MHApps Take Control – Knowing Your Rights – Information On Your Rights – Patient Human Legal Constitutional Employment
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The rights of people with mental health difficulties are further enshrined in many international legal instruments as well as in domestic Irish law.
All people with mental health difficulties have rights. Some rights are absolute, such as the right to life, with the State having an absolute duty to protect the right to life of the person. Other rights such as the right to health are qualified and may be subject to available resources to the State.
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· The right to life
· The right to liberty
· The right to bodily integrity
· The right to privacy
· The right to home and family
· The right to an education
· The right to be heard
· The right to health
· The right to work
· The right to non discrimination
· The right to express your opinions
· The right of access to justice
· The right to vote
It should be noted that the above list of rights is not exhaustive, and most rights can be and are subjected to limitations by the State.
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Key rights in irish law for people with mental health difficulties.where do they come from?
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Written in 1937, it is the highest law in the land. The Constitution contains individual rights and sets up the organs of State that will protect and vindicate the rights of the person.
The key constitutional rights are as follows:
· The right to life
· The right to earn a livelihood
· The right to privacy
· The right to bodily integrity
· The right to free expression
· The right to health
· The right to home and family
· The right to liberty
· The right of access to justice
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This Act was enacted to prohibit discrimination in relation to employment for people with disabilities. Discrimination is defined as “the treatment of a person in a less favourable way than another person, in relation to any aspect of their employment”. An employer is under a legal duty to take appropriate measures to enable a person with a mental health disability to have access to employment, participate or advance in employment or undertake training, unless the measures would impose a disproportionate burden on the employer. People with disabilities cannot be discriminated against in relation to the following aspects of employment.
· Advertising
· Equal pay
· Access to employment
· Terms and conditions of employment
· Promotion or regrading
· Classification of posts
· Dismissal
· Collective agreements
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· The Equality Tribunal is the body established to investigate, hear and decide on claims for discrimination
· A complaint of discrimination or harassment must be made within a six-month time limit from the last act of discrimination, in writing, to the Director of the Equality Tribunal
· There are a number of ways in which the complaint may be handled
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This Act was enacted to protect the rights of persons who are involuntarily detained in psychiatric hospitals. The Act sets out the formal procedures that must be followed when a person with a mental disorder is involuntarily detained.
A mental disorder is defined as follows:
· You have a mental illness, severe dementia, or significant intellectual disability and there is a serious risk that you may cause immediate and serious harm to yourself or others.
or
· You have a mental illness, severe dementia or significant intellectual disability and your judgement is so impaired that your condition could get worse if you were not admitted to hospital for treatment that could only be given to you in hospital and going into hospital would be likely to improve your mental health significantly.
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· Your spouse
· An Authorised Officer
· A member of the Gardai
· Any other person aged 18 or over
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· The doctor must meet and examine you within 24 hours of receiving the application
· He/she may visit you at home
· The doctor will examine your behaviour, mood and assess your thought processes
· If the doctor feels that you meet the conditions for involuntary admission, he/she will make a recommendation to admit you to hospital for mental health care and treatment
· The doctor will fill out a recommendation form
· You will then be admitted to an approved centre
· At arrival at the centre you will be under the care of a nurse or a doctor
· Within 24 hours a consultant psychiatrist will examine you to decide if you have a mental disorder
· If the doctor believes you have a mental disorder an admission order will be signed
· An admission order lasts for 21 days · Your consultant will examine you 7 days before the admission order ends
· If the doctor thinks that you have a mental disorder, he/she will sign a renewal order · A renewal order means that it is in your best interests to stay in hospital for another period of time
· A renewal order can be extended for a further 6 and 12 months
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When this happens I get so angry and frustrated with him that I cut him off completely and then we get back into the spiral of communicating with each other in a polite way rather than a real live way. The voices kick in “there you are now you are no good, a selfish bitch, not able to say anything interesting, no wonder nobody loves you, why don’t you just kill yourself”. I resist and resist until eventually I get so distressed, I cut myself to release the pressure. Usually I wind up back in hospital, thinking, if only I could let my feelings be known to my partner this pattern might not occur as often, I will do it next time. Talk to my partner that is, not kill myself. It’s tough though.”
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“It is brilliant when I start to feel better. My mood improves; I can feel a bit of hope and slowly try to come to terms with my life. However, when this first high of leaving hospital dies out, I am left with an overwhelming feeling of inadequacy. I feel my symptoms building up, but feel I cannot talk about them, because my partner is so happy and delighted that I feel so well, that I do not want to burst his bubble. Although I do try to give hints about how I feel, when he asks how I am? I reply I am grand. He just leaves it at that and doesn’t pursue it anymore, when I know he knows that I know he knows I am not good.
