Mental Health Law: International Legal Standards and Human Rights

Published by Jasmine Cameron at 16/10/2017

Source: Nick Scott for Vice

1. Introduction

We have dedicated our work to supporting the rule of law by assisting human rights defenders and their lawyers. Experience has taught us that human rights violations take a number of different forms. Some of the most outrageous cases we have come across are the ones where the most vulnerable in society, those without any ability to protect themselves or exercise their basic rights, are attacked. People with mental illness and disability fall in to this category. Even more outrageous, we have seen many instances where governments have used the mechanisms for the protection of people with mental illness as an avenue to abuse them and deprive them of their rights or as a way to silence those out of favor of the government. The natural reaction is outrage and disappointment when news comes out of a human rights defender, journalist, activist or opposition member is confined in a mental institution as a result of their activities. Typically, this practice exists because it allows the abusers to avoid or simplify the established civil or criminal procedures by forcefully detaining persons without due process and subjecting them to degrading medical treatment without any checks or access to family or lawyers. It also creates stigma and changes public perceptions of these activities—another reason for the use of this practice.

People suffering from actual mental illness also suffer when mental health is politicized. Human rights violations occur to persons with mental health issues on a daily basis. Such violations occur either inside psychiatric institutions because of inadequate and harmful treatments, abuse and denial of medical care, or by being marginalized and discriminated against by their own families and communities. Such violations initially stemmed from the stigma, myths and misconceptions that sometimes were based on the cultural or religious beliefs or plain ignorance. In fact, it is only in the 1980s to 1990s that people’s attitudes started to change and communities began to recognize mental health rights as human rights.

This shift in the understanding of the rights of the mentally disabled was codified in the adoption of the Convention on the Rights of People with Disabilities (CRPD) in 2006, the main international human rights instrument on the rights of persons with disabilities. These international legal instruments are important in protection of the rights of persons with mental disabilities. Not only do they establish foundational standards for human rights in the protection, promotion, monitoring of these rights, but they also force national governments to create systems, processes and mechanisms that would make the lives of people with mental disabilities better and give them rights that cannot be taken away arbitrarily and without due process. These international agreements are not enough, however. Many things remain to be done in terms of the improvement of human rights for persons with mental disabilities. These next steps include monitoring, implementation of reforms, raising awareness, integration, empowerment, and rehabilitation, especially at the national level. There is a tight connection between human rights and mental disability rights¹Gostin, Lawrence, The Human rights of person with Mental Disabilities: A Global prospective on the Application of Human rights Principles to Mental Health. p. 27, available at http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1088&context=facpub. All of us need to understand, appreciate and demonstrate respect for human rights for people with mental disabilities, and not only when light is being shined on well-known cases.

2. International instruments and norms regulating mental disabilities rights

It was not until approximately two decades ago that the rights of the mentally disabled began to be regulated at the international level and regarded as human rights²Perlin, Michael and Szeli, Eva ‘Mental Health Law and Human Rights: Evolution and Contemporary Challenges’, available at https://www.researchgate.net/publication/300109155_Mental_Health_Law_and_Human_Rights. Thereinafter Perlin and Szeli.. After this change, the rights of persons with mental disabilities were protected to a certain degree under the general principle that “all human beings are born free and equal in dignity and rights,”³Carla Arena Ventura, International Law, Mental Health and Human Rights available at https://humanrights.nd.edu/assets/134859/venturamentalhealth.pdf. Hereinafter Ventura so people with mental disabilities “do not need any additional proof to show that they deserve certain rights.”⁴Gostin, page 22

The main international instruments on human rights that also impact the mentally disable include the International Bill of Rights. This bill is a compilation of three documents: the United Nations (UN) Declaration of Human Rights (1948), the International Covenant on Civil and Political Rights (ICCPR, 1966) and the International Covenant on Economic, Social and Cultural Rights (ICESCR, 1966)⁵International Bill of Rights, available at http://www.ohchr.org/Documents/Publications/FactSheet2Rev.1en.pdf. These instruments laid out foundational standards for the these protections and generally established a framework of fundamental human rights that all UN member nations have to follow, though the Universal Declaration is not legally binding.

