OF THE INTER-AMERICAN COMMISSION ON HUMAN RIGHTS FOR THE PROMOTION AND
PROTECTION OF THE RIGHTS OF THE MENTALLY ILL
In 1990, the Pan American Health Organization (PAHO/WHO) – the World Health Organization’s (WHO) Regional Office of the Americas and a specialized agency of the Organization of American States (OAS)–sponsored the Regional Conference on Restructuring Psychiatric Care in Latin America, with the IACHR as a co-sponsor. At that conference, the Declaration of Caracas was adopted.
The Declaration of Caracas establishes standards on protecting human rights and mental health. Regarding psychiatric care, it indicates that the “resources, care and treatment that are made available must safeguard personal dignity and human and civil rights … and strive to ensure that patients remain in their communities”. It also recommends that countries redraft national legislation to ensure that the “human and civil rights of the mental patients are safeguarded.”
In 1991, the United Nations General Assembly adopted the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care (Mental Health Principles). They are considered to be the most complete, detailed international standards for the protection of the rights of persons with mental illness and are an important guide for States in designing and/or reforming mental health systems.
The IACHR took cognizance of resolution CD.40.R15, adopted by the PAHO/WHO Directing Council on September 26, 1997, in which that body urges member states to “make efforts to improve the legislation to protect the human rights of psychiatric patients.”
According to PAHO/WHO, the United Nations Centre for Human Rights, and the United Nations Commission on Human Rights, the fundamental freedoms and basic rights most often violated in psychiatric hospitals include the right to be treated with humanity and respect, the right to voluntary admission, the right to privacy, freedom of communication, the right to receive treatment in the community, the right to give informed consent before receiving any treatment, and the right to appeal the legality of a psychiatric hospital detention to an independent, impartial court.
Commission has found that, in the Americas, clients, their family members,
mental health workers, attorneys, judges, and other persons involved in
the promotion and protection of mental health have limited knowledge of
international standards and the provisions of conventions protecting the
rights of persons with mental illness. Furthermore, in most cases those
standards and provisions have not been incorporated into national law.
In April 1999, the Inter-American Commission on Human Rights approved Report N° 63/99 in the case of a person with a mental disorder. That report finds that it is “pertinent to apply special standards to the determination of whether the provisions of the Convention have been complied with in cases involving persons suffering from mental illnesses” or detainees in psychiatric hospitals, who are considered to be a particularly vulnerable group. In that report, the IACHR interpreted the standards of the American Convention that provide for the right to physical integrity, the right to life, and the right to judicial protection in light of the Mental Health Principles. In that report, the IACHR also agreed with the position of the European Court of Human Rights, which has established that the state of health of a victim is an important factor in determining whether they have been subjected to inhumane or degrading punishment or treatment and therefore concluded that the incarceration of a mentally disabled person under deplorable conditions and without medical treatment may be considered as inhumane or degrading treatment, prohibited under Article 5(2) of the American Convention on Human Rights.
view of the foregoing,
INTER-AMERICAN COMMISSION ON HUMAN RIGHTS,
Ratify the Inter-American Convention on the Elimination of All
Forms of Discrimination against Persons with Disabilities, adopted by the
OAS General Assembly on June 8, 1999, the objective of which is to prevent
and eliminate all forms of discrimination against persons with physical or
mental disabilities and to promote their full integration into society.
2. Take legislative, judicial, administrative, educational, and other steps to disseminate through appropriate, dynamic channels [among government authorities, NGOs, mental health professionals, attorneys, judges, and other persons involved in promoting mental health policies] the international standards and provisions of human rights conventions that protect the fundamental freedoms and civil, political, economic, social, and cultural rights of persons with mental illness.
Amend existing mental health or disability laws in general and,
where they do not exist, establish laws that guarantee respect for the
fundamental freedoms and human rights of persons with mental disability
and their family members, incorporating international standards and the
provisions of human rights conventions that protect the mentally ill.
Promote and implement, through legislation and national mental
health plans, the organization of community mental health services, to
achieve the full integration of the mentally ill into society and involve
professional organizations, associations of clients and their family
members, their friends, social welfare agencies, and other members of the
community in the rehabilitation of the mentally ill patient.
