AD HOC COMMITTEE ON
AN INTERNATIONAL CONVENTION

Third Session, 24 May - 4 June 2004
Fourth Session, 23 August - 3 September 2004
Working Group, 5-16 January 2004
Previous meetings

THE PANAMERICAN HEALTH ORGANIZATION’S (PAHO) ADVOCACY STRATEGIES FOR THE PROMOTION AND PROTECTION OF THE HUMAN RIGHS OF PERSONS WITH MENTAL DISABILITIES AND THEIR FAMILY MEMBERS

by
Jose Miguel Caldas de Almeida and
Javier Vasquez

I. INTRODUCTION

The persons with mental disabilities frequently are victims of cruel, inhuman, and degrading treatment, and in addition are isolated in psychiatric institutions under deplorable conditions that affect negatively their health and at times can even threaten their own life. This situation, required to take immediate actions in order to protect the life and the physical and psychological integrity of thousands of adults and children who are detained in psychiatric institutions or abandoned on the streets.

In general, the services available in Latin America and the Caribbean are still limited and their orientation is inadequate. Psychiatric care is usually based on hospitals that function with very limited budget. Frequently, these institutions are socially and geographically isolated, and as it has been indicated, the human rights and fundamental freedoms of the patients are violated. [1] According to PAHO[2], the Center of Human Rights of United Nations[3], and the Commission of Human Rights of the United Nations[4], the rights and fundamental freedoms most frequently violated in psychiatric hospitals include the right to be treated with humanity and respect, the right to a voluntary admission in psychiatric institutions, the right to privacy, freedom of communication, the right to receive treatment in the community, the right to provide informed consent before receiving any treatment and the right to appeal to an independent and impartial tribunal that determines the legality of the detention.

As a response to this situation, PAHO’s Mental Health Program (the Program), as regional office for the Americas of the World Health Organization (WHO) and Specialized Agency of the Organization of American States (OAS) launched in 1990 the Initiative for the Restructuring of Psychiatric Care, with the support of the Collaborating Centers of WHO and other regional and international organizations. As part of this initiative, in 1990 PAHO sponsored the Regional Conference for the Restructuring of Psychiatric Care in Latin America, where the Declaration of Caracas was adopted.[5] The Declaration of Caracas proposes the preservation of the basic rights and fundamental freedoms of persons with mental disabilities and the updating of mental health laws, as part of the strategies to carry out this restructuring.[6] The Declaration of Caracas establishes some guidelines with regard to human rights and mental health and is an important instrument with respect to the promotion of community services.

The declaration mentioned above, points out that the organizations, associations, health authorities, mental health professionals, lawyers and jurists undertake “to advocate and develop programs at the country level that will promote the restructuring desired, and at the same time that they commit themselves to monitoring and defending the human rights of mental patients in accordance with national legislation and international agreements…”

Furthermore, the Declaration of Caracas establishes “[t]hat the resources, care, and treatment that are made available must safeguard personal dignity and human and civil rights…”, and recommends that national legislation must be redrafted if necessary “…so that the human and civil rights of mental patients are safeguarded…”

The Declaration of Caracas emphasizes on the right of the mental patients to be treated in their community, and advocates for a comprehensive, continuous, and preventive psychiatric care where the psychiatric hospital does not constitute the only mean of assistance. The Declaration refers to the right of the mental patient to be treated with humanity and respect. In fact, according to this Declaration, the psychiatric hospital “…isolates patients from their natural environment…and creates unfavorable conditions that imperil the human and civil rights of patients….”

In addition, as part of the Initiative for the Restructuring of Psychiatric Care, the Program and the Department of Legal Affairs started joint activities in order to promote and protect the basic rights and fundamental freedoms of persons with mental disabilities. On the basis of this collaboration, in 1998 PAHO published the report “Diagnostic on the situation of human rights of persons with mental illness in Central America.”[7] This study reflected that none of the countries visited by PAHO, had a specific legal instrument to protect the persons with mental disabilities and their family members.

