DESK REVIEWS | 04.05.02. Are there provisions related to protecting the rights of people with dementia? Indicate if they comply with international human rights standards according to the following criteria:

DESK REVIEW | 04.05.02. Are there provisions related to protecting the rights of people with dementia? Indicate if they comply with international human rights standards according to the following criteria:

Yes. There is Law No. 10.741 established in 2003 (“Older People’s Statute”), which guarantees the rights of all Brazilians aged 60 years and over. Older people (those aged 60 years and over) with dementia are included in this law and, in theory, should be given access to social protection, access to healthcare, housing, dignity, food, education, culture, sports, leisure, work, and transport. There is Normative No. 41 (2018) from the Ministry of Health that outlines palliative care and advance care directives in the context of SUS. The aim of this Normative is to provide quality of life for people with life-threatening diseases from the diagnosis to the end of life. The actions carried out include, among others, the provision of medicines to alleviate pain and the offer of psychological support for both the patients and their families (Brazilian Ministry of Health, 2018g, 2019b). The Law number 10.216 (2001) outlines about rights and protection of people living with mental disorders (Presidency of Republic of Brazil, 2001, p. 216). These laws comply with international human rights standards.

References:

Brazilian Ministry of Health. (2018g). RESOLUÇÃO No 41, DE 31 DE OUTUBRO DE 2018—Imprensa Nacional. http://www.in.gov.br/materia

Brazilian Ministry of Health. (2019b). Cuidados Paliativos no SUS. Ministério Da Saúde.

Presidency of Republic of Brazil. (2001). Lei 10.216. http://www.planalto.gov.br/ccivil_03/leis/leis_2001/l10216.htm

The laws relevant to persons with dementia are the following (Government of India, 2016; Ministry of Law and Justice, 2007; Ministry of Law and Justice, 2017; Kumar et al., 2019):

  • The Mental Health Care Act (2017),
  • The Maintenance and Welfare of Parents and Senior Citizens Act (2007),
  • the Rights of Persons with Disabilities Act 2016
References:

Government of India. (2016). The Rights of Persons with Disabilities Act. THE GAZETTE OF INDIA EXTRAORDINARY PART II.

Kumar, C.T.S., Shaji, K.S., Varghese, M., Nair, M.K.C. (Eds) Dementia in India 2020. Cochin: Alzheimer’s and Related Disorders Society of India (ARDSI), Cochin Chapter, 2019. Available from: https://dementiacarenotes.in/dcnfiles/Dementia-in-India-2020.pdf

Ministry of Law and Justice. (2007). Maintenance and welfare of parents and senior citizens Act. Government of India.

Ministry of Law and Justice. (2017). The Mental Health Care Act 2017. Government of India. Available from: https://egazette.nic.in/WriteReadData/2017/175248.pdf

Article 54(1) of the Constitution of Kenya 2010 provides that “a person with disability is entitled;

(a) to be treated with dignity and respect and to be addressed and referred to in a manner that is not demeaning;

(b) to access educational institutions and facilities for persons with disabilities that are integrated into society to the extent compatible with the interests of the person;

(c) to reasonable access to all places, public transport and information;

(d) to use Sign language, Braille or other appropriate means of communication; and

(e) to access materials and devices to overcome constraints arising from the person’s disability.” (Government of Kenya, 2010), page 37.

Article 54(2) states that “The State shall ensure the progressive implementation of the principle that at least five percent of the members of the public in elective and appointive bodies are persons with disabilities” (The Republic of Kenya, 2013), page 37.

There are no other provisions for protecting the rights of people with dementia. However, a recent training workshop (July 2019) for clinicians, NGOs promoting research and advocating for the rights of people with psychosocial disabilities, government institutions and policy makers used the WHO Quality Rights Tool Kit (World Health Organisation, 2012) to create awareness and to transfer knowledge into practice. The Mental Health Amendment Bill of 2018 is the most recent legislation addressing Kenya’s infrastructure around Mental Health. It outlines, among other things, the obligations of  national and county governments to build systems that address mental illness (GoK, 2018). The document does not make mention of any specific illnesses, nor does it provide a protocol for addressing them.   

References:

GoK. (2018). Kenya Gazette Supplement. Finance Act, 2018, 59(59), 165.

