Mental Health, Human Rights, and Legal Capacity

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) continues to play a substantial role globally in shaping mental health policy making, clinical practice, and beyond. Article 12, along with its interpretive General Comment 1, enshrine a right to equal recognition before the law for all people, including those with psychosocial disabilities. General Comment 1, in fact, declares that this right amounts to universal legal capacity, and mandates the immediate development of supported decision-making regimes to eliminate substituted decision-making and coercion in mental health care.

These provisions have sparked debate and resulted in contention, but they have also spurred mobilization among activists, policy makers, and the clinical community. For example, the World Psychiatric Association adopted a position statement in 2020 the calling for widespread implementation of non-coercive mental health care supports. Similarly, law reform and research in the field of supported decision-making have triggered legislative changes, such as Peru's civil code reform, and new forms of crisis support, including the Circle of Care model in India and human rights-based approaches in Kenya. Courts, too, have taken note of the sea-change, as evidenced in Guachalá Chimbo & Others v. Ecuador, where the  Inter-American Court of Human Rights forcefully applied the CRPD to informed consent safeguards in psychiatric hospitals.

HPOD's Executive Director, Professor Michael Ashley Stein, co-authored the comment along with Juliana Restivo, who coordinates both the GlobalMentalHealth@Harvard Initiative and the Mental Health for All Lab at Harvard Medical School, as well as the co-editors of the Cambridge University Press volume Mental Health, Legal Capacity, and Human Rights, including HPOD affiliated faculty Vikram Patel, the Pershing Square Professor of Global Health and Wellcome Trust Principal Research Fellow at the Harvard Medical School's Department of Global Health and Social Medicine; HPOD associate and Senior Program Officer for Mental Health and Rights at Open Society Foundations, Faraaz Mahomed; and Charlene Sunkel, of the Global Mental Health Peer Network.

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