so long as all recipients (including the patient) agree to be contacted.
   2. Uncensored and daily allowance of visitation, as long as;
      
      1. The visitor(s) are not determined to pose an immediate threat to the safety of the patient,
      2. The patient being visited is not determined to pose an immediate threat to the safety of the visitor(s), and
      3. The patient and visitor(s) both freely consent to the visit.
   3. Patients may have their visits monitored by appropriately equipped facility staff at the patient's request or a their visitor's request.
   4. BeingPatients shall be released from the mental health facility as soon as it is safe to do so for the patient as well as society, and with the patient consenting. Proper psychiatric help will continue to be offered so long as the former patient still requests or requires.
   5. Provisions and rights guaranteed within this clause do not necessarily apply to individuals charged with criminal offenses.
6. All feasible steps to ensure a reasonably enjoyable "reasonably" is not a standard. What a conservative nation thinks is "reasonably enjoyable" will be different to what a libertarian nation thinks is. atmosphere, including a diversity of activities for both leisure and personal enrichment for all patients, will be taken within all mental health facilities.
7. Patients are not permitted to be transferred outside of the jurisdiction of the World Assembly for the purposes of bypassing this resolution.

Co-author: Jedinsto I'm fairly sure you can't credit CTE authors anymore? Since Jedinsto is CTE now

Made some of the edits, and changed some things around not exactly according to your edits but in response to them.

Re: Jedinsto; I think it's possible - if I recall when I revived my nation, there was an at-vote proposal in which I was listed as a co-author even though I was CTE'd at the time of submission.

[Tinhampton]

even though I was CTE'd at the time of submission.

No, you weren't - I was to blame for that particular incident and I vividly remember submitting it a week before your CTE. You might want to nag Jeddy to bring his nation back before you submit

Article 1 covers political beliefs but regrettably makes no explicit mention of philosophical or religious beliefs, unless this was intentional.

Article 4 of your thing arguably contradicts Article 2d of GA#540 "Supporting People with Disabilities" (RE detention for posing a danger to oneself) - although I've been talking to another WA author about the prospect of repealacing that (but don't expect updates on this before the New Year rolls around, sorry).

[Morover]

even though I was CTE'd at the time of submission.

No, you weren't - I was to blame for that particular incident and I vividly remember submitting it a week before your CTE. You might want to nag Jeddy to bring his nation back before you submit

Article 1 covers political beliefs but regrettably makes no explicit mention of philosophical or religious beliefs, unless this was intentional.

Article 4 of your thing arguably contradicts Article 2d of GA#540 "Supporting People with Disabilities" (RE detention for posing a danger to oneself) - although I've been talking to another WA author about the prospect of repealacing that (but don't expect updates on this before the New Year rolls around, sorry).

Huh, my timeline may have been off then.

The exclusion of philosophical and religious beliefs was intentional. I believe that at one point in the drafting process for this, such was included, but has since been removed.

You make a somewhat compelling point regarding article four and contradiction, but I don't think it's correct. While this is an oversight in Resolution 540, and should warrant replacement, the actual phrasing of article four avoids contradiction. As-is, it only says that the right granted by this resolution to refuse all care and treatment is not applied if they are a danger to themselves or others. That is not to say that another resolution cannot impose a right to refuse care and treatment in other circumstances, which is what 540 would do. I will not change it for now, given that it is not contradictory in my view and I will not change good policy to make way for bad policy, which will hopefully be soon repealed.

[Simone Republic]

I am broadly worried about clause 4, because it does not actually set a standard for harsher measures for mandatory treatment (including confinement), for example two competent psychiatrists signing off, a competent court with an independent legal guardian, and other protections. (5)(e) is also unsatisfactory, although I am aware that views on this may differ, as (for example in real life) the insanity defence is much more stringent in the United States. The replacement seems to miss an opportunity to be offering protection and to prevent potential abuse.

[Morover]

I am broadly worried about clause 4, because it does not actually set a standard for harsher measures for mandatory treatment (including confinement), for example two competent psychiatrists signing off, a competent court with an independent legal guardian, and other protections. (5)(e) is also unsatisfactory, although I am aware that views on this may differ, as (for example in real life) the insanity defence is much more stringent in the United States. The replacement seems to miss an opportunity to be offering protection and to prevent potential abuse.

If they do not pose a threat to themself or anyone else, I fail to see a compelling purpose behind forcing them into treatment. Sure, it may be personally beneficial for them, but that is no reason to force them into confinement or another area of treatment. To widen the scope any further is to open it up for misuse by member-states.

I'll work on 5e.

[Simone Republic]

Attitudes to mental illness differ greatly from nation to nation, sometimes for cultural and sometimes for other reasons (Japan and the UK for example). I am actually suggesting to tighten Article 4, for example by saying:

"Those with mental illness may refuse all care and treatment including but not limited to confinement to a mental health facility, unless they are assessed by a competent legal authority to pose a direct and imminent threat to the life, health, safety or property of themselves or others, and that due process shall apply on any appeals against such legal authority."