II. SPECIFIC ACTIVITIES

A. Collaboration with WHO (Headquarters) in the campaign “Stop exclusion, dare to care”

One of the components of WHO’s campaign “Stop exclusion, dare to care”[8] is the promotion and protection of the human rights and fundamental freedoms of persons with mental disabilities and their family members. Certainly, the compliance with human rights provisions contributes to the patients’ rehabilitation, the prevention of mental disorders and the elimination of stigma and discrimination[9], which precisely are some of the objectives of the referred campaign. Therefore, in order to achieve these goals, PAHO has been collaborating with WHO’s Department of Mental Health and Substance Dependence (Geneva) through innovative applications of international human rights law.

Thus, on 2 and 3 April 2001, an international symposium on human rights and mental health organized by WHO and PAHO was held at Geneva. The event was attended by 52 experts from all five continents and addressed topics such as the link between human rights and mental health, strategies to promote and implement the international human rights instruments and the role of human rights bodies in the promotion and protection of the rights of persons with mental disabilities and their family members. In addition, such experts participated in the development and revision of a mental health legislation manual which will provide information and practical advise in order to support countries in the area of mental health legislation and assist them in formulating strategies for the drafting and amending of mental health laws, the process for enacting mental health legal frameworks and the implementation of new or existing mental health laws.

Subsequently, on 6 April 2001, and again as part of the above mentioned campaign, WHO with the collaboration of PAHO organized at Geneva, a round table under the name Linking Human Rights and Health. The round table was held at the Palais des Nations on the ocassion of the 57^Th session of the United Nations Commission on Human Rights. At the round table, WHO and PAHO described the most salient features of the technical cooperation between both organizations and international human rights bodies, and referred in particular to the importance of joining efforts to disseminate the international standards and conventional human rights norms that protect persons with mental disabilities through appropriate and dynamic channels.

B. The training workshops: an appropriate and dinamic mechanism

The international standards and conventional human rights norms governing protections due persons with mental disabilities and their family members are largely found in declarations approved by the United Nations General Assembly, and in binding European and Inter-American Conventions specifically devoted to that subject. [10]

These standards, however, as well as other fundamental human rights, have not been generally incorporated into national legal frameworks, and much less in national mental health policies and plans providing equal-opportunities for persons with mental disabilities and their family members.[11] Some of these internationally accepted standards can be found in the Declaration on the Rights of Mentally Retarded Persons[12], the Declaration on the Rights of Disabled Persons[13], the Standard Rules on Equalization of Opportunities for Persons with Disabilities[14], the Principles for the Protection of Persons with Mental Illness and Improvement of Mental Health Care[15], the Declaration of Caracas[16] and the Recommendation of the Inter-American Commission on Human Rights for the Promotion and Protection of the Rights of the Mentally Ill.[17]

PAHO, believes that any discussion of patient's rights and the eventual drafting of domestic legislation in this field must begin with the dissemination among U.N. agencies and other intergovernmental organiPzations, international and national NGO’s, national human rights institutions, ombudspersons, government officials, mental health professionals, lawyers, law students, consumers, their relatives and other persons involved in the promotion of mental health policies of the international standards and conventional norms that protect persons with mental disabilities.

This international legal framework is an important tool of the above mentioned PAHO’s Initiative for the Restructuring of Psychiatric Care in the Americas (started in 1990) and is an integral part of basic human rights and fundamental freedoms already accepted internationally. The dissemination of the international standards and conventional norms contributes to the respect of patient’s rights and at the same time leads to markedly better promotion of mental health. Certainly, these international standards can also provide a framework for action in shaping specific interventions aimed at prevent the impact of health conditions on the lives of individuals with mental disorders.

