“Mental Health As Human Rights”

SUBMITTED TOWARDS THE FULFILLMENT OF THE COURSE TITLED

Human Rights Law

SUBMITTED BY: SUBMITTED TO:

Nayan Singh DR. S.C. Roy

ROLLNO.-1417 FACULTY

HUMAN RIGHTS LAW

CHANAKYA NATIONAL LAW UNIVERSITY, PATNA

Table of Contents

ACKNOWLEDGEMENT.................................................................................................................................3
The Relationship between Human Rights and Mental Health.....................................................................8
Mental Health is a Human Right.............................................................................................................8
Mental Health Declaration of Human Rights.............................................................................................10
The Right to Health Framework.................................................................................................................13
2030 Agenda for Sustainable Development Goals (SDG).....................................................................13
Current Impediments to Improving Mental Health Globally.................................................................14
Indian National Human Rights Commission...............................................................................................15
Mental Health, Mental Illness, And Human Rights In India.......................................................................16
Mental Health, Mental Illness, And Human Rights: What Are The Standards?....................................16
Convention On The Rights Of Persons With Disabilities............................................................................21
The Mental Health Care Bill 2013 vs CRPD provisions...............................................................................22
Involuntary care and the Convention on the Rights of Persons with Disabilities...................................22
Mental capacity and the Convention on the Rights of Persons with Disabilities...................................23
CONCLUSION.............................................................................................................................................26
BIBLIOGRAPHY...........................................................................................................................................27
 ACKNOWLEDGEMENT

The researcher would like to thank her faculty whose guidance helped her a lot in structuring this
project.

The researcher owes the present accomplishment of this project to her friends, who helped her
immensely with materials throughout the project and without whom she couldn’t have completed
it in the present way.

The researcher would also like to extend her gratitude to her parents and all those unseen hands
that helped her out at every stage of her project.

THANK YOU,

NAYAN SINGH.
 Introduction
The historical and current incidence of human rights violations in mental health care across
nations has been variously described as a “global emergency” and an “unresolved global crisis,”
evidenced by reports of physical and sexual abuse; discrimination and stigma; arbitrary
detention; inability to access health care, vocational and residential resources; and denial of self-
determination in financial and marital matters, among other rights deprivations. 1 Mental illness
affects nearly one in three individuals globally during their lifetime and nearly one in five in the
past 12 months.2 Mental and substance abuse disorders were leading causes of disability and
were responsible for 8.6 million years lost to premature death worldwide in 2010. 3 The burden of
these disorders increased by 37.6% from 1990 to 2010. 4 The annual economic cost of mental
illness globally has been estimated to be $2.5 trillion, with a projected increase to $6 trillion by
2030, more than half of the total costs for all non-communicable diseases.5 

The World Health Organization defines mental health as a “state of well-being in which every
individual realizes his or her own potential, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to her or his community.” 6 This
definition implies that mental health is reliant on the wide array of supports and resources that
facilitate individual engagement at the highest level of gainful employment and in other
community roles.7 These factors include, among others, health, the availability of adequate
housing, just and favorable conditions for work, and freedom from discrimination, all of which
are enshrined in international human rights law.8 There are thus significant connections between
mental health and human rights.9

1
World Health Organization, Mental Health, Human Rights & Legislation. Available at
http://www.who.int/mental_health/policy/legislation/en/; N. Drew et al. ”Human rights violations of people with
mental and psychosocial disabilities: An unresolved global crisis.” The Lancet 378 (2011), pp. 1664–1675.
2
Z. Steel et al. “The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-
2013.” International Journal of Epidemiology 43(2) (2014), pp. 476-493.
3
H. A. Whiteford et al. “Global burden of disease attributable to mental and substance use disorders: findings from
the Global Burden of Disease Study 2010.” The Lancet 382(9904) (2013), pp. 1575-1586.
4
Ibid.
5
Bloom et al. The global economic burden of noncommunicable diseases (Geneva: World Economic Forum, 2011).
6
. World Health Organization, Mental health: a state of well-being. (August 2014). Available at:
http://http://www.who.int/features/factfiles/mental_health/en/
7
C. Watters, “Mental health and illness as human rights issues,” in M. Dudley, D. Silove, and F. Gale (eds),  Mental
health and human rights: Vision, praxis and courage (Oxford: Oxford University Press, 2012), pp. 69-79.
8
Universal Declaration of Human Rights (UDHR), G.A. Res. 217A (III) (1948), Art. 7, 23 and 25. Available at
http://www.un.org/Overview/rights.html; International Covenant on Economic, Social and Cultural Rights
(ICESCR), G.A. Res. 2200A (XXI), Art. 2, 6, 11 and 12. (1966). Available at
http://www2.ohchr.org/english/law/cescr.htm
9
S. Rees and D. Silove, “Human rights in the real world: Exploring best practice research in a mental health
context,” in M. Dudley, D. Silove and F. Gale (eds), Mental health and human rights: Vision, praxis and
courage (Oxford: Oxford University Press, 2012), pp. 599-610.
The relationship between mental health and human rights has at least three parts. 10 First, human
rights violations such as torture and displacement negatively affect mental health. 11 Second,
mental health practices, programs, and laws, such as coercive treatment practices, can impact
human rights.12 Finally, the advancement of human rights benefits mental health
synergistically.13 These benefits extend beyond mental health to the close connection between
physical and mental health.14 There are thus clinical and economic reasons, as well as moral and
legal obligations, to advance human rights in mental health care.

A human rights-based approach (HRBA) to mental health care capitalizes on these rich
interconnections. An HRBA “is a conceptual framework…that is normatively based on
international human rights standards and operationally directed to promoting and protecting
human rights.”15 HRBAs have been successfully implemented in a variety of fields, including
international development and HIV treatment.16 In the context of mental health care, an HRBA
means placing emphasis not only on avoiding human rights violations but making sure that
human rights principles are at the center of a service-providing organization.17

Human rights frameworks are increasingly being recognized as important contributors to health
care. Recently, leaders in the fields of neuroscience and global mental health have called for:

a multilayered and multisectoral approach to prevention and treatment… including… provision

of living and working conditions that enable healthy psychosocial development, promotion of
positive interactions within and between social groups, social protection for the poor, anti-
discrimination laws and campaigns, and promotion of the rights of those with mental disorders.18

Similarly, the Grand Challenges in Global Mental Health initiative has noted that:

