[SUBMITTED] Psychiatric Care Act

[Jedinsto]

New thread and draft for Psychiatric Care Act, which was recently discarded due to a legality issue caught during voting.

The World Assembly,

Aware that, while it has taken great steps to protect the rights of the incarcerated, it has remained silent on the rights of those with mental illness, and

Believing that those detained in mental health facilities should not be deprived of the high-quality treatment and care they need,

Enacts the following provisions into law:

1. For the purposes of this resolution, a "professional" means a mental health professional deemed adequately qualified and educated enough to do so.
2. No Individual may be diagnosed with a mental illness without the thorough assessment of a professional. Nationality, race and ethnicity, gender identity, sexual orientation, political, philosophical and religious beliefs in and of themselves shall not be considered mental illness.
3. Individuals may not be persecuted on the basis of having a mental illness; to that effect, the status of having a mental illness shall not be considered a crime.
4. Individuals with mental illness shall not be denied access to psychiatric care that is appropriate, non-abusive, and non-exploitative.
5. Individuals may refuse all care and treatment, including but not limited to confinement to a mental health facility, unless both:
   
   1. The individual has a mental illness, and
   2. A competent, appropriate authority (including a professional) believes that the individual poses a direct threat to themselves or others as a result of the mental illness.
6. Upon admission, every individual involuntarily held at a mental health facility must be re-evaluated as soon as possible by a professional to determine if they meet both of the Clause 5 criteria.
7. Member states shall ensure that all patients in mental health facilities - not necessarily including individuals currently serving a punitive sentence after being convicted of a crime - enjoy the following rights:
   
   1. The right to uncensored transmission and receipt of communication from within mental health facilities (where member states do not choose to censor such communications where allowed under World Assembly law), as long as both:
      
      1. All recipients (including the patient) agree to be contacted, and
      2. The patient does not possess specific information related to a criminal case which a relevant legal authority has deemed sensitive enough to require censoring of communications to prevent the leak of the information,
   2. The right to receive one visitor or group of visitors per day (subject to Clause 8 and where member states do not choose to further limit such visitation rights where allowed under World Assembly law), as long as all of the following apply:
      
      1. The patient and visitor(s) both freely consent to the visit,
      2. Neither the visitor(s) nor the patient they are visiting are determined to post an immediate threat to others, and
      3. The patient does not possess specific information related to a criminal case which a relevant legal authority has deemed sensitive enough to require censoring of communications to prevent the leak of the information.
   3. The right to an independent appeal against their being diagnosed with a mental illness or forcibly confined to their mental health facility which may be exercised an indefinite amount of times and from time to time,
   4. The right to be represented during the aforementioned appeals by themselves, their next of kin, or a competent and duly authorized independent advocate,
   5. The right to be released from the mental health facility they are held in as soon as it is safe to do so for themselves and society (with their consent) or otherwise upon winning an appeal against their being forcibly confined to that facility,
   6. The right to rest, play and leisure, and
   7. The right to freedom of movement (except where restraint is necessary to prevent patients from injuring themselves or others, leaving their mental health facility, or entering areas they are not authorized to enter).
8. Visits made pursuant to Clause 7(b) may be monitored by appropriately equipped facility staff at the request of the patient or their visitor(s).
9. All former mental health patients shall have the right to receive ongoing, proper psychiatric help upon release from their mental health facility, as long as they continue to request or require it.
10. When a patient is released from a mental health facility pursuant to Clause 7(c), member states must attempt to assimilate them back into society and take due care to ensure they are not stigmatized.

Co-authors: Morover, Simone Republic, and Tinhampton

[Kenmoria]

“I believe that there is an editing mistake, in that the subclauses of clause 7 ought to be subclauses of clause 6.” Lewitt comments. “This draft does look better, with the issue of contradiction fixed.”

[Uan aa Boa]

Individuals may not be deemed to have a mental illness without the thorough assessment of at least two mental health professionals deemed adequately qualified and educated enough to do so.

This seems onerous for a patient seeking a prescription for antidepressants.