The role of PAHO is vital not only in order to disseminiate the body of international mental health principles in the countries and to instruct local governments about them, but also in order to incorporate Non-Governmental and consumer organizations [at all levels] that are capable of further dissemination of the international standards as well. Ultimately, NGO’s and consumer organizations could become an important bridge to incorporate the international standards that protect persons with mental disabilities into the nation legislative framework and empower consumers and their relatives as meaningful and active participants.

In order to contribute towards the dissemination mentioned above, PAHO with the collaboration of WHO and other international organizations such as the OAS (Inter-American Commission of Human Rights) is organizing training workshops in the region of the Americas. Such workshops are one of the advocacy strategies implemented by PAHO not only to promote and protect the basic human rights and fundamental freedoms of persons with mental disabilities, but also to offer Member States guidance on how to design and/reform their mental health policies, plans and legislation and to coordinate the development by individuals and organizations (governmental and non-governmental) of integrated national networks for the promotion and protection of mental health.

PAHO has conducted so far training workshops in Nicaragua, Costa Rica and Panama and after having analysed the situation of the human rights of persons with mental disabilities in the Americas, the Program realized that it was necessary to disseminate the international standards and general norms referred above, not only in Central America, but also in the Caribbean and in South America. Accordingly, in December 2001 PAHO intends to organize a training workshop in Asuncion, Paraguay where the Government has shown considerable willingness to reorganize psychiatric care.

The participants to the workshops in Nicaragua, Costa Rica and Panama represented various sectors of the government, civil society and international organizations such as: Ministries of health, ministries of labor, ministries of justice, social security offices, ministries of education, police departments, national psychiatric hospitals, judiciary, legislature, Ombudsman offices, national and private universities, professional associations (nurses, psychiatrists, social workers, journalists, etc.), organizations of consumers and their families, NGO’s, agencies of the United Nations and agencies of the Organization of American States, among others. The outcome of the workshops is summarized as follows:

1) Workshop in Nicaragua (May 28 and 29, 2001):

It was attended by 30 persons.

PAHO visited the National Psychiatric Hospital upon the request of its Director [who participated in the workshop].
The Ombudsman office decided to include the situation of persons with mental disabilities in its national plan by involving consumers, staff members from the National Psychiatric Hospital and universities.
The Ministry of Health’s representative requested PAHO’s advice on the implementation of international standards and human rights norms
The participants drafted a document which included some recommendations such as the need of designing and implementing a national mental health policy according to the international standards discussed in the workshop. The document was submitted to the Ministry of Health, the Supreme Court, the Legislature and the media.
The national network had a first meeting with the Ministry of Health (July 25, 2001) to discuss the importance of designing a national mental health policy. Representatives of PAHO’s office, Ombudsman office, National Psychiatric Hospital and consumer organizations attended this meeting.
The national network, with PAHO’s support, conducted through the months of August and October, 12 local workshops for mental health personnel, journalists, Ombudsman office's personnel, consumers, families, nurses and young leaders.
Two national workshops have been already conducted at the National Psychiatric Hospital where 100 staff members participated. In addition, a national workshop for 30 young community leaders was also organized by the national network.

2) Workshop in Panama (June 8, 2001):

It was attended by 70 persons. The Inter-American Commission on Human Rights (IACHR) visited Panama to perform an observation in loco. As part of its visit, the IACHR visited the National Psychiatric Hospital and was technically assisted by PAHO with regard to the international and regional standards that protect persons with mental disabilities. During the visit, the Director of the Hospital and PAHO agreed on the idea of conducting a training workshop [in the hospital] for staff due to the limited information available in the country with regard to patients’rights.

The participants represented the following departments: psychiatry, nursing care, laboratory, dentistry, alcohol and drugs, occupational therapy, consumers and their families, psychology, pharmacy and legal affairs.
The Director of the Hospital expressed her interest in continuing to receive technical assistance from PAHO.

3) Workshop in Costa Rica (June 27 and 28, 2001):

It was attended by 50 persons.

