Do you think health and social care services based on human rights in the field of psychosocial disabilities exist in your country?
The human rights-based approach in mental health is not sufficiently deployed in Spain. The medical model is still present in mental health and social care settings.
There continues to be a need for training interventions for professionals and also for politicians and managers.
In Lithuania the Convention of the Rights of People with Disability was ratified in 2010. The legislation on data security and confidentiality has been adopted. There is successful implementation and development of the idea of an independent living home. Projects are being implemented across Lithuania to expand access to local services – integral home services. Each institution providing services to the target group has ethical standards, but the level of implementation of human rights may differ from institution to institution. Procedure of hospitalization is regulated by the laws. There are psychosocial, vocational rehabilitation, day centers, mental health centers, social workshops.
Do the professionals from healthcare and social services know the Convention on the Rights of Persons with Disabilities (CRPD)?
CRPD has started to be known thanks to the efforts of activist organizations in the field of psychosocial disabilities that underline the value of CRPD as a tool to guarantee the rights of people with disabilities.
The challenge remains to translate laws to the real context in which people with psychosocial disabilities live. A change of paradigm is needed at the different health and social care levels for people with mental health problems, in order to adopt a human rights-based approach.
The CRPD has been ratified in Lithuania and must be enforced. Information on the Convention and its implementation is available via various media channels – on internet, in brochures. Most social service providers specializing in mental health area and working with people with mental, intellectual disabilities are familiar with the CRPD. Some of the principles of the Convention are an integral part of the work ethic of professionals. On the other hand there is still insufficient discussion and implementation on the human rights of people with mental disabilities in the area of health services.
In your country, has there been an adaption of the Convention on the Rights of Persons with Disabilities?
Despite the fact of legal changes having been made in order to respond to the CRPD, the UN Committee, in its last report about Spain, pointed out that a deeper adaptation is still needed, especially in all the aspects related to an abolition of coercion and the guarantee of health care on the basis of free and informed consent provided by people with psychosocial disabilities.
In Lithuania we have CRPD version for people with intellectual disability, for children. The text is adapted, a lot of pictures are presented in easy-to-read format of CRPD.
What rights need more attention or are more important to work on?
All the rights formulated in the CRPD require intensive monitoring. In the case of people with psychosocial disabilities, the rights related to legal capacity and advancement in support models for decision-making are extremely important.
Also, it is necessary to pay attention to all rights related to freedom and security (articles 14 and 15), and how this translates into involuntary admissions and internments, involuntary treatments and coercive measures (restraint, seclusion)
Last but not least, all the rights related to privacy (visitation regimes, video surveillance cameras).
Sometimes, the right to informed consent is ensured at a more formal level, and it is more difficult to ensure the right to free choice due to insufficient available services or resources. It is also important to strive for better exercise of the right to participate in self-decision-making, the right to information in appropriate format, the right to choose being recording by video or audio or not, to decide about publication of those recordings. The right to adequate limitation periods for keeping documents on a person’s mental health.
What will be the strategies to improve the health and social care offered to people with psychological disabilities?
A greater awareness by the general society is needed. Also, the implication to the legislative level to a better translation of the CRPD is required and politicians have to implement projects and programs that guarantee better rights for people with mental health problems. Finally, at the level of direct health and social care, much training is needed for ending coercion and developing better ways to support people with mental health problems during crisis situations.
More attention should be paid to the integration of the target group persons into the community, society, more attention to participation (empowerment). Improving a person’s transition from hospitalization to a more independent life in the society, need more systematic means and services to support this transition. Employees at all levels should be educated about their commitments to CRPD.
In addition, we have noticed intercultural differences in the position and activeness of service users. In Spain exist different organizations of service users, representatives of these organizations take active roles in representation their needs, protection their rights. They even express their will to choose terminology in talking about disability. E.g. they prefer to be called persons with psychosocial disability. Meanwhile in Lithuania we cannot see so significant initiatives, the terminology is offered by professionals and we still use terminology of mental disability, intellectual disability, physical disability etc. Perhaps Lithuanian professionals may be those who ask the will of disabled people and expand the terminology.