The other two instruments put duties on governments to respect, protect and promote human rights of the persons living within the territories of their states. However, as mentioned earlier, the ICCPR and ICESCR do not specifically provide protection to people with mental disabilities, but rather establish foundational principles for safeguarding and promoting these civil, political, social, economic, and cultural rights⁶Gostin, p. 34. For example, the ICCPR establishes civil and political rights and protects individuals from a government’s actions that violate people’s liberty, privacy, freedom of expression and association. Under the ICCPR’s provisions, mentally disabled people were able to argue for more human treatment and confinement conditions when committed to a psychiatric institution⁷Ventura citing Ashingdane v. United Kingdom, 93 Our. Ct. H.R. at 19 (1985) (plaintiff claimed that his transfer to a higher security hospital resulted in a deprivation of his liberty)..

The ICESCR imposes duties onto governments to provide support for people, including family protection, standard of living, education, and the right to share in scientific advancement and its benefits. According to Article 12, everyone has a right to the “enjoyment of the highest attainable standard of physical and mental health.”⁸Ventura, supra note 5, p. 3 Further, the article lays out the steps necessary for states to take for the realization of this right. In 1996, the Committee on Economic, Social and Cultural Rights, the organization tasked to monitor and implement the treaty, adopted General Comment 5 that elaborated on these rights. According to General Comment 5, provisions of article 12 of the ICESCR were interpreted as being applicable to people with mental and physical disabilities⁹Id..

However, some scholars have argued that although these international rights human instruments existed, they lacked provisions that are specific to persons with mental disabilities, thus, impairing the application of these instruments to persons with mental illnesses¹⁰Perlin and Szeli, supra note 4. As Dr. Theresa Degener, a noted disability scholar and activist, has stated:

[D]rafters of the International Bill of Human Rights did not include disabled persons as a distinct group vulnerable to human rights violations. None of the equality clauses of any of the three instruments of this Bill … mention disability as a protected category¹¹Theresa Degener, International Disability Law – A New Legal Subject on the Rise: The Interregional Experts’ Meeting in Hong Kong, December 13-17, 1999, 18 BERKELEY J. INTL. L. 180, 187 (2000).

Some legal scholars even argued that these international human rights instruments excluded persons with mental disabilities from its coverage. Clarence Sundram wrote that in some countries, persons with mental disabilities were subjected to many “inhumane, degrading treatments and illegal actions including arbitrary detention without legal process, forced sterilization, being chained and caged, being confined to horrible conditions in psychiatric institutions, being forced to use of painful medicines, unmodified electroconvulsive treatments without anesthesia, and medical experimentation.”¹²Gooding, Pierce, Change and Continuity in Mental Health Law: the Long Road to the United Nations Convention on the Rights of Persons with Disabilities and its Implications for Mental Health and the Law Today citing CJ Sundram, ‘Lost in the Shadows: Willowbrook and the Era of Institutionalization’ (presentation paper) Fulfilling the Promise, Albany Law School, March 22, 2013, 4, available at http://webjcli.org/article/view/367/470#_ftn74. Hereinafter Gooding. Sundrum further maintained that:

Generic recognition of human rights for all people has been insufficient to bring people with mental disabilities under the same umbrella because there had been a long history in society of regarding them as a separate class, with separate and lesser rights. Worse, the abuses to which people with mental disabilities have been exposed have generally not been recognized as violations of human rights even by organizations that are engaged in human rights work¹³Id..

However, the exclusion of mental health rights from mainstream human rights international law began to be addressed in the last two decades of 20th century. The perception of mental laws as not being part of human rights were changing as a result of a large movement and huge efforts by many participating actors¹⁴Perlin, Michael and Szeli, supra 4. After these efforts, many people began to understand how interconnected human rights law and mental law really were: (1) mental health policy affects human rights; (2) human rights violations affect mental health; and (3) positive promotion of both mental health and human rights are mutually reinforcing¹⁵Gostin, page 27.

However, there were several legally non-binding instruments that were adopted by the UN later in the 1970s, including the UN Declaration on the Rights of Mentally Retarded Persons (1971) that served as a guideline for good practices in the area of mental health.