The Social Security Office representative announced that a new model on mental health care would be submitted to the board of directors of this entity. The new model will include a national network, patients’families and general hospitals. This announcement was published by the press.
The Ombudsman office made a public announcement to public institutions and civil society about stopping stigma and discrimination of persons with mental disabilities. This office committed to disseminate among public institutions the international standards and general norms which were explained in the workshop. This announcement was covered by the press and t.v. The Ombudsman office will conducted its first workshop for the Judiciary and the association of journalists last August.
The Consejo Nacional de Rehabilitación y Educación Especial, presented a new community based program (residential programs). PAHO visited the houses where consumers live and this institution expressed its interest in receiving technical orientation with regard to the international standards that apply to community based programs.

It is important to mention that the training workshops implement PAHO’s Directing Council Resolution CD40/R/10 of September 27, 2001 which urges Member States “…to make efforts to develop and update legal provisions protecting human rights of people with mental disabilities and promote the participation of consumers and families in mental health care…” With regard to the link between the training workshops and mental health reform, it is important to mention that according to the World Health report 2001, the establishment of mental health policy, programmes and legislation is a necessary step for significant and sustained action in the area of mental health; and therefore the report recommends that such steps be based on human rights considerations.[18]

C. Collaboration with International Human Rights Bodies

In February 2001, the Organization of American States’ Inter-American Commission of Human Rights (IACHR) invited PAHO to discuss the situation of persons with mental disabilities and their family members in the hemisphere during its 110^th ordinary period of sessions. At the time, PAHO recommended that the Commission undertake specific measures to promote and protect the human rights and fundamental freedoms of the persons mentioned above and suggested that OAS collaborate more closely with PAHO to promote the international standards and human rights norms that protect persons with mental disabilities.

Subsequently, during the IACHR’s 111^th Extraordinary Period of Sessions, held in Santiago, Chile, in April 2001, a recommendation directed to OAS Member States regarding the promotion and protection of the human rights of persons with mental disabilities was approved (See Annex I). Such document incorporated PAHO’s technical guidelines to States, civil society, consumers and their family members with regard to the establishment of appropriate mechanisms to disseminate and implement the international human rights instruments that protect persons with mental disabilities, the formulation and/or amendment of national mental health laws, policies and plans and the establishment of monitoring bodies.

The document recommends, inter alia, that the Member States of OAS and civil society should take “legislative, judicial, administrative, educational, and other steps to disseminate through appropriate, dynamic channels [among government authorities, NGO’s, mental health professionals, attorneys, judges, and other persons involved in promoting mental health policies] the international standards and provisions of human rights conventions that protect the fundamental freedoms and civil, political, economic, social, and cultural rights of persons with mental illness”.

It is important to underline that in the document mentioned above, the IACHR addresses the universal principle of non-discrimination that applies to persons with mental disabilities when refers specifically to consumers and their family members [not only to States] and reminds them that “…the mentally ill share the same basic rights and freedoms as all other human beings and that there are international principles protecting them, particularly because of their position of vulnerability and powerlessness.”

As part of this cooperation, the IACHR has decided to include psychiatric hospitals as part of its visits in loco and make its observations according to the international standards explained by PAHO in the meeting mentioned above. Indeed, last June 7, the IACHR visited the National Psychiatric Hospital of Panama and it was the first visit to a psychiatric institution made by this body. Prior to the visit and during the visit, PAHO gave technical assistance with regard to the interpretation of the American Convention on Human Rights according to the United Nations' standards, PAHO's documents and WHO's guidelines on this matter; and assisted the IACHR regarding the general situation of persons with mental disabilities in Panama according to PAHO's previous reports. PAHO visited the Hospital along with the IACHR and the later will release a report on the general situation of human rights in Panama which will include for the first time ever a section on mental health and human rights.