Government of Kenya. (2010). The Kenya Constitution, 2010. Kenya Law Reports. http://www.kenyalaw.org/lex/actview.xql?actid=Const2010

Republic of Kenya. (2013). The National Social Security Fund Act, 2013 No. 45 of 2013. 27 December. Nairobi, Kenya. http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/NationalSocialSecurityFundAct2013.pdf

World Health Organisation. (2012). WHO QualityRights Tool Kit: Assessing and improving quality and human rights in mental health and social care facilities. Geneva, Switzerland. https://apps.who.int/iris/handle/10665/70927

 

Although there are no specific laws on dementia, other laws have an indirect impact.

Laws in South Africa generally protect against discrimination on the grounds of race, age, sex, gender, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, disability, religion, conscience, belief, culture, language, and birth. However, provisions in South Africa are not dementia-specific.

The Mental Health Care Act (2017) has certain provisions that are relevant to persons with dementia such as advance directives and nominated representatives (Ministry of Law and Justice, 2017; Kumar et al., 2019).

References:

Kumar, C.T.S., Shaji, K.S., Varghese, M., Nair, M.K.C. (Eds) Dementia in India 2020. Cochin: Alzheimer’s and Related Disorders Society of India (ARDSI), Cochin Chapter, 2019. Available from: https://dementiacarenotes.in/dcnfiles/Dementia-in-India-2020.pdf

Ministry of Law and Justice. (2017). The Mental Health Care Act 2017. Government of India. Available from: https://egazette.nic.in/WriteReadData/2017/175248.pdf

For people who are perceived as not having capacity to make legal and financial decisions, the nomination of a trusted person is regulated under the Indonesian Civil Code, which is still largely based on the Dutch colonial legal system (Hariyanto, 2019). The process is known as pengampuan (Dutch: curatelle, English: conservatorship), and the legal basis are Article 433, 434, 437, 438, 439, 440, 441, 442, 449 of the Indonesian Civil Code (Indonesia: Civil Code, 1847) which are further described below. The fact that this is based on a legal system dating a century back might explain the use of a stigmatising and derogatory language [dungu (English: stupid) translated into ‘simple-mindedness’; and gila (English: crazy), translated into ‘insanity’).

Legal basis for pengampuan/curatelle/conservatorship:

  • Who is eligible to be put under conservatorship: ‘Article 433. An adult, who is in a continuous state of simple-mindedness, insanity, or rage, shall be placed under conservatorship, notwithstanding that he might have mental capacity from time to time. An adult individual may be placed under conservatorship as a result of improvidence.’ (Indonesia: Civil Code, 1847, p.65)
  • Who can have the conservatorship (trusted to make decisions): ‘Article 434. Each blood relative shall be authorized to request conservatorship on behalf of one of his relatives, due to his simple-mindedness, insanity, or rage. Conservatorship in respect of a person who is improvident may only be requested by the blood relatives in direct line, and by those in a collateral line up to and including the fourth degree. Due to one or more reasons, one spouse may request to put the other under conservatorship. An individual, who feels unable to take proper care of his affairs, due to limited mental capacity, may himself request to be placed under conservatorship.’ (Indonesia: Civil Code, 1847, p.66).
  • Time of the conservatorship being effective:
  • Article 446. The conservatorship shall be effective as of the date that the judgment or decision is passed. All acts committed thereafter by the individual placed in conservatorship shall be invalid by law….
  • Article 447. All acts committed as a result of simple-mindedness, insanity or rage, prior to the judgment granting conservatorship, may be invalidated if the grounds for seeking guardianship appeared to have existed at the time that the acts were committed’ (Indonesia: Civil Code, 1847, p.67).
  • Supporting documents needed to apply for conservatorship:
  • ‘Article 437. The events, which demonstrate simple-mindedness, insanity, rage, or improvidence, shall be specifically described in the letter of request, and the evidential documents as well as a submission of one of the witnesses shall also be enclosed…
  • Article 438. If the court of justice is of the opinion that the events are sufficiently significant to lead to a conservatorship, then the court shall conduct a hearing of the blood relatives or relatives by marriage…
  • Article 439. The court of justice shall, after a hearing or proper summons of the individuals as referred to in the previous article, question the individual whose conservatorship has been requested; in the event that he is immobile, the questioning shall take place in his residence by one or more judges designated thereto, accompanied by the court clerk, and in all matters, in the presence of the prosecution counsel… The prosecution counsel is not required to be present at this questioning; minutes shall be drawn up of the questioning of which an authentic copy shall be submitted to the court of justice… The questioning shall not take place before the letter of request as well as the report containing the views of the blood relatives, have been notified to the individual whose conservatorship is requested.’
  • Others
  • ‘Article 440. In the event that the court of justice, after the hearing or proper summons of the blood relatives or relatives by marriage, or after having heard the individual whose conservatorship is requested, decides that it has been adequately informed, the court shall, without any further formalities, deliberate upon the letter of request; in the event that it decides otherwise, the court shall instruct the hearing of the witnesses for the purpose of clarifying the matters presented.
  • Article 441. Following the questioning mentioned in article 439, the court of justice shall, in the event that there are grounds therefor, nominate a provisional administrator, to take care of the personal matters and assets of the individual, whose in conservatorship has been requested.
  • Article 442. The judgment upon a request for conservatorship shall be passed in a public court session, after a hearing or proper summons of the parties, and pursuant to the conclusions of the prosecution counsel…
  • Article 449. Upon the judgment in respect of conservatorship obtaining legal validity, the court of justice shall appoint a conservator. The appointment shall be immediately notified by the court to the Orphans’ Chamber. The supervising conservatorship shall be assigned to the Orphans’ Chamber… In this regard, the provisional administrator’s involvement shall cease, and he shall be required to submit an account of his administration; in the event that he is appointed as conservator, the account shall be submitted to the supervising conservator’ (Indonesia: Civil Code, 1847, p.66-67).
References:

Hariyanto, E. (2019). BURGELIJK WETBOEK (Menelusuri Sejarah Hukum Pemberlakuannya di Indonesia). Al-Ihkam: Jurnal Hukum Dan Pranata Sosial, IV(1), 141–152.

Indonesia: Civil Code. (1847).

There is no other document except the WHO Quality Rights Tool Kit outlining provision for supported decision making or advance planning in Kenya. Kenya’s legal capacity system does not meet the UN Convention on the Rights of Persons with Disabilities (CRPD). In 2011 the Kenyan government submitted a report to the UN Committee on the Rights of Persons with Disabilities, which contained an expression of intention to take legal steps to move towards supported decision-making from substituted arrangements. So far, this has not been implemented in practice (Mental Disability Advocacy Center (MDAC), 2014).

References:

Mental Disability Advocacy Center (MDAC). (2014). The Right to Legal Capacity in Kenya. Budapest, Hungary. https://tbinternet.ohchr.org/Treaties/CRPD/Shared%20Documents/KEN/INT_CRPD_ICO_KEN_19784_E.pdf

 

In eleven states in Mexico (Aguascalientes, Chihuahua, Coahuila, Colima, Mexico City, Mexico state, Guerrero, Hidalgo, Michoacan, Nayarit, and San Luis Potosí), there are advance directive laws that allow people to freely and consciously decide how they want to be medically treated if they face a terminal illness or an accident. For this reason, people who wish to make the request, must present themselves before notaries to express in advance how to be treated if they find themselves in that position. Regulation regarding advance directives include power of attorney regulated by the Federal Civil Code[1] established as a legal and judiciary condition for those individuals who do not have the capacity to make decisions on their own because of a mental disorder, illness, or due to impairment as a consequence of substance abuses and who are consequently limited as to their integrity and ability to make decisions and take care of themselves, and therefore need to appoint a legal representative (guardian and curator) who must attend to their legal life. Thus, patients with chronic, progressive, and degenerative and/or dementia such as Cerebral Vascular Disease, Huntington’s disease, and Alzheimer’s disease, fall into this category.

The guardian is the person who will be in charge of the guardianship of a person or their material goods, and the curator will be the one who will supervise the fulfillment of the obligations of the guardian. Healthcare power of attorney trials, take place in a family court in most of the country, for which the advice of gerontologists, geriatricians and neuro-geriatricians are recommended. In fourteen states in Mexico, Do Not Resuscitate Orders (DNR) are established through a law and its regulation[2] so that all individuals with intact capabilities can decide if they want to be submitted or not to means, treatments or medical procedures that aim to prolong their life when the person is at the end of life, aiming to protect their dignity, and favouring palliative care and end of life care. The emphasis is on accompanying the patient during this stage of his life, not prolonging or shortening his life, but respecting the natural moment of death. It is a document that will be used at the moment a doctor has diagnosed an advanced stage disease.