[Jedinsto]

“I believe that there is an editing mistake, in that the subclauses of clause 7 ought to be subclauses of clause 6.” Lewitt comments. “This draft does look better, with the issue of contradiction fixed.”

"This is indeed an editing mistake, we appreciate you catching this mistake, ambassador."

Individuals may not be deemed to have a mental illness without the thorough assessment of at least two mental health professionals deemed adequately qualified and educated enough to do so.

This seems onerous for a patient seeking a prescription for antidepressants.

"Is it? Getting a second opinion before getting a depression diagnosis doesn't seem onerous to me. Perhaps I could make the second opinion optional?"

Edit: OOC: I'll be going away for a while starting next Monday, so if I don't touch this draft for about three weeks don't be surprised. Also, this will most likely be submitted a few days after I'm back and hopefully the queue is clear by then.

[Bananaistan]

“I believe that there is an editing mistake, in that the subclauses of clause 7 ought to be subclauses of clause 6.” Lewitt comments. “This draft does look better, with the issue of contradiction fixed.”

"This is indeed an editing mistake, we appreciate you catching this mistake, ambassador."

This seems onerous for a patient seeking a prescription for antidepressants.

"Is it? Getting a second opinion before getting a depression diagnosis doesn't seem onerous to me. Perhaps I could make the second opinion optional?"

Edit: OOC: I'll be going away for a while starting next Monday, so if I don't touch this draft for about three weeks don't be surprised. Also, this will most likely be submitted a few days after I'm back and hopefully the queue is clear by then.

OOC: Getting a second opinion for a prescription is not only onerous, it is also wasteful of scarce resources - physician's time.

Visitation does not seem to be quite the right word. I understand it to mean a rather formal and official inspection.

What exactly is "uncensored visitation" when it's at home?

The rest is ok but strays very heavily on the micro-management side.

[Jedinsto]

OOC: Getting a second opinion for a prescription is not only onerous, it is also wasteful of scarce resources - physician's time.

What if it was optional and only meant to prevent misdiagnoses and such?

What exactly is "uncensored visitation" when it's at home?

That is only for people confined in facilities. And it's meant to essentially mean they're not treated like prisoners when it comes to visitation.

[Uan aa Boa]

"Is it? Getting a second opinion before getting a depression diagnosis doesn't seem onerous to me. Perhaps I could make the second opinion optional?"

Diagnosis of depression is absolutely routine and doesn't even need a mental health specialist. Bear in mind that nothing compulsory follows that kind of diagnosis - if a patient disagrees with their doctor's view they can simply ignore it. Nothing stops them consulting another doctor, but what would be the point? So they can go back to the first doctor and say "I told you so?" Meanwhile, as Comrade Banana says, if a patient has come to the doctor to seek help for depression, requiring a second opinion not only wastes resources but introduces a needless delay to them receiving that help. If you wouldn't require 2 doctors to diagnose a common physical illness why would you need that for a common mental illness? This is micromanagement.

There could be a place for a second opinion in a situation where someone is being detained against their will on psychiatric grounds, but in this case the question is usually not whether the patient has a mental illness (they'll often have been known to the system for years) but whether they meet the legal threshold for detention (danger to self or others or equivalent). And remember that in many cases detention occurs before such an assessment has taken place and is enforced to allow the assessment to be completed. This often happens in traumatic crisis situations and unsafe locations, and it's kinder to remove someone to hospital to complete the process than prolong that situation waiting for additional opinions. Additionally, if drugs and alcohol are involved the person can't be assessed until no longer under their influence, which takes time. For these reasons many jurisdictions allow a single practitioner to invoke a 48-72hr emergency detention order for assessment. It wouldn't be in the best interests of patients to make that too difficult.

[Jedinsto]

"Is it? Getting a second opinion before getting a depression diagnosis doesn't seem onerous to me. Perhaps I could make the second opinion optional?"