In the 1980s, several events took place in the development of the international system for mental law standards, including the United Nations announcement of 1981 as the International Year of Disabled Persons, the UN World Programme of Action Concerning Disabled Persons, and 1983 to 1992 was declared the Decade of Disabled Persons¹⁶United Nations, 10th anniversary of the adoption of Convention on the Rights of Persons with Disabilities (CRPD), available at https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/the-10th-anniversary-of-the-adoption-of-convention-on-the-rights-of-persons-with-disabilities-crpd-crpd-10.html. Two special rapporteurs to investigate the human rights needs of persons with mental disabilities were appointed at this time by the UN as well¹⁷Id..

In the 1990s, other initiatives were taking place, including the adoption by the UN General Assembly of the Principles for the Protection of Persons with Mental Illness and of the Improvement of Mental Health Care (MI Principles)¹⁸Id.. Some scholars characterized the MI Principles as “the most comprehensive international human rights standards for persons with mental disabilities, and their adoption was a critical global step in recognizing mental disability rights issues within the human rights arena.”¹⁹Perlin and Szeli, supra 16 Specifically, the MI Principles required more humane, less restrictive and more individualized approach towards persons with mental disabilities, and the treatments for the persons with mental disability had to be done under the independent and impartial authority of mental health tribunals²⁰ Gooding, supra 15. The MI Principles, however, still reflected the old views of the principle of informed consent and involuntary medical treatment endorsing it when a person is considered to lack competence²¹Id..

Other non-legally binding documents were adopted in the 1990s and served as interpretive guidelines to international treaty obligations, including the Standard Rules for Equalization of Opportunities for Persons with Disabilities (1993) and the Declaration of Madrid (1996). Other standards such as WHO’s Mental Health Care Law: Ten basic principles and WHO Guidelines for the Promotion of Human Rights of Persons with Mental Disorders (1996) were also adopted during this time²²Ventura, supra note 5.

In 2001, the UN General Assembly established an Ad Hoc Committee “to consider proposals for a comprehensive and integral international convention to promote and protect the rights and dignity of persons with disability.”²³Comprehensive and Integral Convention to Promote and Protect the Rights and Dignity of Persons with Disabilities, G.A. Res. 168, U.N. GAOR, 56th Sess., 88th plen. mtg., U.N. Doc. A/56/583/Add.2 (2001). The Ad Hoc Committee included over 40 representatives from different countries and over 400 representatives from NGOs²⁴UN, 10th anniversary of the adoption of Convention on the Rights of Persons with Disabilities (CRPD), available at https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/the-10th-anniversary-of-the-adoption-of-convention-on-the-rights-of-persons-with-disabilities-crpd-crpd-10.html. These organizations adopted the motto “nothing about us without us,” and their contributions based on personal experiences of life with disabilities made this process much more important. The Convention on the Rights of Persons with Disabilities was the result of five years’ work and eight sessions of this committee²⁵Arlene S. Kantor, The promise and challenge of the disability convention, p. 308, available at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2109836.

3. Convention on the Rights of Persons with Disabilities (CRPD)

On December 13, 2006, the UN General Assembly adopted the main international instrument to protect the rights of people with disabilities – the Convention on the Rights of Persons with Disabilities²⁶Convention on the Rights of Persons with Disabilities (A/RES/61/106), available at https://www.un.org/development/desa/disabilities/resources/general-assembly/convention-on-the-rights-of-persons-with-disabilities-ares61106.html (CRPD) together with its Optional Protocol. While the previous instruments, declarations, documents, and other initiatives provided general legal foundations and overall coverage for the persons with mental disabilities, CRPD was the main comprehensive instrument that established international legal standards for the specific protection of the rights of people with disabilities as a defined vulnerable group. Further, the CRPD is an international legally binding treaty that gave hope to approximately 650 million people with disabilities around the world²⁷United Nations, 10th anniversary of the adoption of Convention on the Rights of Persons with Disabilities (CRPD), available at https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/the-10th-anniversary-of-the-adoption-of-convention-on-the-rights-of-persons-with-disabilities-crpd-crpd-10.html.

After the CRPD was opened for signature on March 30, 2007, it became the most swiftly ratified international treaty in history²⁸Id.. As of September 11, 2017, 174 states and the EU ratified the Convention, representing 89% of Member States in the United Nations²⁹10th anniversary of the adoption of Convention on the Rights of Persons with Disabilities (CRPD), available at https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/the-10th-anniversary-of-the-adoption-of-convention-on-the-rights-of-persons-with-disabilities-crpd-crpd-10.html. The Convention entered into force on May 3, 2008.