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“Where, after all, do universal human rights begin? In small places, close to home, so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person: the neighborhood he lives in; the school or college he attends; the factory, farm or office where he works. Such are the places where every man, woman and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.” (Eleanor Roosevelt)
This statement was written in 1948, shortly after the Universal Declaration on Human Rights, adopted by the General Assembly of the United Nations. The continuing authority of this declaration means that it is universally accepted and makes it a common reference point in the human right’s field, for all peoples.
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When a person is out of hospital for a few weeks and things are going well, it may be time to start thinking about getting involved in other things.
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· The right to information
· The right to a review by a mental health tribunal
· The right of access to a lawyer
· The right to appeal to the Circuit Court
· The right to contact the Inspector of Mental Health Services
Amnesty International has produced a guide that details the specific issues relating to mental health and human rights. Its development was directed by a steering group of people with self-experience of mental ill health. Experts by experience in other words.
“We are not asking for anything more than for the human rights of people experiencing mental health problems to be respected. We want them to be treated with dignity and respect. To be truly given a choice in relation to treatment and support to challenge, in a positive manner, the predominant medical model of mental health problems. We want a system which supports everyone’s right to housing, employment and education – all essential to recovery and wellbeing. We are not powerless, we have a voice.” (Mental Health and Your Human Rights. A Brief Guide)
Amnesty International published “Let’s Make It Happen” an action briefing document on mental health policy in 2006. This campaign followed their work in 2003 on Mental Illness: The Neglected Quarter. They document how and why government policy must be challenged in the area of mental illness.
“The right to mental health services General Comment 14 of the UN Committee on Economic, Social and Cultural Rights instructs that a mental health system must meet the following “interrelated and essential” standards:
1. Availability, i.e. health facilities and services have to be available in sufficient quantity.
2. Accessibility, health facilities, goods and services have to be accessible to everyone without discrimination based on:
· policy of non-discrimination in law and in practice
· physical accessibility (including for marginalized peoples including people with disabilities)
· economic accessibility (affordability) whether privately or publicly provided
· accessibility of information, including the right to seek, receive and impart information, consistent with confidentiality of personal data
3. Acceptability, i.e. all health facilities, goods and services must be respectful of medical ethics and culturally appropriate.
4. Quality, i.e. health facilities, goods and services must also be scientifically and medically appropriate and of good quality.
General Comment 14 further instructs that the state’s obligations to realize the right to mental health are of three types:
To respect: not to interfere, directly or indirectly, with a person’s enjoyment of the right to mental health. This is an immediate obligation.
To protect: to ensure others do not interfere, with a person’s enjoyment of the right to mental health, primarily through effective regulation. States must prevent, investigate, punish and ensure redress for the harm caused by abuses of human rights by third parties – private individuals, commercial enterprises or other nonstate actors. This is an immediate obligation
To fulfill: including to promote rights, facilitate access to rights, and provide for those unable to provide for themselves States have an obligation to fulfil the right to mental health by taking promotional, legislative, administrative, budgetary, judicial and other steps towards the full realization of that right (and related rights). As many aspects are resource-dependent, international standards recognize that this obligation may be realized progressively. Governments must give immediate priority to meeting the minimum essential levels of each right, especially for the most vulnerable.
International human rights standards take the form of declarations, resolutions or recommendations issued by international bodies like the UN. They are not binding, but are guidelines as to what states should do to comply with human rights conventions. Some apply specifically to mental health, such as the 1991 UN Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (called the MI Principles). There is no human rights convention specific to mental health, but mental health human rights standards, while not legally binding on States, can and should influence national mental health policy, practice and law, since they represent the consensus of nations.” (Let’s Make It Happen. Action Briefing. Amnesty International 2006)
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The first six weeks after a person with mental illness leaves hospital is the most difficult and dangerous time for them. One explanation for this is the fear of re-experiencing symptoms, which can be very clear to a person as they are now feeling a bit better. The anxiety of going back to the cycle of illness becomes unacceptable.
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“We should have known. He was very well for at least five weeks. John came in from the fields after shooting crows, he left the loaded gun against the wall by the back door, poor Jimmy went out for a smoke, next thing we heard a loud bang, and we knew exactly what it was. We ran out but were too late, he was dead. John found it very hard, he got really depressed after it, especially after he had just finished a suicide awareness course and one of the don’ts was: do not leave a loaded gun, large amount of medications or poisons easily accessible.”
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“What can you say? Things are going well, but it is like a ticking time bomb. When she says she is grand, I am so afraid; sometimes I just want to bury my head in the sand. Do you know the most difficult thing in all this, is knowing what to do? When she is sitting there looking into space I have not got a clue what is going on in her head, if she could only tell me we could face it together, deal with it, instead of the self-harm and hospitalisation. She has to know how much I love her, I would walk across red hot coals for her, I wish she would just tell me what is going on for her, the waiting is agony.”