Diagnosis of depression is absolutely routine and doesn't even need a mental health specialist. Bear in mind that nothing compulsory follows that kind of diagnosis - if a patient disagrees with their doctor's view they can simply ignore it. Nothing stops them consulting another doctor, but what would be the point? So they can go back to the first doctor and say "I told you so?" Meanwhile, as Comrade Banana says, if a patient has come to the doctor to seek help for depression, requiring a second opinion not only wastes resources but introduces a needless delay to them receiving that help. If you wouldn't require 2 doctors to diagnose a common physical illness why would you need that for a common mental illness? This is micromanagement.

There could be a place for a second opinion in a situation where someone is being detained against their will on psychiatric grounds, but in this case the question is usually not whether the patient has a mental illness (they'll often have been known to the system for years) but whether they meet the legal threshold for detention (danger to self or others or equivalent). And remember that in many cases detention occurs before such an assessment has taken place and is enforced to allow the assessment to be completed. This often happens in traumatic crisis situations and unsafe locations, and it's kinder to remove someone to hospital to complete the process than prolong that situation waiting for additional opinions. Additionally, if drugs and alcohol are involved the person can't be assessed until no longer under their influence, which takes time. For these reasons many jurisdictions allow a single practitioner to invoke a 48-72hr emergency detention order for assessment. It wouldn't be in the best interests of patients to make that too difficult.

"The second opinion part has been changed to be optional and only for people that have been involuntarily admitted."

[Potted Plants United]

OOC: I meant to give the draft a proper look-see, but I know I'm too tired for that now, so just a couple of comments:

Individuals may not be persecuted on the basis of having a mental illness.

Persecuted? By who? And in whose opinion? Someone with delusional paranoia may certainly feel persecuted by regular actions of others even if the actions weren't persecutory or even aimed at that person.

Clause 5... big issues, if having a mental illness and being perceived (by whom, by the way?) to be a danger to others means forcible treatment, even if the two weren't in any way related. Like, if you have mild depression, and then get in a drunken brawl, you can be locked up in a mental hospital and pumped full of meds, even though you were a danger to others because you were drunk, not because you were depressed?

Clause 7.a.ii. - wouldn't practically everyone have knowledge of such info? Like contact info of minors (like their own children), at least their own (and possibly their spouse's and/or children's) bank details, medical history, social security numbers etc.

Clause 7.b., what is "allowance of visitation"?

Clau 7.f. is problematic. Should be other way around. Instead of "freedom to go everywhere except X", should be "freedom to only go to Y". Even in normal hospitals you're not supposed to wander needlessly around, because there are other people in vulnerable situations in other rooms. Applies to mental hospitals as well. Shared spaces, sure, but elsewhere, no. Even if a room was empty at the moment, if it's still a room for a patient or patients, it's not general recreational space and so shouldn't be gone into unsupervised.

7.g. - people serving a sentence should be left out of the scope of the proposal entirely, instead of that.

7.h. should really be its own clause, not a subclause of clause 7.

Clause 8 is weird. Why should a mental hospital patient be appointed an advocate when the patient is legally competent theirself? Or is that just in general, as some kind of bureaucratic entity? What are "independent appeals" in context? Especially against a diagnosis (clause 2)??? Like, what, an abusive parent doesn't believe their teenager can actually be clinically depressed and so can keep appealing it to keep their teen from getting treatment?

Clause 9 is even weirder. Drop "mental" from that sentence and then tell me if it sounds like something from a dystopic novel to you too? Mental health isn't that divorced from physical health as you seem to imagine.

There's probably more, but those were most obvious ones.

[Jedinsto]

Persecuted? By who? And in whose opinion? Someone with delusional paranoia may certainly feel persecuted by regular actions of others even if the actions weren't persecutory or even aimed at that person.

This would be in the WACC or WAJC's opinion.

Clause 5... big issues, if having a mental illness and being perceived (by whom, by the way?) to be a danger to others means forcible treatment, even if the two weren't in any way related. Like, if you have mild depression, and then get in a drunken brawl, you can be locked up in a mental hospital and pumped full of meds, even though you were a danger to others because you were drunk, not because you were depressed?

Clarifications will be made.