In addition, the IACHR will request PAHO's technical opinions to interpret the American Convention on Human Rights and the American Declaration on the rights and Duties of Man in light of the international standards of protection that apply to mental health. The IACHR will incorporate these standards in final reports regarding to individual cases where the victims are persons with mental disabilities and in special reports issued by the IACHR with regard to the situation of human rights in OAS Member States. As it has been said, during the visit to Panama, the Director of the Hospital and PAHO agreed on the idea of conducting a training workshop [in the hospital] for staff members.

Finally, in October 2001, the IACHR invited PAHO, once again, to discuss the specific activities that had been carried out to implement the recommendation of the IACHR mentioned above. PAHO referred to the training workshops as one of the strategies implemented to protect and promote the human rights and fundamental freedoms of persons with mental disabilities according to the IACHR’s recommendation mentioned above and [PAHO] took the opportunity to invite the IACHR to participate in these workshops, as it has done in others. PAHO urged the IACHR to continue to include the issue of mental disability rights in its special reports on the human rights situation in the Member States of the Inter-American System and recommended that in the same reports, the IACHR urge the Member States of the OAS to reform existing mental health legislation, and in the absence of such legislation, to draw up legislation which ensures that the human rights and fundamental freedoms of persons with mental disabilities are respected, by incorporating the international standards and general human rights norms that protect persons with mental disabilities.

D. “Basic International Documents on Mental Health & Human Rights”: upcoming PAHO Publication

As it has been pointed out, most of the instruments that protect persons with mental disabilities and their family members are not widely known, and as such, do little to stop stigma, discrimination and frequent violations to the rights of the persons mentioned above. To further this urgent objective, PAHO [through the Program and the Department of Legal Affairs] will publish a compilation of relevant international standards and general human rights norms that guarantee the basic rights and fundamental freedoms of persons with mental disabilities, as adopted by the United Nations, as well as European and Inter-American human rights bodies, and standards adopted by NGO’s.

This publication is intended to be an essential tool for government officials, national human rights institutions, Ombudspersons, international organizations, specialized agencies of the United Nations, NGO’s, mental health staff, lawyers, laws students, consumers, their family members and other persons involved in the promotion and protection of the rights of persons with mental disabilities and in the formulation of mental health plans, policies and laws.

ANNEX I

ORGANIZATION OF AMERICAN STATES

INTER - AMERICAN COMMISSION ON HUMAN RIGHTS

RECOMMENDATION OF THE INTER-AMERICAN COMMISSION ON HUMAN RIGHTS FOR THE PROMOTION AND PROTECTION OF THE RIGHTS OF THE MENTALLY ILL

In 1990, the Pan American Health Organization (PAHO/WHO) – the World Health Organization’s (WHO) Regional Office of the Americas and a specialized agency of the Organization of American States (OAS) – sponsored the Regional Conference on Restructuring Psychiatric Care in Latin America, with the IACHR as a co-sponsor. At that conference, the Declaration of Caracas[19]was adopted.

The Declaration of Caracas establishes standards on protecting human rights and mental health. Regarding psychiatric care, it indicates that the “resources, care and treatment that are made available must safeguard personal dignity and human and civil rights … and strive to ensure that patients remain in their communities”. It also recommends that countries redraft national legislation to ensure that the “human and civil rights of the mental patients are safeguarded.”

In 1991, the United Nations General Assembly adopted the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care[20](Mental Health Principles). They are considered to be the most complete, detailed international standards for the protection of the rights of persons with mental illness and are an important guide for States in designing and/or reforming mental health systems.

The IACHR took cognizance of resolution CD.40.R15, adopted by the PAHO/WHO Directing Council on September 26, 1997, in which that body urges member states to “make efforts to improve the legislation to protect the human rights of psychiatric patients.”[21]

According to PAHO/WHO,[22] the United Nations Centre for Human Rights,[23] and the United Nations Commission on Human Rights,[24] the fundamental freedoms and basic rights most often violated in psychiatric hospitals include the right to be treated with humanity and respect, the right to voluntary admission, the right to privacy, freedom of communication, the right to receive treatment in the community, the right to give informed consent before receiving any treatment, and the right to appeal the legality of a psychiatric hospital detention to an independent, impartial court.