10
J. M. Mann, “Introduction,” in J. M. Mann et al. (eds), Health and Human Rights, (New York: Routledge 1999)
pp. 3-7.
11
Z. Steel et al. “Association of torture and other potentially traumatic events with mental health outcomes among
populations exposed to mass conflict and displacement: A systematic review and meta-analysis.” JAMA 302(5)
(2009) pp. 537-549.
12
L. O. Gostin and L. Gable, “The human rights of persons with mental disabilities: A global perspective on the
application of human rights principles to mental health.” Maryland Law Review 63(20) (2009) pp. 20-121.
13
Ibid.; Mann (1999, see note 5.)
14
M. Prince et al. “No health without mental health.” The Lancet 370 (9590) (2007), pp. 859-877.
15
Office of the United Nations High Commissioner for Human Rights, Frequently asked questions on a human
rights-based approach to development cooperation, (Geneva: OHCHR, 2006) pp. 15.
16
V. Gauri and S. Gloppen, Human rights based Approaches to development: Concepts, evidence and
policy (Washington D. C.: World Bank, 2012); V. Paiva et al. ”Religious communities and HIV prevention: An
intervention study using a human rights-based approach.” Global Public Health 5(3) (2010), pp. 280-294.
17
17. M. J. Curtice and T. Exworthy, “FREDA: A human rights-based approach to healthcare.” The Psychiatrist 34
(2010) pp. 150-156.

18
D. J. Stein et al. “Global mental health and neuroscience: potential synergies.” The Lancet Psychiatry 2(2) (2015),
pp. 178-185.
efforts to build mental capital—the cognitive and emotional resources that influence how well an
individual is able to contribute to society and experience a high quality of life—could also
mitigate the risk of disorders such as depression, substance-use disorders, bipolar disorder and
dementia…. Thus, health-system-wide changes are crucial, together with attention to social
exclusion and discrimination199

However, “all care and treatment interventions—psychosocial or pharmacological, simple or

complex—should have an evidence base to provide programme planners, clinicians and policy-
makers with effective care packages.”20 HRBAs have the potential to fulfill these demands at
relatively low costs. Their potential should be examined in order to provide the evidence called
for above.

These frameworks have both normative and legal backing and have substantial overlap with
medical ethics. Human rights set out universal, non-negotiable standards for all people, and can
thus act as powerful catalysts for change in areas such as mental health care that have historically
been marred by discrimination and, in some cases, disregard for the inherent worth and dignity
of patients. Though there is little doubt that infringement of human rights has negative effects on
mental welfare, few papers have sought to explore the converse part of this reciprocal
relationship21

19
P. Y. Collins et al. “Grand challenges in global mental health.” Nature 475(7354) (2011), pp. 27-30.
20
Ibid.
21
https://www.hhrjournal.org/2016/05/human-rights-based-approaches-to-mental-health-a-review-of-programs/
OBJECTIVES

The objectives of the research paper are the following:

1. To present a detailed study as to why mental health should be classified as Human

Rights.

2. To know about the legal structure India boasts to tackle the issue.

3. To understand the global initiatives in this regard.

4. To know asses the efficiency of Indian and Global efforts.

LIMITATION

The researcher has relied only on doctrinal study for medical negligence. The study is limited to
medical negligence in India only. The research does not make a comparative analysis of the topic
with other countries.

HYPOTHESIS

The researcher believes that since the ambit of human rights in India is as vast as the right
guaranteed under article 21 of the Indian constitution, mental health as human rights enjoys
considerable cushion and protection under the above mentioned provision and through specific
government initiatives and statutes.

RESEARCH METHODOLOGY

The researcher has adopted doctrinal method of research. Various books, articles, law journals,
Acts etc. will be referred for the preparation of this project work. The sources used for the
collection of materials regarding this topic will be primary as well as secondary sources. A
uniform method of citation shall be followed in this whole project work.
The Relationship between Human Rights and Mental Health
The UN Human Rights Council (UNHRC) is an inter-governmental body within the UN’s
system that is made up of 47 countries elected from the full membership. 22 The council is
responsible for the promotion and protection of all human rights around the globe, and it views
physical and mental health as a central tenet of its work. Through its appointed Special
Rapporteur, the UNHRC helps Member States and others promote and protect the right to the
highest attainable standard of physical and mental health (right to health). 23 The council
acknowledges the following principles:

 The right to health is an inclusive right, extending not only to timely and appropriate
health care, but also to the underlying determinants of health, such as access to safe and
potable water and adequate sanitation, healthy occupational and environmental
conditions, and access to health-related education and information, including sexual and
reproductive health.

 The right to health contains both freedoms and entitlements. Freedoms include the right
to control one’s health, including the right to be free from non-consensual medical
treatment and experimentation.  Entitlements include the right to a system of health
protection (i.e., health care and the underlying determinants of health) that provides
equality of opportunity for people to enjoy the highest attainable standard of health.

 The right to health is a broad concept that can be broken down into more specific
entitlements such as the rights to maternal, child and reproductive health; healthy
workplace and natural environments; the prevention, treatment and control of diseases,
including access to essential medicines; and access to safe and potable water.24

Mental Health is a Human Right

The Office of the United Nations High Commissioner for Human Rights (OHCHR) declares that
“the right to health is a fundamental part of our human rights and of our understanding of a life
in dignity”.25 The preamble to the 1946 Constitution of the World Health Organization (WHO)
defines health as “a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.”26 The relationship between mental health and human rights is an
22
https://www.ohchr.org/EN/hrbodies/hrc/pages/membership.aspx
23
Ibid.
24
Ibid.
25
Ibid.
26
https://apps.who.int/iris/handle/10665/71722
integral and interdependent one. For instance, human rights violations such as torture and
displacement negatively affect mental health. Second, mental health practices, programs, and
laws, such as coercive treatment practices, can hinder human rights. Finally, the advancement of
human rights benefits mental health. These benefits extend beyond mental health to the close
connection between physical and mental health. There are thus clinical and economic reasons, as
well as moral and legal obligations, to advance mental health care as fundamental to human
rights.

In their 2014 report, WHO estimates that globally, less than 5 percent of general government
health expenditures are allocated to address mental health, and this figure is significantly less in
lower-income countries (WHO, 2015). Simply put, mental health does not enjoy parity with
physical health in terms of budgeting and attention, and this creates an unintended hierarchy
where mental health is ranked lower than physical health. 27 The OHCHR reports that in some
countries, the only care available for mentally-ill individuals is in psychiatric institutions, and
many of them are associated with significant human rights violations reflected in inhumane
treatment and living conditions, such as shackling or locking up in confinement for extended
periods of time.28

27
https://www.who.int/gho/publications/world_health_statistics/2014/en/
28
https://www.ohchr.org/EN/NewsEvents/Pages/MentalHealthIsAhumanright.aspx
Mental Health Declaration of Human Rights
by Citizens Commission on Human Rights.29

All human rights organizations set forth codes by which they align their purposes and activities.
The Mental Health Declaration of Human Rights articulates the guiding principles of CCHR and
the standards against which human rights violations by psychiatry are relentlessly investigated
and exposed.