This convention establishes a comprehensive international framework to guide national policy and law making with the end goal of building a disability-inclusive society. These established international instruments promote, facilitate and support disability inclusive practices and processes among signatory states. Once these international instruments were established, national systems would be required to adopt and harmonize legislation, norms and practices in order to comply with these international standards³⁰Id..

In order to implement the norms established by the CPRD, the Committee on the Rights of Persons with Disabilities was created in October, 2008. The committee consists of 18 independent experts who meet in Geneva three times a year to review the periodical national reports on implementation of the CRPD, to work on general comments of certain provisions of the CRPD, and to respond to the communications on violations of human rights that are covered by the CPRD. The Office of High Commissioner for Human Rights based in Geneva (OHCHR) generally supports the work of the Committee³¹ There are other UN structures to support the work of the CPRD implementation. In September 2006, the UN Inter-Agency Support Group on the Convention on the Rights of Persons with Disabilities (IASG) was established per a decision by the CEB to strengthen coordination and coherence of the work of UN agencies, funds and programs and to promote their policies and mechanisms to be inclusive of and accessible to persons with disabilities. The IASG has currently over 30 members who meet periodically, with DESA serving as the co-chair..

CRPD is one of the nine UN core international human rights instruments³²The Core International UN Human Rights Instruments and their monitoring bodies, available at http://www.ohchr.org/EN/ProfessionalInterest/Pages/CoreInstruments.aspx that provide protection to vulnerable groups of persons and complement and intersect with each other. Thus, the CRPD outlines rights that, arguably, are already covered by other UN treaties, but the CRPD frames these rights in a way that is specific for people with disabilities, a group of persons rarely referred to in those other human rights treaties³³Gooding, supra 14. In other words, the CRPD changes the approach towards the persons with mental disability from “in the words of the then United Nations Human Rights Commissioner, Louise Arbour, a ‘view of persons with disabilities as objects of charity, medical treatment and social protection’ and to affirm them instead as ‘subjects of rights, able to claim those rights as active members of society.’”³⁴Id.

The main goal of the convention is the elimination of discrimination against persons with disabilities and providing assurances that rights are to be enjoyed on an equal basis with others.

According to Article 1, the overall purpose of the CRPD is to “promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity”³⁵Convention on the Rights of Persons with Disabilities (A/RES/61/106), available at https://www.un.org/development/desa/disabilities/resources/general-assembly/convention-on-the-rights-of-persons-with-disabilities-ares61106.html. The convention also provides a fluid and ‘evolving’ definition of disability based on the concept that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders full and effective participation in society on an equal basis with others. Article 3 sets out main principles such as equality, non-discrimination, respect for inherent dignity, full and effective participation and inclusion in society, respect for difference and acceptance of persons with disabilities as part of human diversity and humanity, equal opportunity, accessibility³⁶Convention on the Rights of Persons with Disabilities (A/RES/61/106), available at https://www.un.org/development/desa/disabilities/resources/general-assembly/convention-on-the-rights-of-persons-with-disabilities-ares61106.html.

The CRPD’s Article 4 establishes a duty for the participating states to take certain measures to make sure that national laws, policies, practices and customs do not discriminate against persons with disabilities³⁷Gostin, supra 1. These obligations include, for example, a duty to provide appropriate training regarding disability issues to those involved in the administration of justice, concrete programs to assist people with disabilities and their caregivers to recognize and combat exploitation, obligations to provide community support services, and overarching duties on states to raise awareness of disability issues and to combat discrimination³⁸Id, article 5, 13, 16, 19.

Specifically, the CRPD enumerates many rights that are also covered by other treaties, including the civil and political rights such as the right to liberty and integrity of persons, right to freedom of expression, right to privacy, the right to be free from torture and inhuman treatment, and rights to equal treatment and access to justice³⁹Id, articles 14, 17, 21, 22, 15, 12, 13. The CRPD also lists the rights of an economic, social and cultural nature, including the rights to health, right education and home and family life⁴⁰Id, article 23, 24, 25. As stated earlier, some of these rights have been framed so as to have particular relevance to people with disabilities: the right to be free from exploitation and abuse, the right to non-discrimination, the right to personal mobility, the right to independent living and community inclusion, the right to work and employment, and the right to participation in cultural life⁴¹Ventura, citing articles 5, 19, 27, 28, 30.