[Morover]

Attitudes to mental illness differ greatly from nation to nation, sometimes for cultural and sometimes for other reasons (Japan and the UK for example). I am actually suggesting to tighten Article 4, for example by saying:

"Those with mental illness may refuse all care and treatment including but not limited to confinement to a mental health facility, unless they are assessed by a competent legal authority to pose a direct and imminent threat to the life, health, safety or property of themselves or others, and that due process shall apply on any appeals against such legal authority."

Ah, I see what you mean now. I'll look into other relevant WA legislation and make some slight tweaks, because this is a valuable point. My apologies for misunderstanding!

[Minskiev]

5b(i) and (ii) are incredibly vague and subjective (moreover, Morover, "are not determined" says nothing about who is the determiner).

5e is possibly very problematic if extant WA law doesn't prohibit member states from criminalizing people with mental illnesses. Then, there would be no rights for patients in those member states. (Although I think GA#37 might help you out.)

Edit: if the language used is charged, then this is very problematic indeed. Swaths of rights may be rescinded without a check on the process, GA#37 only ensures that the trial itself is fair.

[Maowi]

OOC: In addition to the feedback you've already received on clause 4, it might be worth thinking about rephrasing it slightly - at the moment, if someone is posing a a direct and imminent threat to themselves or others, they're not allowed to refuse any care and treatment at all, whereas it might make more sense for them to be allowed to refuse care and treatment that is not to do with removing that threat?

[Free Algerstonia]

Algerstonia will NOT be forced to once again waste more money on frivolous endeavors designed by the fanatics in the General Assembly. In what world is it the World Assembly to determine where sovereign nations can entertain their citizens? Hospitals are hospitals, not playgrounds! Patients aren't here to have fun, they are here to get well! OPPOSED!

[Fachumonn]

If the resolution at-vote passes (which it will) then I will support this proposal. However, I would have wished if the repeal had more effort and thought put into it.

[Baltic Sea Swarm]

I fail to see how this in any way fixes the supposed flaw in the previous act you are repealing, in fact i feel it even worsens the flaw, by not mentioning any court assigned no contact provisions. The previous act was more detailed, better written, and this is not a replacement for it in any capacity.

[Penguin Dictators]

My question is, what does this do to assauge the problematic worries that the repeal states, especially when it comes to criminals who happen to be mentally ill, but are not diagnosed as such (since not all mental illnesses are easy to spot) or are misdiagnosed either accidentally or intentionally?

[Morover]

I see these comments - I was supposed to get to this (and other NS stuff) today, but something rather urgent IRL came up. This will not be submitted until it is done and ready, rest assured.

[Penguin Dictators]

I see these comments - I was supposed to get to this (and other NS stuff) today, but something rather urgent IRL came up. This will not be submitted until it is done and ready, rest assured.

You're totally fine, do what you gotta do and take care of your IRL stuff first since that matters most.

I also noticed this bit on the original isn't addressed in the new bill:

• Be employable -- dependent upon their ability to perform said work without their mental illness establishing a new threat to the safety and wellbeing of themselves or others as determined by domestic courts;

While I realize it may fall under persecuting someone for their illness, I feel like omitting this could potentially introduce folks being denied a job due to their mental illness (since it's no long an explicitly given right/protection), even if it's something like depression or anxiety.

[Baltic Sea Swarm]

I see these comments - I was supposed to get to this (and other NS stuff) today, but something rather urgent IRL came up. This will not be submitted until it is done and ready, rest assured.

You submitted the reapeal before it was done, what's wrong with submitting this one too. It'll be just as half assed.

[Barfleur]

"Barfleur opposes any law which permits a person to be deprived of liberty simply because they present a risk to their own person. I do, however, broadly support the remaining provisions of this proposal. With GA#140 repealed, I do think this is the next best candidate to set out the rights of those who receive psychiatric care."

[Xanthorrhoea]

"Barfleur opposes any law which permits a person to be deprived of liberty simply because they present a risk to their own person. I do, however, broadly support the remaining provisions of this proposal. With GA#140 repealed, I do think this is the next best candidate to set out the rights of those who receive psychiatric care."

You clearly have never met a manic person or a person with dementia.

[Barfleur]

"Barfleur opposes any law which permits a person to be deprived of liberty simply because they present a risk to their own person. I do, however, broadly support the remaining provisions of this proposal. With GA#140 repealed, I do think this is the next best candidate to set out the rights of those who receive psychiatric care."

You clearly have never met a manic person or a person with dementia.

OOC: Not quite true, though I wish it were otherwise.

IC: "If a person you speak of has a mental illness and poses a threat to another person, I see no issue in ordering psychiatric treatment to the extent needed to protect others from harm. But a person who, for one of many legitimate reasons, does not wish to continue in this world or with that condition should not be subject to force by the state or by an ostensibly benevolent organization."

[Xanthorrhoea]

You clearly have never met a manic person or a person with dementia.