A. The right to full informed consent, including:

1. The scientific/medical test confirming any alleged diagnoses of psychiatric disorder

and the right to refute any psychiatric diagnoses of mental “illness” that cannot be
medically confirmed.

2. Full disclosure of all documented risks of any proposed drug or “treatment.”

3. The right to be informed of all available medical treatments which do not include the
administration of a psychiatric drug or treatment.

4. The right to refuse any treatment the patient considers harmful.

B. No person shall be given psychiatric or psychological treatment against his or her will.

C. No person, man, woman or child, may be denied his or her personal liberty by reason of
mental illness, so-called, without a fair jury trial by laymen and with proper legal representation.

D. No person shall be admitted to or held in a psychiatric institution, hospital or facility because
of their political, religious or cultural beliefs and practices.

E. Any patient has:

1. The right to be treated with dignity as a human being.

2. The right to hospital amenities without distinction as to race, color, sex, language,
religion, political opinion, social origin or status by right of birth or property.

3. The right to have a thorough, physical and clinical examination by a competent

registered general practitioner of one’s choice, to ensure that one’s mental condition is

29
https://www.cchr.org/about-us/mental-health-declaration-of-human-rights.html
not caused by any undetected and untreated physical illness, injury or defect and the right
to seek a second medical opinion of one’s choice.

4. The right to fully equipped medical facilities and appropriately trained medical staff in
hospitals, so that competent physical, clinical examinations can be performed.

5. The right to choose the kind or type of therapy to be employed, and the right to discuss
this with a general practitioner, healer or minister of one’s choice.

6. The right to have all the side effects of any offered treatment made clear and
understandable to the patient, in written form and in the patient’s native language.

7. The right to accept or refuse treatment but in particular, the right to refuse sterilization,
electroshock treatment, insulin shock, lobotomy (or any other psychosurgical brain
operation), aversion therapy, narcotherapy, deep sleep therapy and any drugs producing
unwanted side effects.

8. The right to make official complaints, without reprisal, to an independent board which
is composed of nonpsychiatric personnel, lawyers and lay people. Complaints may
encompass any torturous, cruel, inhuman or degrading treatment or punishment received
while under psychiatric care.

9. The right to have private counsel with a legal advisor and to take legal action.

10. The right to discharge oneself at any time and to be discharged without restriction,
having committed no offense.

11. The right to manage one’s own property and affairs with a legal advisor, if necessary,
or if deemed incompetent by a court of law, to have a State appointed executor to manage
such until one is adjudicated competent. Such executor is accountable to the patient’s
next of kin, or legal advisor or guardian.

12. The right to see and possess one’s hospital records and to take legal action with
regard to any false information contained therein which may be damaging to one’s
reputation.

13. The right to take criminal action, with the full assistance of law enforcement agents,
against any psychiatrist, psychologist or hospital staff for any abuse, false imprisonment,
assault from treatment, sexual abuse or rape, or any violation of mental health or other
law. And the right to a mental health law that does not indemnify or modify the penalties
for criminal, abusive or negligent treatment of patients committed by any psychiatrist,
psychologist or hospital staff.
14. The right to sue psychiatrists, their associations and colleges, the institution, or staff
for unlawful detention, false reports or damaging treatment.

15. The right to work or to refuse to work, and the right to receive just compensation on a
pay scale comparable to union or state/national wages for similar work, for any work
performed while hospitalized.

16. The right to education or training so as to enable one to earn a living when

discharged, and the right of choice over what kind of education or training is received.

17. The right to receive visitors and a minister of one’s own faith.

18. The right to make and receive telephone calls and the right to privacy with regard to
all personal correspondence to and from anyone.

19. The right to freely associate or not with any group or person in a psychiatric
institution, hospital or facility.

20. The right to a safe environment without having in the environment, persons placed
there for criminal reasons.

21. The right to be with others of one’s own age group.

22. The right to wear personal clothing, to have personal effects and to have a secure
place in which to keep them.

23. The right to daily physical exercise in the open.

24. The right to a proper diet and nutrition and to three meals a day.

25. The right to hygienic conditions and non overcrowded facilities, and to sufficient,
undisturbed leisure and rest.
 The Right to Health Framework
The UN’s work to address mental health stigma and discrimination has largely focused on the
right to health framework. 

This framework is envisioned to be a long term goal. It asserts that health and health care is an
inclusive right encompassing both timely and appropriate health care and the underlying
determinants of health.  In the case of mental health, determinants include low socioeconomic
status, violence and abuse, adverse childhood experiences, early childhood development and
whether there are supportive and tolerant relationships in the family, the workplace, and other
settings.  The right to health contains freedoms (such as the right to be free from non-consensual
medical treatment) and entitlements (such as the right to a health system that provides equal
access to quality treatment) previously mentioned in this article.  This framework has been
included in many UN documents, including the International Covenant on Economic, Social and
Cultural Rights (Article 2(1), the Convention on the Rights of the Child (Article 24), the
Convention on the Rights of Persons with Disabilities (Article 25) and the Convention on the
Elimination of All Forms of Discrimination against Women (Articles 10 (h), 11 (1) (f), 11 (2), 12
and 14 (2) (b)). These efforts emphasize support for anti-stigma and discrimination programming
and policies.  

The right to health framework suggests a human rights-based approach to ensure that health
facilities, goods, and services for mental health are available in sufficient quantity and are
accessible and affordable on the basis of non-discrimination.  The services need to be gender-
sensitive, scientifically and medically appropriate, of good quality and respectful of medical
ethics.  An integral feature of the right to health is the expectation for meaningful participation of
all stakeholders in decisions and policies on health.  It is also important that there are transparent
processes that are ensured for persons with mental health issues and those who use mental health
services.30

2030 Agenda for Sustainable Development Goals (SDG)

The right to health framework has been complemented by the global commitment made in the
2030 Agenda for Sustainable Development Goals (SDG), especially SDG 3, which aims to
ensure healthy lives and promote well-being for all, at all ages.31

30
https://www.apa.org/international/pi/2018/12/mental-health-rights
31
https://sustainabledevelopment.un.org/sdg3
  Target 3.4 - addresses prevention and treatment, and promotes mental health and well-
being

 Target 3.5 - addresses the prevention and treatment of substance abuse, including narcotic
drug abuse and the harmful use of alcohol

 Target 3.8 - addresses universal health coverage. While this target focuses on areas where
mental health is not specifically referenced, there are other relevant issues that include
financial risk protection, access to quality essential health-care services, affordable
essential medicines, and vaccines for all.