The Convention also establishes the UN Committee on the Rights of Persons with Disabilities. State Parties are required on a periodic basis to report to the Committee on their progress in implementing the Convention, and the Committee in turn publishes comments about this progress. Crucially, Article 33 of the Convention requires governments to ensure that representatives of civil society, in particular persons with disabilities and their representative organizations, are fully involved in monitoring the implementation of the Convention. Furthermore, for states that have ratified the optional protocol, individuals who consider themselves victims of violations of the Convention will be able to make formal complaints for determination by the Committee. For individual complaints, determinations will be public to help encourage positive resolution of the issue⁴²United Nations, 10th anniversary of the adoption of Convention on the Rights of Persons with Disabilities (CRPD), available at https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/the-10th-anniversary-of-the-adoption-of-convention-on-the-rights-of-persons-with-disabilities-crpd-crpd-10.html.

While the CRPD was considered a ‘paradigm shift’ in people’s attitudes and approaches towards the persons with disabilities, the more important work still remains with national governments in implementing these standards established by CRPD into the everyday life of the people with disabilities and into societies as a whole.

4. Regional Instruments

The regional human rights instruments and systems serve as additional tools of protection of the rights for persons with mental disabilities. Moreover, due to the fact that states have to create implementation mechanisms on the national level, and due to the specificities of the local systems, regional systems may provide more direct, targeted, specific means of protection. Regional courts are able to review the complaints and actions from local residents and provide redress for their grievances in cases where local courts were not able to address the disputes to the satisfaction of the petitioners. Such bodies are also used to challenge the local polices, practices and processes that discriminate and violate the rights of persons with disabilities⁴³Ventura, supra 5.

Of the various regional systems, the European regional system is relatively well developed, and has a sophisticated approach to the matters of mental health and protections of the rights of persons with mental disabilities⁴⁴Fennell, Philip, The Third Way in Mental Health Policy: Negative Rights, Positive Rights and the Convention..

The European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR), also known as the European Convention on Human Rights, was adopted in Rome in November 1950 and came into force in 1953⁴⁵European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR), available at http://www.echr.coe.int/pages/home.aspx?p=basictexts. It was the first regional instrument to give effect to and make binding certain rights stated in the Universal Declaration of Human Rights. It is also the highest regional instrument that regulates the human rights of persons, including the persons with mental disabilities, and affirmed “the enjoyment by all persons … of human rights and fundamental freedoms.”⁴⁶Id. Article 3 of the ECHR states that none shall be subjected to torture or to inhuman or degrading treatment or punishment. Generally, the European Court of Human Rights (ECtHR) applied this article in cases where intent or purpose to inflict degrading treatment was present, so this article was not applied in many occasions in cases with persons with mental disabilities⁴⁷Gostin, supra 4. Once applied, however, European Torture Convention might be relevant as well.

Article 5 of the ECHR guarantees that everyone has a right to liberty and security of persons. It further lists instances where governments may be justified in deprivation of a persons’ liberty, specifically paragraph 1 (e) refers to the instance of detention of “persons of unsound mind.”⁴⁸Gostin, supra 4 Governments have to inform the persons of the reasons for the detentions (part 2) and provide speedy review of the detention by a court (part 4). Here, however, we will not discuss the definition for the detention and how the ECtHR interpreted it in cases. The ECHR also contains provisions that provide protections for a person’s civil rights including the right to a fair trial (Article 6), right to respect for private and family rights (Article 8), and right to marriage and procreation (Article 12)⁴⁹European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR), available at http://www.echr.coe.int/pages/home.aspx?p=basictexts.

The European Social Charter also establishes legally binding provisions as it contains specific rights for persons with disabilities. According to Article 15 of the Charter, the persons with disabilities have rights to independence, social integration and participation in the life of the community. Further, Article E provides that the rights of the Charter shall be secured without discrimination on any ground⁵⁰Thorsten Afflerbach and Angela Garabagiu, Council of Europe Actions to promote human rights and full participation of people with disabilities: improving the quality of life of people with disabilities in Europe, 34 Syracuse J. Int’l L. & Com. 463. Hereinafter Afflerbach and Garabagiu.. Other legally binding European standards especially relevant to the rights of persons with disabilities include: the Council of Europe Conventions on Preventing and Combating Violence against Women and Domestic Violence (Istanbul Convention); on the Protection of Children against Sexual Exploitation and Sexual Abuse (Lanzarote Convention); and the Action against Trafficking in Human Beings⁵¹Id..

