Search

The United Nations Convention on the Rights of Persons with Disabilities requires a paradigm shift from a medical model of disability to a social model that emphasizes overcoming the barriers to equality created by attitudes, laws, government policies and the social, economic and political environment. The approach adopted by the social model recognizes that people with psychosocial disabilities have the same right to take decisions and make choices as other people, particularly regarding treatment, and have the right to equal recognition before the law. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. Although recent mental health laws in some countries have attempted to realize a rights- based approach to decision-making by reducing coercion, implementing the Convention on the Rights of Persons with Disabilities can be challenging because it requires continuous refinement and the development of alternatives to coercion. This article reviews the impact historical trends and current mental health frameworks have had on the rights affected by the practice of involuntary treatment and describes some legal and organizational initiatives that have been undertaken to promote noncoercive services and supported decision-making. The evidence and examples presented could provide the foundation for developing a context-appropriate approach to implementing supported decision-making in mental health care. La Convention des Nations Unies relative aux droits des personnes handicapees necessite un changement radical pour passer d'un modele medical du handicap a un modele social mettant l'accent sur la levee des obstacles en matiere d'egalite, crees par des attitudes, des lois, des politiques gouvernementales ainsi que l'environnement social, economique et politique. Lapproche adoptee par le modele social reconnait que les personnes presentant un handicap mental ont le meme droit de prendre des decisions et de faire des choix que les autres, notamment en matiere de traitement, et ont droit a une reconnaissance egale devant la loi. Par consequent, la prise de decision directe ou accompagnee doit etre la norme et il ne doit exister aucune prise de decision substitutive. Bien que certains pays aient recemment cherche, a travers des lois sur la sante mentale, a instaurer une approche fondee sur les droits en matiere de prise de decision en reduisant la coercition, la mise en reuvre de la Convention relative aux droits des personnes handicapees peut poser probleme, car elle exige une amelioration continue et l'elaboration de solutions autres que la coercition. Cet article examine l'impact que les tendances historiques et les cadres actuels en matiere de sante mentale ont eu sur les droits leses par la pratique du traitement involontaire et decrit plusieurs initiatives legislatives et organisationnelles qui ont ete prises pour promouvoir les services non coercitifs et la prise de decision accompagnee. Les donnees et les exemples presentes peuvent servir de fondement a l'elaboration d'une approche adaptee au contexte pour mettre en place la prise de decision accompagnee en matiere de soins de sante mentale. La Convencion de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad requiere un cambio de paradigma, de un modelo medico de discapacidad a un modelo social que haga hincapie en la superacion de las barreras a la igualdad creadas por las actitudes, las leyes, las politicas gubernamentales y el entorno social, economico y politico. El enfoque adoptado por el modelo social reconoce que las personas con discapacidad psicosocial tienen el mismo derecho a tomar decisiones y a elegir como cualquier otra persona, especialmente en lo que se refiere al tratamiento, y tienen derecho a un reconocimiento igualitario ante la ley. Por lo tanto, la toma de decisiones directa o apoyada deberia ser la norma y no deberia haber un responsable sustituto de la toma de decisiones. Aunque las recientes leyes sobre salud mental de algunos paises han tratado de aplicar un enfoque basado en los derechos para la adopcion de decisiones mediante la reduccion de la coercion, la implementacion de la Convencion sobre los Derechos de las Personas con Discapacidad puede ser un reto, ya que requiere un continuo perfeccionamiento y el desarrollo de alternativas a la coercion. Este articulo evalua el impacto que las tendencias historicas y los marcos actuales de salud mental han tenido sobre los derechos afectados por la practica del tratamiento involuntario y describe algunas iniciativas legales y organizativas que se han emprendido para promover servicios no coercitivos y apoyar la toma de decisiones. La evidencia y los ejemplos presentados podrian servir de base para desarrollar un enfoque apropiado al contexto para la implementacion de la toma de decisiones apoyada en la atencion de la salud mental., Introduction In December 2018, an independent review of the 1983 Mental Health Act of the United Kingdom of Great Britain and Northern Ireland concluded that reforms were needed to reduce [...]

Background: Family life is a near-universal condition and a fundamental human right. It can also have a significant impact on mental health, including recovery from mental health conditions. In India, families play a considerable role, representing a source of social, cultural, religious and, often, financial support. However, families can also play a stigmatising role. Aim: To examine the experiences of mental health service users (MHSUs) relating to stigma and support provided by family members and to consider ways in which family support can be improved. Method: This is a qualitative study. A total of 17 residential MHSUs at the Ahmedabad Hospital for Mental Health were interviewed. The results were evaluated using thematic content analysis. Results: The results revealed that all 17 MHSUs considered their families to be important sources of support, while 14 of the 17 MHSUs also experienced stigma emanating from their families. A total of 11 experienced lack of knowledge, 4 spoke of prejudicial attitudes and 5 mentioned discriminatory behaviours. There were important gender differences in experiences. MHSUs mentioned needs ranging from education and peer support for family members to financial support. Conclusions: Families act both as sources of support and stigmatisation. Education needs are considerable, while the need for peer support for families and resources to aid families in supporting people with mental health conditions are also important considerations. [ABSTRACT FROM AUTHOR]