Current Impediments to Improving Mental Health Globally

Obtaining widespread understanding of the etiology of mental illness is still a major task.  A
significant proportion of the world population lacks understanding of the biological etiology of
mental illness, and therefore, attributes mental illness to supernatural forces and the enemy. 32  In
some parts of the world, cultural factors include ideas that mental illness is owned by the entire
family and is a source of shame, and environmental-based mental health problems are seen as
personal weaknesses.  Other notable factors that contribute to this lack of understanding include
the lack of systematic training for health professionals, less information about the cultural factors
that are protective and/or could be integrated into development of treatment and prevention
interventions, minimal research, and the absence of explicit human rights to health framework
training programs in States and organizations.33

32
Armiya’u, A. Y. (2015).  A review of stigma and mental illness in Nigeria. Journal of Clinical Case
Reports 5:488. doi:10.4172/2165-7920.1000488
33
Supra note 30.
 Indian National Human Rights Commission

In a 1997 Indian Supreme Court decision, the National Human Rights Commission was given
the mandate to monitor and supervise performance at the mental health institutions at Agra,
Gwalior, and Ranchi “to ensure that [they function] in the manner as is expected for achieving
the object for which [they were] set up.” 34 Since then, this mandate has extended to all similar
institutions in India. The Commission’s first steps were to analyze the existing status and
shortcomings of 37 mental health institutions. The Commission then published a list of
recommendations including abolition of cell admissions; restructuring of closed into open wards;
construction of smaller capacity wards; ensuring adequate supply of potable water and access to
sanitation; provision of nutritious food at 3,000 calories per day; ensuring compatibility of
policies with the Mental Health Act (1987); provision of individual cots and mattresses; in-house
training of staff; and occupational therapy for patients. A later set of recommendations included
expanding patient access to public goods such as late-age pensions. In addition, the Commission
established an advisory group with representatives from the Department of Health, the national
legislature, and the Ministries for Social Justice and Women and Child Development; expanded
data reporting requirements; engaged with the Indian Medical Council and Department of Health
to expand mental health training and recruitment; and carried out regular site visits to monitor
compliance.

A report of site visits at 13 institutions was prepared by the Commission’s Special Rapporteur, L.
D. Mishra, in 2012.35 The rapporteur found improvements in hospital infrastructure, including
the construction and improvement of outpatient departments and delivery of potable water, as
well as improved use of technology, including electronic data collection. The inspections found
improvements in integration of primary care and provision of nutritious food. In addition,
patients were now able to access improved dining and recreational facilities and had better access
to sanitation. Hygiene standards were improved, and some patients were offered occupational
therapy as well as yoga and meditation opportunities. However, the report also highlighted the
continuing dearth of mental health resources in the country, with an estimated shortfall of
roughly 8,500 psychiatrists, 16,750 clinical psychologists and 22,600 psychiatric social workers.
The report also noted the chronic lack of psychiatric beds as well as the dilapidated and archaic
facilities, overcrowding of institutions, lack of modern tools, and persistence of practices such as
unnecessary restraint and inadequate investigative facilities.

34
Indian National Human Rights Commission (2012, see note 22.)
35
Ibid.
 Mental Health, Mental Illness, And Human Rights In India.

The Mental Health Care Bill 2013 was introduced to the Rajya Sabha, India's upper house of
parliament, on 19 August 2013. The legislation aimed “to provide for mental health care and
services for persons with mental illness and to protect, promote, and fulfill the rights of such
persons during delivery of mental health care and services and for matters connected therewith or
incidental thereto” (Preamble). The twin emphasis on providing care and promoting rights is
critically important in India, as it is elsewhere. This legislative initiative is therefore an
exceptionally important one with real potential to improve the position of the mentally ill and
enhance their experiences of good mental health, social justice, and liberty.36

The current paper examines this development in the broader global context of human rights,
mental health, and mental illness. More specifically, the paper looks at the background to current
human rights standards relating to mental illness, and the second part focuses on the Convention
on the Rights of Persons with Disabilities (CRPD),37 which was adapted by the United Nations
(UN) in 2006 and ratified by India in 2007. The 2013 Bill sought explicitly to harmonize Indian
legislation with the CRPD, so this part of the paper focuses on two key issues in this context:
involuntary care and mental capacity.

Mental Health, Mental Illness, And Human Rights: What Are The Standards?

In light of the unprecedented humanitarian atrocities of the Second World War, the UN was
established in October 1945 to promote international peace and security and reduce the
possibility of further wars. One of the primary aims of the new organization was to articulate an
intellectual and legal framework that would support the observance of human rights among
member states and promote a culture of human rights throughout the world.

To promote these goals, the Universal Declaration of Human Rights (UDHR) was adopted by the
UN General Assembly at Palais de Chaillot in Paris on 10 December 1948. 38 The UDHR was
presented as a nonbinding statement of rights, the first stage in a process which continued with
the drafting of the International Covenant on Civil and Political Rights and the International
Covenant on Economic, Social and Cultural Rights, adapted by the UN General Assembly in
1966.
36
1. Firdosi MM, Ahmad ZZ. Mental health law in India: Origins and proposed reforms. BJPsych Int. 2016;13:65–
7. 
37
2. United Nations. Convention on the Rights of Persons with Disabilities. Geneva: United Nations; 2006.
38
United Nations. Universal Declaration of Human Rights. Geneva: United Nations; 1948. 
The UDHR comprises thirty articles, preceded by a short preamble which recognizes that “the
inherent dignity (and) the equal and inalienable rights of all members of the human family is the
foundation of freedom, justice and peace in the world,” and that “it is essential, if man is not to
be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that
human rights should be protected by the rule of law” (Preamble).

The first article of the UDHR states that “all human beings are born free and equal in dignity and
rights. They are endowed with reason and conscience and should act toward one another in a
spirit of brotherhood” (Article 1). Article 2 emphasizes the universal nature of rights:

 “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without
distinction of any kind, such as race, color, sex, language, religion, political or other
opinion, national or social origin, property, birth or other status.”