Promote, through the Ombudsman, the establishment of specific
initiatives to protect the human rights of the mentally ill.
Take the necessary steps for all mental health institutions to
display the rights of mental health patients in a visible location, such
as waiting rooms, admission services, and other locations frequented by
patients and their family members.
Support the establishment of organs that supervise compliance with
human rights norms in all psychiatric care institutions and services;
committee activities should involve patients, their family members and
representatives, and mental health workers.
Establish mechanisms for raising awareness, public education
(development and dissemination of educational materials, such as
pamphlets, posters, videos, etc.) and actions aimed at combating
stigmatization and discrimination against the mentally ill, through state
agencies and NGOs, in keeping with international standards and the
provisions of conventions protecting these persons.
all parties involved in promoting mental health (institutional defense
committees; associations of psychiatrists, psychologists, social workers
and nurses; civic groups; NGOs; associations of clients and their family
members; attorneys; law students; etc.)
Become actively involved in protecting the human rights of the
mentally ill and include concrete measures in their programs.
Disseminate international standards and the provisions of
conventions protecting the rights of the mentally ill, through meetings,
conventions, scientific publications or educational campaigns, using all
Make an effort to celebrate the World Mental Health Day every
October 10th and use that opportunity to promote the rights of
the mentally ill.
4. Coordinate actions with the ministries of health, social security
funds, health centers, ombudsmen, and other government agencies
responsible for implementing mental health policies to protect the rights
of the mentally ill.
clients and their family members
Be aware that the mentally ill share the same basic rights and
freedoms as all other human beings and that there are international
principles protecting them, particularly because of their position of
vulnerability and powerlessness.
Approved by the Inter-American Commission on Human Rights at its 111° special session held in Santiago, Chile April 4, 2001
In 1990, the Pan American Health Organization (PAHO/WHO) convened
different mental health organizations, associations, and professionals
and jurists to the Regional Conference on Restructuring Psychiatric
Care in Latin America (1990), held in Caracas, Venezuela.
The Declaration of Caracas was adopted in the framework of that
Conference. The full text
of the Declaration is reproduced in Itzak Levav, Helena Restrepo, and
Carlyle Guerra de Macedo, The
Restructuring of Psychiatric Care in Latin America: A New Policy for
Mental Health Services, 15 J. PUBLIC HEALTH & POLICY, p. 71
Principles for the Protection of Persons with Mental Illness and for
the Improvement of Mental Health Care, G.A. Res. 119, U.N. GAOR, 46th
Session, Supp No. 49, Annex, pp. 188-192. U.N. Doc.A/46/49 (1991).
See I. Levav & R. González Uzcátegui, Rights of Persons with
Mental Illness in Central America, 101 ACTA PSYCHIATRICA SCANDINAVICA,
p. 84 (2000).
Diagnosis of the Human Rights
Situation of the Mentally Ill in Central America, Final Report,
Tegucigalpa, July 1998, Pan American Health Organization/World Health
Organization. This report
diagnoses the situation in five countries: Costa Rica, El Salvador,
Honduras, Nicaragua, and Panama.
United Nations, Centre for Human Rights, Study
Series Human Rights and Disabled Persons, 1993, p. 27 (Special
Rapporteur Leandro Despouy).
United Nations, Economic and Social Council, Commission on Human
Rights, Sub-Commission on Prevention of Discrimination and Protection
of Minorities, Principles,
Guidelines and Guarantees for the Protection of Persons Detained on
Grounds of Mental Ill-Health or Suffering from Mental Disorder,
U.N. Doc. E/CN.4/Sub.2/1983/17, pp. 24-27 (Special Rapporteur Erica
IACHR, Report N° 63/99, Case N° 11.427 (Victor Rosario Congo),
Ecuador, Annual Report 1998.
In that report the IACHR also
concluded that Mr. Victor Rosario Congo was unable to care for his own
person or affairs and, consequently, required care, treatment and
control for his own protection.