OOC: Not quite true, though I wish it were otherwise.

IC: "If a person you speak of has a mental illness and poses a threat to another person, I see no issue in ordering psychiatric treatment to the extent needed to protect others from harm. But a person who, for one of many legitimate reasons, does not wish to continue in this world or with that condition should not be subject to force by the state or by an ostensibly benevolent organization."

It’s a question of capacity. The problem is that in many cases of acute or chronic mental illness, a person is no longer capable of having legitimate reasons to make some decisions. You don’t ask a 5 year old if they want surgery, they physiologically aren’t capable of understanding the decision. You don’t ask an unconscious person permission to intubate them, they aren’t capable of perceiving the information.

Similarly, acute reversible illnesses such as mania and schizophrenia or more permanent diseases such as dementia or strokes can remove a persons ability to perceive, interpret, understand, and/or process information or express a decision they may have made. Their brains are physiologically not capable of doing it in the same way a cat can’t read or a game boy colour can’t produce the same sounds as a modern iPhone. There are physiological and physical limits that prevent someone in such a state from being capable of making a meaningful decision.

In such states, decisions regarding management still have to be made by somebody, either by the treating team, the family, their guardian or some other proxy. A medical professional’s first duty is to uphold a patient’s autonomy. When a patient has no autonomy due to being physiologically incapable of making a considered decision, then your primary duty becomes preventing harm, even in cases where a person is acutely distressed or is apparently insisting otherwise.

Your policy of just allowing people their freedom will inevitably lead to huge numbers of geriatric grandparents being hit by cars, dying in kitchen fires, or dying of heat stroke after getting lost because they were given the freedom to make their own decisions at their own risk. Acutely psychotic people will cut their wrists in the honest belief that they will be reborn as Jesus. People will suffer permanent irreversible avoidable harm due to a treatable condition that can be managed in a way that gives excellent quality of life. That is completely unethical, utterly negligent, and a complete failure of your nation’s duty of care to protect its citizens.

You don’t let 2-year-olds run around in broken glass. For the same reason, their must be a mechanism to stop acutely manic people from running around in society. Freedom is important, but it cannot be held sacred to the detriment of all else. This is a hill I will die on.

Edit as it’s late and I got a little carried away: I strongly support a more stringent wording of clause 4 to include references to a lack of capacity, as the current wording is too broad and can lead to people with capacity being confined. However, their must remain the ability to confine patients or enforce care for patients who lack capacity.

[Barfleur]

Snip.

OOC: Of course I think there should be ways to provide assistance and support to people with diminished or functionally nonexistent capacity, as long as it is in a manner which respects their fundamental right to ownership of their own person. That is the important part. Even putting aside my (admittedly radical) views regarding autonomy, there remains the fact that a government or institution capable of stripping a person of liberty based on a unilateral determination that the person lacks capacity will have virtually no check on its ability to incarcerate without the benefit of a criminal trial. Sure, those who cut themselves hoping to be reborn as Jesus will be institutionalized, but any person who is a political opponent of the government (or of the institution) or who is seen as an "oddball" or "freak" of any kind will be liable to be institutionalized as well. There is a long, documented history of the abuse of psychiatry for political and social engineering purposes, and any proposal which seeks to regulate the practice (as this one does well) needs to have safeguards in place to prevent that.

IC: "On second thought, I will be amenable to allowing confinement only if a person is deemed by an impartial and unbiased body to 'pose a direct and imminent threat to themselves.' There should also be an accessible and unbiased way to appeal such a determination by a person deemed to lack capacity."

[Baltic Sea Swarm]

With GA#140 repealed, I do think this is the next best candidate to set out the rights of those who receive psychiatric care."

"Second best" is putting it lightly. This is the previous resolution but put through a thesaurus. It sets the exact same rules, but it's worded less clearly. More like "the lesser of two evils," the other being no replacement at all.

[Cretox State]

"Support in principle.

Gender identity, sexual orientation, political alignment, political beliefs, or any other reductive or arbitrary characteristics shall not be considered mental illness, nor shall any individual possessing these qualities be diagnosed with a mental illness on the basis of these characteristics.

What if those political beliefs are demonstrably... insane? We're still cleaning off the butterscotch pudding smeared across our High Conciliatory Chamber from the days of the Leaping Bunny Boing Boing Party.

Those with mental illness may refuse all care and treatment including but not limited to confinement to a mental health facility, unless they pose a direct and imminent threat to themselves or others.

What if their mental illness demonstrably compromises their ability to make informed decisions?

Uncensored and daily allowance of visitation, as long as... [t]he visitor(s) are not determined to pose an immediate threat to the safety of the patient

Determined by whom?

Patients released from the mental health facility as soon as it is safe to do so for the patient as well as society, and with the patient consenting.

Might want to check your grammar there, ambassador. You seem to be missing a word or two.

Provisions and rights guaranteed within this clause do not necessarily apply to individuals charged with criminal offenses.

Why the "necessarily"?"