This emphasis on universality is both useful and necessary, not least because previous
declarations of rights had commonly been interpreted in such a way as to exclude certain groups.
While mental illness was not mentioned explicitly in the list of factors which were not to form
the basis of discrimination, it undoubtedly belongs under the term “other status.” In 1991, the
UN made this more explicit in its Principles for the Protection of Persons with Mental Illness
and the Improvement of Mental Health Care:

“Every person with a mental illness shall have the right to exercise all civil, political, economic,
social and cultural rights as recognized in the Universal Declaration of Human Rights,
the International Covenant on Economic, Social and Cultural Rights, the International Covenant
on Civil and Political Rights, and in other relevant instruments, such as the Declaration on the
Rights of Disabled Persons and the Body of Principles for the Protection of All Persons under
Any Form of Detention or Imprisonment’ (Principle 1[5]).39

The remainder of the UDHR went on to articulate a range of rights fundamentally rooted in the
principle of liberty, including “the right to life, liberty, and security of person” (Article 3). The
explicit articulation of this right, especially in the context of universal rights, is particularly
relevant to the mentally ill, not least because of their increased risk of lengthy involuntary
detention in various institutions. Again, the need to respect the right to liberty, along with the
other rights outlined in the UDHR, was strongly re-emphasized in 1991 in the UN's Principles
for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care.

Historically, however, people with mental disorder have often experienced high levels of abuse
or neglect of human rights, including the rights to liberty and treatment. 40 The first
comprehensive statement of the rights of persons with mental illness was UN's Principles for the

39
United Nations. Principles for the Protection of Persons with Mental Illness and the Improvement of Mental
Health Care. New York: United Nations, Secretariat Centre for Human Rights; 1991.
40
Kelly BD. Dignity, Mental Health and Human Rights: Coercion and the Law. Abingdon, Oxon: Routledge; 2015.
Protection of Persons with Mental Illness and the Improvement of Mental Health Care in 1991.
Key principles include as follows:

 All people are entitled to receive the best mental health care available and be treated with
humanity and respect

 There should be no discrimination on the grounds of mental illness. All people with
mental illness have the same rights to medical and social care as others

 Everyone with mental illnesses has the right to live, work, and receive treatment in the
community, as far as possible

 Mental health care should be based on internationally accepted ethical standards

 Each patient's treatment plan should be reviewed regularly with the patient

 There shall be no misuse of mental health skills and knowledge41

The 1991 statement of principles was important not only for its specific provisions, but also its
acknowledgement of a particular need to protect the rights of persons with mental disorder,
especially persons with enduring mental disorders whose rights have been significantly ignored
in the past. Against this background, the World Health Organization (WHO) went on to
articulate ten basic principles of mental health care law in 1996, further emphasizing many of the
1991 principles, and distilling them into ten key principles:

 All persons should benefit from the best possible measures to promote mental well-being
and prevent mental disorders

 All persons in need should have access to basic mental health care

 Mental health assessments should be performed in accordance with internationally

accepted medical principles and instruments

 All persons with mental disorders should be provided with health care which is the least
restrictive possible

 Consent is needed before any type of interference with a person can occur

 If a patient experiences difficulties appreciating the implications of a decision, although

not unable to decide, the patient shall benefit from the assistance of an appropriate third
party of his or her choice

 There should be a review procedure for any decision made by official, surrogate or
representative decision-makers and health care providers
41
Supra note 39.
  For decisions affecting integrity or liberty, with a long-lasting impact, there should be
automatic periodical review mechanisms

 All decision-makers acting in official or surrogate capacity should be qualified to do so

 All decisions should be made in keeping with the body of law in force in the jurisdiction
involved and not on any other basis, or an arbitrary basis.42

Specific aspects of the application of these principles were developed further in 2005 in
the WHO Resource Book on Mental Health, Human Rights, and Legislation which presents a
detailed statement of human rights issues which, according to the WHO, need to be addressed at
national level.[7] More specifically, the Resource Book includes a detailed “Checklist on Mental
Health Legislation” based, in large part, on previous UN and WHO publications. The checklist is
a companion to the WHO Resource Book on Mental Health, Human Rights, and Legislation and
its objectives are to: (a) assist countries in reviewing the adequacy and comprehensiveness of
existing mental health legislation; and (b) help countries in the process of drafting new law. This
checklist can help countries assess whether key components are included in legislation or policy,
and ensure that the broad recommendations contained in the Resource Book43 are carefully
examined and considered.

The checklist, although lengthy, detailed and explicitly informed by the UDHR, is not a set of
absolute rules, and is not legally binding. There are no sanctions for states which fail to accord
with its standards and unlike the UN International Covenant on Civil and Political Rights, the
UN Human Rights Committee does not review member states’ compliance with it.

The WHO checklist is, rather, designed to work by influencing member states as they redraft and
implement national mental health laws and policies. Given the checklist's close links with the
UDHR and WHO documents outlining the rights of the mentally ill, the authors make the
assumption that the checklist standards will be accepted by the international community and
deemed worth reflecting in national mental health law and policies. The WHO also explicitly
states that some countries may address some or all of these mental health issues in general
legislation (e.g., equality legislation), other forms of (not legally binding) regulation, or mental
health policy, rather than specific mental health legislation.

The history of psychiatry, however, supports the unique importance of dedicated mental health
legislation, rather than general law or nonbinding regulation, for protecting the rights of the
mentally ill: while there were substantial advances in the articulation of human rights standards
for the general population throughout the early twentieth century, the plight of the mentally ill
remained bleak until much later in most jurisdictions, suggesting a need for specific and

42
 Division of Mental Health and Prevention of Substance Abuse (World Health Organization). Mental Health Care
Law: Ten Basic Principles. Geneva: World Health Organization; 1996.
43
World Health Organization. WHO Resource Book on Mental Health, Human Rights and Legislation. Geneva:
World Health Organization; 2005.
dedicated measures to protect their rights. The WHO implicitly acknowledges the centrality of
law in this process when it presents its final checklist in the Resource Book as a “Checklist on
Mental Health Legislation” (italics added).

The Resource Book is especially useful owing to its emphasis on a broad concept of human
rights, encompassing not only just issues relating to the right to liberty but also social rights,
which are commonly neglected among the mentally ill. 44 It is this broader concept of human
rights to which I will return in the conclusions to this paper. However, first, it is necessary to
consider in some depth the CRPD, which is undoubtedly the most significant and challenging
development in this field in recent decades, and holds out real hope for significant progress on
human rights in the decades ahead.

44
Kelly BD. Mental health legislation and human rights in England, Wales and the Republic of Ireland. Int J Law
Psychiatry. 2011;34:439–54.
 Convention On The Rights Of Persons With Disabilities
The CRPD was passed by the UN General Assembly in 2006. It was signed and ratified by India
in 2007. The CRPD commits ratifying countries ‘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’ (Article 1). It specifies that “persons with
disabilities include those who have long-term physical, mental, intellectual, or sensory
impairments which in interaction with various barriers may hinder their full and effective
participation in society on an equal basis with others.”

