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How effective is international law in protecting the rights of psychiatric patients? Not very, according to a Washington, D.C.,-based advocacy group that sponsored a panel at this year's annual meeting. The group, Mental Disability Rights International (MDRI), operates on the premise that international law mandates a minimum, humane standard for the care of psychiatric patients that, in theory, protects patients from abusive treatment even in the absence of adequate national legislation. In practice, the enforcement of international human rights protections is extremely difficult, but the overhaul of Hungarian health care regulations this March, in part in response to the MDRI report, shows that moral suasion can make a difference, said MDRI's executive director, Eric Rosenthal, J.D.
"For too long there's been a failure to understand that international human rights do apply to people with psychiatric disabilities," he noted.
The relevant resolutions include the "United Nations Principles for the Protection of Persons With Mental Illness," the 1993 "Vienna Declaration," and the "United Nations Standard Rules on Equalization of Opportunities for People With Disabilities."
"None of the protections is as strong as I would like them to be," but they set minimum standards, Rosenthal remarked.
The international laws restrict arbitrary use of civil commitment, requiring an independent assessment. They prohibit physical harm and establish the right to "live, work, and receive treatment in the community" if possible, said Rosenthal. If implemented, these standards would require major changes in the provision of mental health services in many nations, he noted.
During visits to Eastern Europe and South America as an adviser to MDRI, Robert Okin, M.D., heard many criticisms of deinstitutionalization in the United States and the widespread presence of the homeless mentally ill. He said that he felt no need to defend the U.S. system.
"There is absolutely no reason that human rights and concern for human rights should stop at borders," commented Okin, a professor of clinical psychiatry and vice chair of the department of psychiatry at the University of California, San Francisco. Other nations can learn from both the mistakes and successes of mental health care in the United States.
In contrast to the U.S., there is "virtually no case management" in any of the South American and Eastern European facilities visited by the MDRI team, said Okin. There is a similar absence of outpatient services and supportive housing.
The end result of these deficiencies is that many patients receive treatment in psychiatric hospitals or the psychiatric wards of general hospitals even if, by U.S. standards, they would be good candidates for outpatient treatment.
The relevant Web sites for more information are the United Nations at www.un.org and Mental Disability Rights International at www.mdri.org.