Clause 7.a.ii. - wouldn't practically everyone have knowledge of such info? Like contact info of minors (like their own children), at least their own (and possibly their spouse's and/or children's) bank details, medical history, social security numbers etc.

I'll clarify that this only applies to information related to a criminal case where a court has ordered specific information cannot be shared.

Clause 7.b., what is "allowance of visitation"?

It is allowing visitors to visit the patient.

Clau 7.f. is problematic. Should be other way around. Instead of "freedom to go everywhere except X", should be "freedom to only go to Y". Even in normal hospitals you're not supposed to wander needlessly around, because there are other people in vulnerable situations in other rooms. Applies to mental hospitals as well. Shared spaces, sure, but elsewhere, no. Even if a room was empty at the moment, if it's still a room for a patient or patients, it's not general recreational space and so shouldn't be gone into unsupervised.

I'll find a way to work this in.

Clause 8 is weird. Why should a mental hospital patient be appointed an advocate when the patient is legally competent theirself? Or is that just in general, as some kind of bureaucratic entity? What are "independent appeals" in context? Especially against a diagnosis (clause 2)??? Like, what, an abusive parent doesn't believe their teenager can actually be clinically depressed and so can keep appealing it to keep their teen from getting treatment?

Individuals need not have their own advocate, nor use any kind of advocate, but they will have access to one. And sure, if someone wants to look at it that way, that's on them, but it's meant to allow people who, say, aren't schizophrenic to not be pumped full of antipsychotics.

Clause 9 is even weirder. Drop "mental" from that sentence and then tell me if it sounds like something from a dystopic novel to you too? Mental health isn't that divorced from physical health as you seem to imagine.

The suicide rates for people immediately following their discharge from mental hospitals is unbelievably high. Remove mental from that sentence, and then tell me if it sounds like something from a dystopic novel to you too?

[Uan aa Boa]

Clause 8 is weird. Why should a mental hospital patient be appointed an advocate when the patient is legally competent theirself? Or is that just in general, as some kind of bureaucratic entity? What are "independent appeals" in context? Especially against a diagnosis (clause 2)??? Like, what, an abusive parent doesn't believe their teenager can actually be clinically depressed and so can keep appealing it to keep their teen from getting treatment?

Somebody confined to a medical facility because they are otherwise a danger to themselves or others is by definition not legally competent. And even legally competent people can find it daunting to the point of impossibility to challenge medical professionals without support from someone who knows the system.

If someone is detained against their will then there should be a regular review to make sure this remains justified (though you could argue that the clause saying restrictions must be lifted as soon as it's safe to do so covers this). I am a little confused about due process that's exercised "from time to time and at all times."

Appealing a diagnosis is really just a different way of describing getting a second opinion. It's by no means unusual for detained psychiatric patients to claim they are not ill at all, but a sensible system can dismiss spurious appeals as such without denying everyone the right to appeal. Regarding your example, surely below the "danger to self and others" threshold parents do have the right to withhold consent to treatment for a child?

[Jedinsto]

Bump. This will be submitted when the queue clears up a bit.

[Kenmoria]

(OOC: The grammar in clause 7 is wonky. Subclauses 7a and 7b don’t form complete sentences, being done as expanded noun-phrases, in the sense of a list of rights, whereas the other subclauses do form complete sentences.)

[Potted Plants United]

Clause 8 is weird. Why should a mental hospital patient be appointed an advocate when the patient is legally competent theirself? Or is that just in general, as some kind of bureaucratic entity?

Somebody confined to a medical facility because they are otherwise a danger to themselves or others is by definition not legally competent.

OOC: Since when? I think you're thinking of people declared "criminally insane", as regular psychiatric patients are no more legally incompetent than people with COVID-19, despite being a danger to others (or themselves).

[Jedinsto]

(OOC: The grammar in clause 7 is wonky. Subclauses 7a and 7b don’t form complete sentences, being done as expanded noun-phrases, in the sense of a list of rights, whereas the other subclauses do form complete sentences.)

I'm gonna be completely honest I don't really know how to fix this, but I hope the new slight edits make things better.