In the context of psychiatry, it seems clear that this definition does not include all people with
mental illness, because many mental illnesses are not “long-term.” 45 The CRPD does not,
however, present its definition of “persons with disabilities” as a comprehensive one but
specifies that the term “persons with disabilities” includes people with “long-term” impairments;
others, presumably, also fit this definition.46 As a result, it is likely that some people with mental
illness meet the definition at least some of the time (e.g., a person with chronic schizophrenia or
an intellectual disability) but others do not (e.g., a person with time-limited adjustment disorder).

In India, the Mental Health Care Bill 2013 noted, in its preamble, that “India has signed and
ratified the said Convention on the 1 st day of October, 2007” and “it is necessary to align and
harmonize the existing laws with the said Convention.” Thus, the 2013 Bill was explicitly
intended to bring India into compliance with the requirements of the CRPD. Did it?

The spirit and principles of the 2013 Bill were certainly in keeping with the CRPD, and the
measures outlined would go a long way toward promoting community-based treatment, ensuring
access to care, increasing patients’ involvement in key care decisions, and strengthening
governance in the mental health system. These would be important and historic steps in
improving the position of the mentally ill, promoting their rights, and increasing their
experiences of mental health care and social justice.

45
Kelly BD. An end to psychiatric detention. Implications of the United Nations Convention on the rights of persons
with disabilities? Br J Psychiatry. 2014;204:174–5.
46
Szmukler G, Daw R, Callard F. Mental health law and the UN convention on the rights of persons with
disabilities. Int J Law Psychiatry. 2014;37:245–52.
 The Mental Health Care Bill 2013 vs CRPD provisions
It is not, entirely clear, however, if the 2013 Bill would be compliant with the CRPD in certain
other respects, especially in relation to involuntary care, termed ‘supported admission’ in the
Bill.47 According to the 2013 Bill, ‘supported admission’ could occur if, following independent
examination, it appeared ‘that the person has a mental illness of such severity that the person

(i) has recently threatened or attempted or is threatening or attempting to cause bodily harm to
himself; or

(ii) has recently behaved or is behaving violently toward another person or has caused or is
causing another person to fear bodily harm from him; or

(iii) has recently shown or is showing an inability to care for himself to a degree that places the
individual at risk of harm to himself’ (Section 98[1][a]).

In addition, the Bill would require that:

 “The psychiatrist or the mental health professionals or the medical practitioner, as the
case may be, certify, after taking into account an advance directive, if any, that admission
to the mental health establishment is the least restrictive care option possible in the
circumstances” (Section 98[1][b]); and

 “The person is ineligible to receive care and treatment as an independent patient because
the person is unable to make mental health care and treatment decisions independently
and needs very high support from his nominated representative in making decisions”
(Section 98[1][c]).

There are two issues here: first, the CRPD does not appear to permit involuntary care based on
mental illness;48 second, with regard to the reference to “unable” in (Section 98[1][c]), the CRPD
might not permit any distinction between people on the grounds of mental capacity either 49 (let
alone using mental capacity as a basis for deciding upon involuntary care, as in the 2013 Bill).
These two issues merit consideration.

Involuntary care and the Convention on the Rights of Persons with Disabilities

47
 Kala A, Kala K. Involuntary admission and treatment. Indian J Soc Psychiatry. 2015;31:130–3.
48
Supra note 42.
49
Supra note 45.
First is the issue of involuntary care. The CRPD states that “the existence of a disability shall in
no case justify a deprivation of liberty” (Article 14[1][b]). If certain people with “mental illness”
as defined in the 2013 Bill (e.g., some people with chronic schizophrenia) fit the UN definition
of “persons with disabilities,” then the 2013 Bill would be inconsistent with the CRPD in this
respect, given the clear links it draws between mental illness, risk and involuntary admission (see
above). This is also the case for mental health legislation in England, Wales, Scotland, Northern
Ireland, Ireland and most other jurisdictions, all of which violate this article of the CRPD.50

In 2009, the UN High Commissioner for Human Rights (2009) underlined this issue by objecting
explicitly to any link between ‘preventive detention’ and risk to self or others stemming from
“mental illness”:

 “Legislation authorising the institutionalisation of persons with disabilities on the

grounds of their disability without their free and informed consent must be abolished.
This must include the repeal of provisions authorising institutionalisation of persons with
disabilities for their care and treatment without their free and informed consent, as well as
provisions authorising the preventive detention of persons with disabilities on grounds
such as the likelihood of them posing a danger to themselves or others, in all cases in
which such grounds of care, treatment and public security are linked in legislation to an
apparent or diagnosed mental illness” (Paragraph 49).51

Mental capacity and the Convention on the Rights of Persons with Disabilities

The second area of apparent inconsistency between India's Mental Health Care Bill 2013 and the
CRPD concerns the 2013 Bill's use of mental capacity when making decisions regarding
involuntary care. This featured in the Section 98 criteria for “supported admission,” which would
require that the person “is unable to make mental health care and treatment decisions
independently and needs very high support from his nominated representative in making
decisions” (Section 98(1)(c)). This would, essentially, be a test of mental capacity.

Article 12 of the CRPD states “that persons with disabilities have the right to recognition
everywhere as persons before the law” and “enjoy legal capacity on an equal basis with others in
all aspects of life.” Legal capacity is a person's authority or right under law to be recognized as
an actor in law, as opposed to mental capacity, which is the cognitive ability to make decisions.

50
Ibid.
51
United Nations High Commissioner for Human Rights. Annual Report of the United Nations High Commissioner
for Human Rights and Reports of the Office of the High Commissioner and the Secretary-General: Thematic Study
by the Office of the United Nations High Commissioner for Human Rights on Enhancing Awareness and
Understanding of the Convention on the Rights of Persons with Disabilities. New York: United Nations; 2009.
Article 12 requires ratifying states to “take appropriate measures to provide access by persons
with disabilities to the support they may require in exercising their legal capacity”:

 “States Parties shall ensure that all measures that relate to the exercise of legal capacity
provide for appropriate and effective safeguards to prevent abuse in accordance with
international human rights law. Such safeguards shall ensure that measures relating to the
exercise of legal capacity respect the rights, will and preferences of the person, are free of
conflict of interest and undue influence, are proportional and tailored to the person's
circumstances, apply for the shortest time possible and are subject to regular review by a
competent, independent and impartial authority or judicial body. The safeguards shall be
proportional to the degree to which such measures affect the person's rights and interests”
(Article 12[4]).