There are also a few specific non-binding legal documents on the protection of the rights of persons with mental disability. One of these is the so-called Helsinki Declaration signed in Helsinki, on 17 January 2005. In this declaration, the health ministers of the WHO European Region Member States endorsed the Mental Health Declaration for Europe: Facing the Challenges, Building Solutions. In this Declaration, ministers responsible for health committed themselves, “subject to national constitutional structures and responsibilities, to recognizing the need for comprehensive evidence-based mental health policies and to considering ways and means of developing, implementing and reinforcing such policies in our countries.”⁵²Id. Later in 2006, the European Union also published a Green Paper and launched a public consultation on its future strategy for mental health⁵³Id..

One other non-binding document was the Action Plan to Promote the Rights and Full Participation of Persons with Disabilities in Society: Improving the Quality of Life of Persons with Disabilities in Europe for 2006–2015⁵⁴Recommendation Rec(2006)5 of the Committee of Ministers on the Council of Europe Action Plan to promote the rights and full participation of people with disabilities in society: improving the quality of life of people with disabilities in Europe (2006-2015).. The Council of Europe adopted this plan in April, 2006, in order to encourage the shift in people’s attitudes from the old medical-based approach to mental disability to one based on human rights and on the principles of equality, societal inclusiveness, human dignity, independence, non-discrimination⁵⁵Council of Europe, Rights of Persons with Disabilities, available at http://www.coe.int/en/web/disability. The 2015–16 evaluation of the plan identified some accomplishments including national legislation, service delivery, the physical environment, and attitudes towards persons with disabilities. Some challenges noted in the evaluation were a better need for national compliance with international standards to eradicate discrimination and to ensure the respect of all human rights of persons with disabilities. The new Council of Europe’s Disability Strategy 2017–2023 has a goal of achieving equality, dignity and equal opportunities for persons with disabilities that could be achieved through ensuring independence, freedom of choice, full and effective participation in all areas of life and society, including living in the community⁵⁶Council of Europe’s disability strategy 2017-2023: A reality for all, available at https://rm.coe.int/16806fe7d4.

Last, but not the least, is the European Court of Human Rights (ECtHR). This court plays an important role in encouraging the member States to undertake legislative changes to safeguard human rights of persons with disabilities. The Court decides cases submitted by individuals and NGOs who are victims of a violation by a member state to the Council of Europe, when the domestic legal adjudication can be deemed to be inadequate⁵⁷Council of Europe, European Court of Human rights, available at http://www.echr.coe.int/. One of the most notable earliest cases on mental disability that the ECtHR reviewed was Winterwerp v. Netherlands that was brought under the European Convention of Human Rights Articles 5 and 6. In this case, the ECtHR held that that the Netherlands had infringed articles 5(4) and 6(1) of the ECHR by failing to provide mental patients with the ability to challenge their detention, but dismissed the claim under article 5(1) that the detention itself was unlawful. Following this case, the court heard many cases on the rights of persons with mental disabilities under various articles of the Convention⁵⁸Perlin and Szeli, supra 4.

Another notable case is Shtukaturov v Russia, where the Court found that Russia had violated several rights of the European Convention on Human Rights. As a result of this decision, the Russian Constitutional Court found three provisions that regulated the capacity and consent as applied to persons with mental disabilities as unconstitutional and ended up striking these provisions of the local laws.

5. Conclusion

The international basis of combating the violation of human rights of persons with mental disabilities is the framework created by international and regional legal instruments that establish a foundation to support the rights of persons with mental disabilities. Though there have been improvements in general awareness, the general public is normally not that aware of human rights abuses and violations in the area of mental health. Public attention generally only becomes focused on this issue when there is a series of separate incidents reported in the media. Examining history of these international and regional instruments, it is apparent that they play an important role not only in establishing legal structures, but also in encouraging governments to socialize populations on the importance of equal rights for those with mental disability. It is important for society as whole to be involved in this issue and to be aware of the important role mental health law plays in human rights law.[:]