[1] CÓDIGO CIVIL FEDERAL. Nuevo Código publicado en el Diario Oficial de la Federación en cuatro partes los días 26 de mayo, 14 de julio, 3 y 31 de agosto de 1928. TEXTO VIGENTE: Última reforma publicada DOF 03-06-2019; http://www.diputados.gob.mx/LeyesBiblio/pdf/2_030619.pdf

[2] Ley de Voluntad Anticipada para el Distrito Federal, 2008 (https://drive.google.com/file/d/0B0qDlFGzsYQfaHFCQWQ0cXZKRzA/view ) and its Reglamento (https://drive.google.com/file/d/0B0qDlFGzsYQfSEJJV2QyTmMtNjQ/view )

South Africa lacks legislation that supports decision-making in persons with impaired capacity that need assisted decision-making provisions or a provision for an enduring power of attorney (Marilyn, 2015). The latter is practiced in other parts of the world; however, it does not currently form part of South African law despite being recommended in 1988 by the South African Law Commission (Meyer, 2016).

References:

Marilyn, H. (2015). Alzheimer’s – “The window of opportunity.” YE! Available from: https://youve-earned-it.co.za/finance/alzheimers-the-window-of-opportunity/

Meyer. (2016). Legal positions of persons incapable of managing their own affairs.

The Maintenance and Welfare of Parents and Senior Citizens Act (2007) places the responsibility on children or relatives to take care of the elderly and highlights that neglect or abandonment of elderly people is a punishable offence by law (Ministry of Law and Justice, 2007). In addition, the Rights of Persons with Disabilities Act 2016 and the Mental Health Care Act 2017 highlight protection of rights of people with disabilities and mental health conditions, respectively (Government of India, 2016; Ministry of Law and Justice, 2017).

References:

Government of India. (2016). The Rights of Persons with Disabilities Act. THE GAZETTE OF INDIA EXTRAORDINARY PART II.

Ministry of Law and Justice. (2007). Maintenance and welfare of parents and senior citizens Act. Government of India.

Ministry of Law and Justice. (2017). The Mental Health Care Act 2017. Government of India. Available from: https://egazette.nic.in/WriteReadData/2017/175248.pdf

Human rights of all persons (including safeguarding against exploitation, violence, or abuse) are regulated by the Law no. 9/1999 on Human Rights. There is an independent legal body called the National Commission on Human Rights (Komnas HAM) whose function is to carry out assessment, research, counselling, monitoring, and mediation. It has the capacity to receive appeals/complaints, to run investigations, and to perform monitoring-evaluations when needed (UU No. 39/1999 Tentang Hak Asasi Manusia (Law No. 39/1999 on Human Rights), 1999).

There is also a law pertaining domestic violence, which is applicable to abuse committed within the household. There is no mention of different approaches in cases where the victim is an older person or a person living with dementia (UU No. 23/2004 Tentang Penghapusan Kekerasan Dalam Rumah Tangga (Law No. 23/2004 on Elimination of Domestic Violence), 2004).

References:

UU No. 23/2004 tentang Penghapusan Kekerasan Dalam Rumah Tangga (Law No. 23/2004 on Elimination of Domestic Violence), (2004) (testimony of Republik Indonesia).

UU no. 39/1999 tentang Hak Asasi Manusia (Law no. 39/1999 on Human Rights), (1999) (testimony of Republik Indonesia).

The care and protection of older members of society bill, 2018; PART III provides for the prohibition, notification, and register of abuse of an older member of society. PART VII indicates the manner in which matters concerning older members of society are to be tackled while taking into consideration the unique needs of such persons (Republic of Kenya, 2018b). However, this is not specific to people with dementia.

References:

Republic of Kenya. (2018b). The Care and Protection of Older Members of Society Bill, 2018. Kenya Gazette Supplement No. 73 (Senate Bills No. 17), pp. 333–363. Nairobi, Kenya. http://www.parliament.go.ke/sites/default/files/2018-08/The%20Care%20and%20Protection%20of%20Older%20Members%20of%20Society%20Bill%2C%202018.pdf

 

While there are no specific laws in favor of persons with dementia or their caregivers in Mexico, more general laws are aimed at preserving their rights as persons, such as the Federal Law to Prevent and Eliminate Discrimination, and the General Law for the Inclusion of Persons with Disabilities. However, it must be recognised that neither of these two mentions dementia specifically.

