(adopted by the WPA General Assembly in Athens, l7th October, 1989)
The WPA's Executive Committee brought for approval by the General Assembly during the VIII World Congress of Psychiatry in Athens last year a charter on the rights of mental patients. In a way this charter extends and complements the Declaration of Hawaii.
- It consists of statements that the WPA's outgoing leadership has made public in the past six years, mainly on the occasion of our Association's interventions to the Working Group established by the Economic and Social Council (through the UN Commission on Human Rights) (on the question of persons detained on the grounds of mental ill health or suffering from mental disorder). It is known past publication in the WPA's Newsletter that both the Preamble and the Articles proposed in the Report of this Working Group (known after the name of its chair-lady as Daes-Report) had aroused concern in our Association and its major Member Societies, as being virtually an anti-psychiatric document. The WPA's concern was at a latter stage shared by other Non-Governmental Organizations in a joint meeting convened by the WHO's Mental Health Division and proposals for amendments to several articles of the final version of the Daes-Report were submitted to the UN Agencies. The following represent a condensed catalogue of the WPA's Executive Committee and Ethics Committee statements and viewpoints that largely reflect the body of general guidelines on the rights of mental patients, approved by the WPA's Ordinary General Assembly in Athens October l7th, 1989.
- Persons suffering from mental illness shall enjoy the same human rights and fundamental freedoms as all other citizens. They shall not be the subject of discrimination on grounds of mental illness.
- Mentally ill persons have the right to professional, human and dignified treatment. They shall be protected from exploitation, abuse and degradation, in accordance with the ethical standards of the Declaration of Hawaii, revised and approved by the General Assembly of the World Psychiatric Association in Vienna, 1983.
- The World Psychiatric Association adheres to the general principles outlined in the Declaration of Hawaii, which clearly specifies the minimal requirement for ethical standards of the psychiatric profession. The Declaration of Hawaii states that the aim of psychiatry is to treat mental illness and to promote mental health. It denounces abuse of psychiatry in all respects and emphasizes that psychiatrist shall serve the best interests of the patient, consistent with accepted scientific knowledge and ethical principles.
- Health Legislation shall provide for adequate and effective treatment of all patients, including psychiatric patients, and safeguard their right to treatment in or outside institutions of an acceptable standard. There shall be no discrimination of psychiatric patients in this context. Wherever possible, psychiatric services shall be integrated into the health and social care system. All patients shall be treated and cared for, as far as possible, in the community where they live.
- Psychiatric patients should, as a principle, be treated along the same lines as other patients, favored by the fact that great majority of patients may be treated informally and voluntarily in outpatient facilities without hospitalization.
- Voluntary treatment should be encouraged and access to voluntary treatment should not be administrated differently from access to treatment of physical illness. Patients who are voluntarily admitted to a mental health facility or apply for assistance, shall be protected by the same legal safeguards and ethical rules as patients with any other type of illness.
- Involuntary intervention is a great infringement of the human rights and the fundamental freedom of a patient. Therefore, specific and carefully defined criteria and safeguards are needed for such intervention. Hospitalization or treatment against the will of a patient should not be carried out, unless the patient suffers from serious mental illness. Involuntary intervention must be carried out in accordance with the least restrictive principle.
- A diagnosis that a person is mentally ill shall be determined in accordance with the internationally accepted medical standards. Physicians, in determining whether a person is suffering from mental illness, should do so in accordance with medical science.
- The seriousness of the mental illness and the seriousness of the harm that the patient may cause to himself and/or others shall be determined by definition in national legislation.
- Difficulty in adapting to moral, social, political, or other values, in itself should not be considered a mental illness.
- National legislation shall provide directions with regard to which kind of persons are authorized to request an involuntary admission, and which body is authorized to carry out the physical force that may be necessary for the implementation of the involuntary intervention.
- The final decision to admit or detain a patient in a mental health facility as an involuntary patient shall be taken only by a court or a competent independent body prescribed by law and only after appropriate and proper hearing.
- Patients shall be fully informed of their treatment and rights. They have the right of appeal and to be heard personally by the court or competent body.
- The necessity for the deprivation of liberty shall be reviewed at regular and fixed intervals as prescribed by national law.
- Patients who are deprived of their liberty, shall have the right to a qualified guardian or counsel to protect their interests.
- Clinical trials and experimental treatments shall never be carried out on patients involuntarily hospitalized.
- Patients have the right to receive appropriate treatment and care in accordance with the highest available standards. The quality of treatment also depends on appropriate physical settings, staff and resources.
- Patients deprived of their liberty shall have the right to free communication, limited only as strictly necessary in the interests of the health or safety of themselves or others.
The principles set out in these articles shall to the widest possible extent apply to mentally ill offenders, who are admitted to a mental health facility.