[Chipoli]

(OOC)

Minor grammar issue in 7d:

Proper psychiatric help will continue to be offered so long as the former patient still requests or requires it.

[Kenmoria]

(OOC: The grammar in clause 7 is wonky. Subclauses 7a and 7b don’t form complete sentences, being done as expanded noun-phrases, in the sense of a list of rights, whereas the other subclauses do form complete sentences.)

I'm gonna be completely honest I don't really know how to fix this, but I hope the new slight edits make things better.

(OOC: Below are the slight edits required for grammaticality.

7. The following rights are guaranteed to patients in mental health facilities, and shall be upheld in all member-states:

1. The right to uncensored communication (and uncensored receiving of communication) from within mental health facilities must be ensured, so long as all of the following apply:
   
   1. All recipients (including the patient) agree to be contacted.
   2. The patient does not possess specific information related to a criminal case which a relevant legal authority has deemed sensitive enough to require censoring of communications to prevent the leak of the information.
   3. Member nations do not choose to censor or limit communications where allowed under extant Word Assembly Law, prior or future.
2. Uncensored and daily allowance of visitation will be available to all patients, as long as all of the following apply:
   
   1. The visitor(s) are not determined to pose an immediate threat to the safety of the patient or others.
   2. The patient being visited is not determined to pose an immediate threat to the safety of the visitor(s) or others.
   3. The patient and visitor(s) both freely consent to the visit.
   4. The patient is not being investigated or charged for a crime and possesses sensitive information which cannot be leaked to the public.
   5. Member nations do not choose to censor or limit visitation rights where allowed under extant Word Assembly Law, prior or future.
3. Visits may be monitored by appropriately equipped facility staff at the patient's request or their visitor's request.
4. Patients must 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 it.
5. 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.
6. Patients are entitled to freedom of movement and lack of restraint except where necessary to prevent individuals from injuring themselves or others, leaving the facility, or entering areas restricted to certain individuals.
7. Provisions and rights guaranteed within this clause do not necessarily apply to individuals currently serving a punitive sentence after being convicted of a crime.
8. The status of having a mental illness shall not be considered a crime.

See how every clause forms a complete sentence sentence in and of itself. Not doing so would be completely fine, but only where there was consistency. Now, it is entirely consistent.)

[Jedinsto]

Thanks, fixed.

[Simone Republic]

You might as well check and re-check this, since even if you submit it now, late March is likely to be when you get to vote, and if there are more last calls/changes etc., April.

[Tinhampton]

You called?

The World Assembly,

Aware that, while it has taken great steps to protect the rights of the incarcerated, it has remained silent on the rights of those with mental illness, and

Believing that those detained in mental health facilities should not be deprived of the high-quality treatment and care they need,

Enacts the following provisions into law:

1. For the purposes of this resolution, a "professional" means a mental health professional deemed adequately qualified and educated enough to do so.
2. No Individual may be diagnosed with a mental illness without the thorough assessment of a professional. Nationality, race and ethnicity, gender identity, sexual orientation, political, philosophical and religious beliefs in and of themselves shall neither be considered mental illness nor factor into whether any individual will be diagnosed with a mental illness.
3. Individuals may not be persecuted on the basis of having a mental illness; to that effect, the status of having a mental illness shall not be considered a crime.
4. Individuals with mental illness shall not be denied access to psychiatric care that is appropriate, non-abusive, and non-exploitative.
5. Individuals may refuse all care and treatment, including but not limited to confinement to a mental health facility, unless both:
   
   1. The individual has a mental illness, and
   2. A competent, appropriate authority (including a professional) believes that the individual poses a direct threat to themselves or others as a result of the mental illness.
6. Every individual involuntarily held at a mental health facility must be re-evaluated as soon as possible by a professional to determine if they meet both of the Clause 5 criteria.
7. Member states shall ensure that all patients in mental health facilities - not necessarily including individuals currently serving a punitive sentence after being convicted of a crime - enjoy the following rights:
   