There are no provisions specifically for persons living with dementia. However, the South Africa Human Rights Commission (SAHRC) was established in 1995 as an institution that is mandated to support constitutional democracy and project human rights of all persons in South Africa. Violations and/or issues of concern can be lodged as complaints to the SAHRC and can be investigated in the interest of safeguarding against exploitation, violence, and abuse.

This section to be updated soon.

In the LTC guideline for Puskesmas, transitional/subacute care (from hospital to community care) is recognised as an important part of LTC. However, it is not yet widely available in Indonesia and needs further development (Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat, 2018).

References:

Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat. (2018). Pedoman untuk Puskesmas dalam Perawatan Jangka Panjang bagi Lanjut Usia. Kementerian Kesehatan RI.

The care and protection of older members of society bill, 2018; PART III section 10 (1) states that “each county government shall establish and implement Community based programmes for the care and protection of older members of society residing within the county” (Republic of Kenya, 2018b), page 341. However, this is not specific to people with dementia.

References:

Republic of Kenya. (2018b). The Care and Protection of Older Members of Society Bill, 2018. Kenya Gazette Supplement No. 73 (Senate Bills No. 17), pp. 333–363. Nairobi, Kenya. http://www.parliament.go.ke/sites/default/files/2018-08/The%20Care%20and%20Protection%20of%20Older%20Members%20of%20Society%20Bill%2C%202018.pdf

 

There are no specific guidelines for transitioning to community-based services.

The Older Person’s Act is based in a philosophy of ‘active aging’, whereby older persons are promoted to participate and live in communities as long as possible, promoting a movement toward deinstitutionalising care (Government Gazette, 2006; Jordan, 2009). However, these legislative frameworks acknowledge that funding is still biased to residential care instead of community-based services (Jordan, 2009).

References:

Government Gazette. (2006). Older Persons Act, No.13 of 2006 (Vol. 13, Issue 1098). Available from: https://www.westerncape.gov.za/other/2012/3/older_persons_act.pdf

Jordan, C. (2009). Older Person’s Programme: Concept paper. Available from: https://www.westerncape.gov.za/other/2009/10/concept_paper-_programme_older_persons.pdf

This section to be updated soon.

The Ministry of Social Affair monitors institutions providing care to older people through direct visits, supervision, and regular evaluation to ensure the provision of sustainable quality care adhering to standards (Ministry of Social Affairs Republic of Indonesia, 2018).

References:

Ministry of Social Affairs Republic of Indonesia. (2018). Ministry of Social Affairs Regulation No. 5/2018 on National Standard of Older People Social Rehabilitation (Permensos No. 5/2018 tentang Standar Nasional Rehabilitasi Sosial Lanjut Usia).

The care and protection of older members of society bill, 2018; PART VI section 33 (1) states that “the county executive committee member shall, for purposes of monitoring and evaluating the provision of services by homes registered under this Act, appoint such number of inspectors as the county executive committee member may consider appropriate” (Republic of Kenya, 2018b), page 354.

References:

Republic of Kenya. (2018b). The Care and Protection of Older Members of Society Bill, 2018. Kenya Gazette Supplement No. 73 (Senate Bills No. 17), pp. 333–363. Nairobi, Kenya. http://www.parliament.go.ke/sites/default/files/2018-08/The%20Care%20and%20Protection%20of%20Older%20Members%20of%20Society%20Bill%2C%202018.pdf

There are clinical practice guidelines for the detection and management of elder abuse (CENETEC, 2013; IMSS, 2013). But they do not make any specifications about people living with dementia.

References:

CENETEC. (2013). Detección y Manejo del Maltrato en el Adulto Mayor. www.cenetec.salud.gob.mx

IMSS. (2013). Guía de Práctica Clínica GPC. Detección y manejo del maltrato en el adulto mayor.

Guided by the South African Human Rights Commission Act 40 of 2013 (South African Human Rights Commission Act 40 of 2013, 2014), the South African Human Rights Commission (SAHRC) is a body that investigates violations and conditions of human rights for all vulnerable populations in South Africa (safeguarding against exploitation, violence and abuse). The SAHRC has held an investigative hearing into systematic complaints relating to the treatment of older persons in 2015 (SAHRC, 2015). This investigation focused on stakeholder engagements, informing the public about violations brought to its attention, as well as identifying systemic issues that are in violation of older persons’ constitutional rights.