The Commission has found that, in the Americas, clients, their family members, mental health workers, attorneys, judges, and other persons involved in the promotion and protection of mental health have limited knowledge of international standards and the provisions of conventions protecting the rights of persons with mental illness. Furthermore, in most cases those standards and provisions have not been incorporated into national law.

In April 1999, the Inter-American Commission on Human Rights approved Report N° 63/99 in the case of a person with a mental disorder.[25] That report finds that it is “pertinent to apply special standards to the determination of whether the provisions of the Convention have been complied with in cases involving persons suffering from mental illnesses” or detainees in psychiatric hospitals, who are considered to be a particularly vulnerable group. In that report, the IACHR interpreted the standards of the American Convention that provide for the right to physical integrity, the right to life, and the right to judicial protection in light of the Mental Health Principles. In that report, the IACHR also agreed with the position of the European Court of Human Rights, which has established that the state of health of a victim is an important factor in determining whether they have been subjected to inhumane or degrading punishment or treatment and therefore concluded that the incarceration of a mentally disabled person under deplorable conditions and without medical treatment may be considered as inhumane or degrading treatment, prohibited under Article 5(2) of the American Convention on Human Rights.[26]

In view of the foregoing,

THE INTER-AMERICAN COMMISSION ON HUMAN RIGHTS,
RECOMMENDS:

That the States

1. Ratify the Inter-American Convention on the Elimination of All Forms of Discrimination against Persons with Disabilities, adopted by the OAS General Assembly on June 8, 1999, the objective of which is to prevent and eliminate all forms of discrimination against persons with physical or mental disabilities and to promote their full integration into society.

2. Take legislative, judicial, administrative, educational, and other steps to disseminate through appropriate, dynamic channels [among government authorities, NGOs, mental health professionals, attorneys, judges, and other persons involved in promoting mental health policies] the international standards and provisions of human rights conventions that protect the fundamental freedoms and civil, political, economic, social, and cultural rights of persons with mental illness.

3. Amend existing mental health or disability laws in general and, where they do not exist, establish laws that guarantee respect for the fundamental freedoms and human rights of persons with mental disability and their family members, incorporating international standards and the provisions of human rights conventions that protect the mentally ill.

4. Promote and implement, through legislation and national mental health plans, the organization of community mental health services, to achieve the full integration of the mentally ill into society and involve professional organizations, associations of clients and their family members, their friends, social welfare agencies, and other members of the community in the rehabilitation of the mentally ill patient.

5. Promote, through the Ombudsman, the establishment of specific initiatives to protect the human rights of the mentally ill.

6. Take the necessary steps for all mental health institutions to display the rights of mental health patients in a visible location, such as waiting rooms, admission services, and other locations frequented by patients and their family members.

7. Support the establishment of organs that supervise compliance with human rights norms in all psychiatric care institutions and services; committee activities should involve patients, their family members and representatives, and mental health workers.

8. Establish mechanisms for raising awareness, public education (development and dissemination of educational materials, such as pamphlets, posters, videos, etc.) and actions aimed at combating stigmatization and discrimination against the mentally ill, through state agencies and NGOs, in keeping with international standards and the provisions of conventions protecting these persons.

That all parties involved in promoting mental health (institutional defense committees; associations of psychiatrists, psychologists, social workers and nurses; civic groups; NGOs; associations of clients and their family members; attorneys; law students; etc.)

1. Become actively involved in protecting the human rights of the mentally ill and include concrete measures in their programs.

2. Disseminate international standards and the provisions of conventions protecting the rights of the mentally ill, through meetings, conventions, scientific publications or educational campaigns, using all available media.

3. Make an effort to celebrate the World Mental Health Day every October 10^th and use that opportunity to promote the rights of the mentally ill.

4. Coordinate actions with the ministries of health, social security funds, health centers, ombudsmen, and other government agencies responsible for implementing mental health policies to protect the rights of the mentally ill.