In a “General Comment” on Article 12, however, the Committee on the Rights of Persons with
Disabilities, appointed by the UN under the CRPD, explicitly rejects the use of “mental capacity”
in any form to determine what supports might be needed for the exercise of legal capacity,
arguing that “mental capacity is not, as is commonly presented, an objective, scientific and
naturally occurring phenomenon. Mental capacity is contingent on social and political contexts
as are the disciplines, professions, and practices which play a dominant role in assessing mental
capacity” (Paragraph 14).52

The Committee contends that the “functional approach” to assessing mental capacity “is often
based on whether a person can understand the nature and consequences of a decision and/or
whether he or she can use or weigh the relevant information,” and argues that “this approach is
flawed for two key reasons:”

 “(a) it is discriminatorily applied to people with disabilities; and (b) it presumes to be

able to accurately assess the inner-workings of the human mind and when the person does
not pass the assessment, it then denies him or her a core human right-the right to equal
recognition before the law. In all of those approaches, a person's disability and/or
decision-making skills are taken as legitimate grounds for denying his or her legal
capacity and lowering his or her status as a person before the law. Article 12 does not
permit such discriminatory denial of legal capacity…’ (Paragraph 15).

The committee concludes that “the provision of support to exercise legal capacity should not
hinge on mental capacity assessments; new, nondiscriminatory indicators of support needs are
required in the provision of support to exercise legal capacity” (Paragraph 29[i]). The Committee
also explicitly rejects the idea of ‘substitute decision-making’ of any description:

 “States parties’ obligation to replace substitute decision-making regimes by supported

decision-making requires both the abolition of substitute decision-making regimes and
52
Committee on the Rights of Persons with Disabilities. General Comment No.1: Article 12: Equal Recognition
before the Law. New York: United Nations; 2014.
 the development of supported decision-making alternatives. The development of
supported decision-making systems in parallel with the maintenance of substitute
decision-making regimes is not sufficient to comply with Article 12 of the Convention”
(Paragraph 28).

The fact that India's 2013 Bill used the concept of mental capacity as one of the criteria for
“supported admission” appears to place it in discord with the Committee's interpretation of
Article 12. The Committee's ‘General Comment’ has, however, been critiqued strongly, chiefly
because it dismisses not only the very concept of mental capacity but also substitute decision-
making of any sort and diversion of the mentally ill from prison on the basis of mental
incapacity, among other things.53 These interpretations of the CRPD diverge significantly from
the text of the Convention itself and diverge very substantially from clinical and social realities.
This is, presumably, attributable to narrow consultation with service-users and the paucity of
clinical personnel on the Committee.

There is a real risk here that the Committee's “General Comment” will create the impression that
the CRPD is simply impossible to implement and therefore irrelevant. This would be a real pity:
the CRPD, including Article 12, is a vital articulation of the rights of people with disabilities,
including some people with mental illness. It offers a strong incentive for change and reform.
Legislation along the lines of India's 2013 Bill offers much that is positive and progressive in
terms of overall standards of care, revised processes for involuntary admission, and enhanced
governance throughout the mental health system. In this way, this kind of legislation, although
imperfect, promotes the principles enshrined in the CRPD, true to the goals of such legislation
and as clearly outlined in the preamble to the 2013 Bill.

53
Freeman MC, Kolappa K, de Almeida JM, Kleinman A, Makhashvili N, Phakathi S, et al. Reversing hard won
victories in the name of human rights: a critique of the general comment on article 12 of the UN convention on the
rights of persons with disabilities. Lancet Psychiatry. 2015;2:844–50. 
 CONCLUSION
Following some 134 official amendments, Mental Health Care Bill 2013 was passed by the
Rajya Sabha in August 2016. Reforms of mental health law, such as this, present real
opportunities to improve the experiences and lives of the mentally ill and their families,
notwithstanding the various issues relating to the CRPD (discussed above). It is likely that future
years will see these interpretative issues with the CRPD explored further, producing ever greater
recognition of the rights of the mentally ill based on the text of the Convention itself.

Perhaps the most compelling element of the CRPD in this context is the admirable breadth of its
ambition. The Convention seeks nothing less than “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” (Article 1). This is precisely as it should be.
While the Indian legislation is undoubtedly challenging for services, 54 and there are preexisting
issues with compliance with preexisting standards (e.g., in relation to prisoners), 55 there can be
no doubt that change is proceeding in the correct direction.

It is important that such initiatives focus not only on the right to liberty but also on rights to
treatment, social care, social inclusion and political empowerment of the mentally ill. 56 As
Amartya Sen points out, what matters most is whether or not measures designed to promote
justice actually realize this goal in day-to-day life, and not just in theory. 57 That is, we need to
look at the real-life outcomes of measures intended to protect rights, as opposed to simply
verifying that current legislation and other arrangements appear likely to promote human rights.
We need to focus on what actually happens.

We know that, to date, the mentally ill around the world have increased rates of imprisonment,
homelessness, social exclusion, untreated illness, and various other denials of rights.58 The Indian
legislative initiative, in the context of the CRPD, offers an important framework within which to
start to address this situation. It is important that the relevant principles and values are applied
not only in the development of legislation, but also in its application, and in mental health and
social services, courtrooms, prisons, and other locations across India, the rest of Asia and
elsewhere around the world.

54
 Narayan CL, Shekhar S. The mental health care bill 2013: a critical appraisal. Indian J Psychol
Med. 2015;37:215–9.
55
 Subramanian N, Ramanathan R, Kumar VM, Chellappan DK, Ramasamy J. A review of reception order in the
management of mentally ill persons in a psychiatric institute. Indian J Psychiatry. 2016;58:171–7.
56
Subramanian N, Ramanathan R, Kumar VM, Chellappan DK, Ramasamy J. A review of reception order in the
management of mentally ill persons in a psychiatric institute. Indian J Psychiatry. 2016;58:171–7.
57
Sen A. The Idea of Justice. London: Allen Lane/Penguin Books; 2009.
58
Kelly BD. Mental illness, human rights and the law. London: RCPsych Publications; 2016.
Globally, the rights of the mentally ill have been neglected for far, far too long. It is time to fix
this.

BIBLIOGRAPHY
In order of citation.

1. World Health Organization, Mental Health, Human Rights & Legislation. Available at

http://www.who.int/mental_health/policy/legislation/en/; N. Drew et al. ”Human rights
violations of people with mental and psychosocial disabilities: An unresolved global crisis.” The
Lancet 378 (2011), pp. 1664–1675.

2. Z. Steel et al. “The global prevalence of common mental disorders: a systematic review and
meta-analysis 1980-2013.” International Journal of Epidemiology 43(2) (2014), pp. 476-493.