   1. The right to uncensored transmission and receipt of communication from within mental health facilities (where member states do not choose to censor such communications where allowed under World Assembly law), as long as both:
      
      1. All recipients (including the patient) agree to be contacted, and
      2. The patient does not possess specific information related to a criminal case which a relevant legal authority has deemed sensitive enough to require censoring of communications to prevent the leak of the information,
   2. The right to receive one visitor or group of visitors per day (subject to Clause 8 and where member states do not choose to further limit such visitation rights where allowed under World Assembly law), as long as all of the following apply:
      
      1. The patient and visitor(s) both freely consent to the visit,
      2. Neither the visitor(s) nor the patient they are visiting are determined to post an immediate threat to others, and
      3. The patient does not possess specific information related to a criminal case which a relevant legal authority has deemed sensitive enough to require censoring of communications to prevent the leak of the information.
   3. The right to an independent appeal against their being diagnosed with a mental illness or forcibly confined to their mental health facility,
   4. The right to be represented during the aforementioned appeals by themselves, their next of kin, or a competent and duly authorized independent advocate,
   5. The right to be released from the mental health facility they are held in as soon as it is safe to do so for themselves and society (with their consent) or otherwise upon winning an appeal against their being forcibly confined to that facility,
   6. The right to receive ongoing, proper psychiatric help upon release from their mental health facility, as long as they continue to request or require it,
   7. The right to rest, play and leisure, and
   8. The right to freedom of movement (except where restraint is necessary to prevent patients from injuring themselves or others, leaving their mental health facility, or entering areas they are not authorized to enter).
8. Visits made pursuant to Clause 7(b) may be monitored by appropriately equipped facility staff at the request of the patient or their visitor(s).
9. When a patient is released from a mental health facility pursuant to Clause 7(c), member states must attempt to assimilate them back into society and take due care to ensure they are not stigmatized.

About 4,500 characters. This is largely a rewrite, but:
A: I no longer say that visitation must be "uncensored." This is implied in Article 7a's ban on censorship of communications, unless WA law affords otherwise.
B: Pursuant to Jedinsto's reply to PPU, I have moved the old Article 8 into Article 7 (a list of rights; Article 8 afforded an optional right, not a mandatory benefit).
C: Article 7b(iii) is now identical to Article 7a(ii). The standard of possessing information about a criminal case which a court believes should not be transmitted is clearer than the standard of "possess[ing] sensitive information which cannot be leaked to the public."
D: I have removed Article 11. When Unibot wrote Institutional Psychiatry Act, he could not have possibly known about GA#197 "Banning Extrajudicial Transfer."
E: I have no idea what qualified psychiatric care is.
F: The list of things that can't be considered mental illness has massively expanded. My fault.

[Kenmoria]

F: The list of things that can't be considered mental illness has massively expanded. My fault.

(OOC: I see an issue with that expansion, particularly with “nor factor into whether any individual will be diagnosed”. A rapid, dramatic, and unexplained change in religious, political, or philosophical belief would be no cause for concern by itself, but it could certainly factor into a diagnosis.)

[Jedinsto]

snip

Your rewrite has been accepted with a few minor changes.

(OOC: I see an issue with that expansion, particularly with “nor factor into whether any individual will be diagnosed”. A rapid, dramatic, and unexplained change in religious, political, or philosophical belief would be no cause for concern by itself, but it could certainly factor into a diagnosis.)

I have the same problem with that suggestion, considering someone very close to me suffers from psychosis with a religious aspect. He would likely not get any diagnosis if that suggestion were implemented in its entirety.

[Jedinsto]

This has been submitted.

[Saint Tomas and the Northern Ice Islands]

If proposal authors cannot be bothered to write a decent campaign telegram with effort, I will also not be bothered to read your resolution, and will vote against.

[Jedinsto]

If proposal authors cannot be bothered to write a decent campaign telegram with effort, I will also not be bothered to read your resolution, and will vote against.

I find that short, effortless campaign telegrams are much more effective than detailed ones, so I'm just gonna follow those statistics and use the short, effortless ones. Sorry.