That clients and their family members

1. Be aware that the mentally ill share the same basic rights and freedoms as all other human beings and that there are international principles protecting them, particularly because of their position of vulnerability and powerlessness.

Approved by the Inter-American Commission on Human Rights at its 111° special session held in Santiago, Chile April 4, 2001

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[1] In April 1999, the Inter-American Commission on Human Rights approved a Report in the case of a person with a mental disorder known as the case of Victor Rosario Congo. That report finds that it is “pertinent to apply special standards to the determination of whether the provisions of the American Convention have been complied with in cases involving persons suffering from mental illnesses” or detainees in psychiatric hospitals, who are considered to be a particularly vulnerable group. In that report, the Inter-American Commission on Human Rights considered that the Ecuadorian State violated the right of Victor Rosario Congo to physical integrity, life, and judicial protection. In that report, the Commission also agreed with the position of the European Court of Human Rights, which has established that the state of health of a victim is an important factor indetermining whether they have been subjected to inhumane or degrading punishment or treatment and therefore concluded that the incarceration of a mentally disabled person under deplorable conditions and without medical treatment may be considered as inhumane or degrading treatment, prohibited under Article 5(2) of the American Convention on Human Rights. See Inter-American Commission on Human Rights, Report No. 63/99, Case No. 11.427, Ecuador, Annual Report 1998.

[2] Diagnóstico sobre el estado de los derechos humanos de las personas con enfermedad mental en países de Centro América, Informe Final, Tegucigalpa, julio 1998, OPS/OMS. This report diagnosed the situation in five countries: Costa Rica, El Salvador, Honduras, Nicaragua and Panama.

[3] United Nations, Center for Human Rights, Study Series Human Rights and Disabled Persons, 1993, p. 27 (Special Rapporteur Leandro Despouy)

[4] United Nations, Economic and Social Council, Commission on Human Rights, Sub-Commission on Prevention of Discrimination and Protection of Minorities; Principles, Guidelines and Guarantees for the Protection of Persons Detained on Grounds of Mental Ill-Health or Suffering from Mental Disorder, U.N. Doc. E/CN.4/Sub.2/1983/17, p. 24-27 (Special Rapporteur Erica Irene Daes).

[5] In 1990, lawyers, judges, professional associations and mental health professionals gathered in Caracas and drafted the Declaration of Caracas. See Itzak Levav, Helena Restrepo y Carlyle Guerra de Macedo, The Restructuring of Pasychiatric Care in Latin America: A new policy for Mental Health Services, 15 J. PUBLIC HEALTH & POLICY, p. 71 (1994).

[6] To date, only ten American nations possess a comprehensive legal framework specifically defining the rights and freedoms of people with mental disabilities and their family members (Argentina, The Bahamas, Barbados, Canada, Chile, Guyana, Jamaica, Mexico, Trinidad & Tobago and the United States). It is important to mention that before the Declaration of Caracas were approved, only 6 countries possessed such legal framework and subsequently, after 1990, 4 other countries enacted mental health laws.

A somewhat lesser degree of protection is afforded in a second group of countries, by way of general or disability laws (Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Paraguay and Peru. See Pan American Health Organization/World Health Organization (OPS/OMS) , Public Policy and Health Program, Psychiatric care and Mental Health Legislation in the English-speaking Caribbean Countries, Technical Reports Series No. 71, Washington D.C. 1999.

[7] Id. supra note 2.

[8] WHO launched in 2001 a campaign under the slogan “Stop exclusion, dare to care”. The main aim of the campaign is to promote and protect global mental health, on account of the major impact that mental disorders have on the population, and to eliminate the stigma and discrimination that go hand in hand with such disorders.