3. H. A. Whiteford et al. “Global burden of disease attributable to mental and substance use
disorders: findings from the Global Burden of Disease Study 2010.” The Lancet 382(9904)
(2013), pp. 1575-1586.

4. Ibid.

5. Bloom et al. The global economic burden of noncommunicable  diseases (Geneva: World

Economic Forum, 2011).

6. World Health Organization, Mental health: a state of well-being. (August 2014). Available at:

http://http://www.who.int/features/factfiles/mental_health/en/

7. C. Watters, “Mental health and illness as human rights issues,” in M. Dudley, D. Silove, and
F. Gale (eds), Mental health and human rights: Vision, praxis and courage (Oxford: Oxford
University Press, 2012), pp. 69-79.

8. Universal Declaration of Human Rights (UDHR), G.A. Res. 217A (III) (1948), Art. 7, 23 and
25. Available at http://www.un.org/Overview/rights.html; International Covenant on Economic,
Social and Cultural Rights (ICESCR), G.A. Res. 2200A (XXI), Art. 2, 6, 11 and 12. (1966).
Available at http://www2.ohchr.org/english/law/cescr.htm
9. S. Rees and D. Silove, “Human rights in the real world: Exploring best practice research in a
mental health context,” in M. Dudley, D. Silove and F. Gale (eds), Mental health and human
rights: Vision, praxis and courage  (Oxford: Oxford University Press, 2012), pp. 599-610.

10. J. M. Mann, “Introduction,” in J. M. Mann et al. (eds), Health and Human Rights, (New
York: Routledge 1999) pp. 3-7.

11. Z. Steel et al. “Association of torture and other potentially traumatic events with mental
health outcomes among populations exposed to mass conflict and displacement: A systematic
review and meta-analysis.” JAMA 302(5) (2009) pp. 537-549.

12. L. O. Gostin and L. Gable, “The human rights of persons with mental disabilities: A global
perspective on the application of human rights principles to mental health.” Maryland Law
Review 63(20) (2009) pp. 20-121.

13. Ibid.; Mann (1999, see note 5.)

14. M. Prince et al. “No health without mental health.” The Lancet 370 (9590) (2007), pp. 859-
877.

15. Office of the United Nations High Commissioner for Human Rights, Frequently asked
questions on a human rights-based approach to development cooperation, (Geneva: OHCHR,
2006) pp. 15.

16. V. Gauri and S. Gloppen, Human rights based Approaches to development: Concepts,

evidence and policy (Washington D. C.: World Bank, 2012); V. Paiva et al. ”Religious
communities and HIV prevention: An intervention study using a human rights-based
approach.” Global Public Health  5(3) (2010), pp. 280-294.

17. M. J. Curtice and T. Exworthy, “FREDA: A human rights-based approach to

healthcare.” The Psychiatrist 34 (2010) pp. 150-156.

18. D. J. Stein et al. “Global mental health and neuroscience: potential synergies.” The Lancet
Psychiatry 2(2) (2015), pp. 178-185.
19. P. Y. Collins et al. “Grand challenges in global mental health.” Nature 475(7354) (2011), pp.
27-30.

20. https://www.hhrjournal.org/2016/05/human-rights-based-approaches-to-mental-health-a-
review-of-programs/

21. https://www.ohchr.org/EN/hrbodies/hrc/pages/membership.aspx
22. https://apps.who.int/iris/handle/10665/71722
23. https://www.who.int/gho/publications/world_health_statistics/2014/en/
24. https://www.ohchr.org/EN/NewsEvents/Pages/MentalHealthIsAhumanright.aspx
25. https://www.cchr.org/about-us/mental-health-declaration-of-human-rights.html
26. https://www.apa.org/international/pi/2018/12/mental-health-rights
27. https://sustainabledevelopment.un.org/sdg3
28. Armiya’u, A. Y. (2015).  A review of stigma and mental illness in Nigeria. Journal of
Clinical Case Reports 5:488. doi:10.4172/2165-7920.1000488
29. Indian National Human Rights Commission (2012, see note 22.)
30. Firdosi MM, Ahmad ZZ. Mental health law in India: Origins and proposed reforms. BJPsych
Int. 2016;13:65–7. 
31. United Nations. Convention on the Rights of Persons with Disabilities. Geneva: United
Nations; 2006.
32. United Nations. Universal Declaration of Human Rights. Geneva: United Nations; 1948. 
33. United Nations. Principles for the Protection of Persons with Mental Illness and the
Improvement of Mental Health Care. New York: United Nations, Secretariat Centre for Human
Rights; 1991.
34. Kelly BD. Dignity, Mental Health and Human Rights: Coercion and the Law. Abingdon,
Oxon: Routledge; 2015.
35. Division of Mental Health and Prevention of Substance Abuse (World Health Organization).
Mental Health Care Law: Ten Basic Principles. Geneva: World Health Organization; 1996.
36. World Health Organization. WHO Resource Book on Mental Health, Human Rights and
Legislation. Geneva: World Health Organization; 2005.
37. Kelly BD. Mental health legislation and human rights in England, Wales and the Republic of
Ireland. Int J Law Psychiatry. 2011;34:439–54.
37. Szmukler G, Daw R, Callard F. Mental health law and the UN convention on the rights of
persons with disabilities. Int J Law Psychiatry. 2014;37:245–52.
38. Kala A, Kala K. Involuntary admission and treatment. Indian J Soc Psychiatry. 2015;31:130–
3.
39. United Nations High Commissioner for Human Rights. Annual Report of the United Nations
High Commissioner for Human Rights and Reports of the Office of the High Commissioner and
the Secretary-General: Thematic Study by the Office of the United Nations High Commissioner
for Human Rights on Enhancing Awareness and Understanding of the Convention on the Rights
of Persons with Disabilities. New York: United Nations; 2009.
40. Committee on the Rights of Persons with Disabilities. General Comment No.1: Article 12:
Equal Recognition before the Law. New York: United Nations; 2014.
41. Freeman MC, Kolappa K, de Almeida JM, Kleinman A, Makhashvili N, Phakathi S, et al.
Reversing hard won victories in the name of human rights: a critique of the general comment on
article 12 of the UN convention on the rights of persons with disabilities. Lancet
Psychiatry. 2015;2:844–50. 
42. Narayan CL, Shekhar S. The mental health care bill 2013: a critical appraisal. Indian J
Psychol Med. 2015;37:215–9.
43. Subramanian N, Ramanathan R, Kumar VM, Chellappan DK, Ramasamy J. A review of
reception order in the management of mentally ill persons in a psychiatric institute. Indian J
Psychiatry. 2016;58:171–7.
44. Sen A. The Idea of Justice. London: Allen Lane/Penguin Books; 2009.