[9] See David P. Fidler: “International Law and Public Health: Materials on and Analysis of Global Health Jurisprudence”, TransnOne of the components of WHO’s campaign “Stop exclusion, dare to care”[9] is the promotion and protection of the human rights and fundamental freedoms of persons with mental disabilities and their family members. Certainly, the compliance with human rights provisions contributes to the patients’ rehabilitation, the prevention of mental disorders and the elimination of stigma and discrimination[9], which precisely are some of the objectives of the referred campaign. Therefore, in order to achieve these goals, PAHO has been collaborating with WHO’s Department of Mental Health and Substance Dependence (Geneva) through innovative applications of international human rights law.

[10] Persons with mental disability and their family members have the right to exercise all civil, political, economic, social, and cultural rights and fundamental freedoms as recognized in the Universal Declaration of Human Rights, American Declaration of the Rights and Duties of Man, the International Covenant on Civil and Political Rights, The American Convention on Human Rights, the European Convention for the Protection of Human Rights and Fundamental Freedoms, the International Covenant on Economic, Social and Cultural Rights and the Additional Protocol to the American Convention on Human Rights (Pact of San Salvador), among others.

[11] See Informe Centroamerica, supra note 2

[12] G.A. Res. 2856, U.N. GAOR, 26^th Sess., Supp. No. 29, at 99, UN Doc. A/8429 (1971).

[13] G.A. Res. 3447, U.N. GAOR, 30^th Sess., Supp. No. 34, at 92, UN Doc. A/10,034 (1975).

[14] G.A. Res. 48/96, U.N. GAOR, 48^th Sess., Supp. No. 49 at 202, UN Doc.A/48/49 (1993).

[15] G.A. Res. 46/119, U.N. GAOR, 46^th Sess., Supp. No. 49 at 189, UN Doc. A/46/49 (1991).

[16] Id. supra note 5.

[17] Annual report of the Inter-American Commission on Human Rights 2000, IACHR, OAS/ser/L/V/II.111/doc. 20, rev (2001).

[18] The World Health Report 2001, “Mental Health: New Understanding, New Hope”, World Health Organization, Geneva, p. 111.

[19] In 1990, the Pan American Health Organization (PAHO/WHO) convened different mental health organizations, associations, and professionals and jurists to the Regional Conference on Restructuring Psychiatric Care in Latin America (1990), held in Caracas, Venezuela. The Declaration of Caracas was adopted in the framework of that Conference. The full text of the Declaration is reproduced in Itzak Levav, Helena Restrepo, and Carlyle Guerra de Macedo, The Restructuring of Psychiatric Care in Latin America: A New Policy for Mental Health Services, 15 J. PUBLIC HEALTH & POLICY, p. 71 (1994).

[20] Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care, G.A. Res. 119, U.N. GAOR, 46^th Session, Supp No. 49, Annex, pp. 188-192. U.N. Doc.A/46/49 (1991).

[21] See I. Levav & R. González Uzcátegui, Rights of Persons with Mental Illness in Central America, 101 ACTA PSYCHIATRICA SCANDINAVICA, p. 84 (2000).

[22] Diagnosis of the Human Rights Situation of the Mentally Ill in Central America, Final Report, Tegucigalpa, July 1998, Pan American Health Organization/World Health Organization. This report diagnoses the situation in five countries: Costa Rica, El Salvador, Honduras, Nicaragua, and Panama.

[23] United Nations, Centre for Human Rights, Study Series Human Rights and Disabled Persons, 1993, p. 27 (Special Rapporteur Leandro Despouy).

[24] United Nations, Economic and Social Council, Commission on Human Rights, Sub-Commission on Prevention of Discrimination and Protection of Minorities, Principles, Guidelines and Guarantees for the Protection of Persons Detained on Grounds of Mental Ill-Health or Suffering from Mental Disorder, U.N. Doc. E/CN.4/Sub.2/1983/17, pp. 24-27 (Special Rapporteur Erica Irene Daes).

[25] IACHR, Report N° 63/99, Case N° 11.427 (Victor Rosario Congo), Ecuador, Annual Report 1998.