References:

SAHRC. (2015). Investigative Hearing Report: Investigating hearing into systemic complaints relating to the treatment of Older Persons. Available from: http://www.sahrc.org.za/construction-site/home/21/files/SAHRC Investigative hearing report.pdf

South African Human Rights Commission Act 40 of 2013, Pub. L. No. No.40 of 2013, 1 (2014). http://www.joasa.org.za/2013-040.pdf

Yes and no.

There is guidance, for example, from the Brazilian Society of Geriatrics and Gerontology, in partnership with ‘Choosing Wisely’, which states that people should not be mechanically contained/restrained (SBGG, 2018). However, this is not prohibitive and still is common practice in Brazil. Mostly, the guidance available says restrains (chemical/physical/environmental) should be avoided and should be done only as a last resource to a) protect the person, b) protect others, c) guarantee effective treatment. This decision should be discussed among the multidisciplinary team and with the family, and the reasons for that should be documented.

References:

SBGG. (2018, June 7). CBGG 2018: SBGG divulga recomendações sobre escolhas sensatas em saúde em parceria com Choosing Wisely Brasil. SBGG. https://sbgg.org.br/cbgg-2018-sbgg-divulga-recomendacoes-sobre-escolhas-sensatas-em-saude-em-parceria-com-choosing-wisely-brasil/

 

This section to be updated soon.

There is no specific regulation regarding coercive practices targeted at people with dementia. However, stigma in mental illnesses often results through physical restraining of people living with mental illness, especially in areas where healthcare can be difficult to access. The practice is known as pasung (shackling) and can still be found in Indonesia despite being banned since 1977 (Human Rights Watch, 2016). In 2017, the Ministry of Health has issued a regulation which covers the prevention of the practice as well as management and rehabilitation guidelines for people affected by these practices. Management of ending of the practice is approached not only through advocacy and education, but also by making pharmacological and non-pharmacological interventions accessible. This is done by facilitating the registration of people affected with the NHIS as well as through home visits and home care, day care and vocational rehabilitation (Permenkes No. 54/2017 Tentang Penanggulangan Pemasungan Pada Orang Dengan Gangguan Jiwa (Ministry of Health Regulation No. 54/2017 on Countermeasures of Shackling Practice on People with Mental Illness), 2017).

References:

Human Rights Watch. (2016). Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia. Human Rights Watch.

Permenkes No. 54/2017 tentang Penanggulangan Pemasungan pada Orang dengan Gangguan Jiwa (Ministry of Health regulation No. 54/2017 on Countermeasures of Shackling Practice on People with Mental Illness). (2017). (Testimony of Ministry of Health Republic of Indonesia).

Kenya still relies on the Convention on the Rights of Persons with Disabilities (CRPD). Article 16: Freedom from exploitation, violence, and abuse states that “in order to prevent the occurrence of all forms of exploitation, violence, and abuse, States Parties shall ensure that all facilities and programmes designed to serve persons with disabilities are effectively monitored by independent authorities” (United Nations, 2006), page 12.

References:

United Nations. (2006). Convention on the Rights of Persons with Disabilities and Optional Protocol. https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf

 

The Official Mexican Standard 025 (DOF, 2015) for the Provision of Services in Psychiatric Medical Hospital Care Units, indicates a set of Provisions that regulate the treatment and rehabilitation of people with a mental disorder, respecting their human rights and covering two areas: a) Quality specialised medical care, and b) Preservation of the human rights of the user. With respect to this second item, it is stated that people with mental disorders have the right to receive dignified and humane treatment by mental health personnel, they are not to be discriminated against because of their condition, not to be the object of diagnosis or treatment for political, social, racial, religious or other reasons different from or external to the state of their health, they have to be protected against all exploitation, abuse or degrading treatment, and they are not to be subjected to physical restrictions or involuntary confinement.

References:

DOF. (2015). Norma Oficial Mexicana NOM-025-SSA2-2014. Para la prestación de servicios de salud en unidades de atención integral hospitalaria médico-psiquiátrica. http://www.dof.gob.mx/normasOficiales/5805/salud3a11_C/salud3a11_C.html

South Africa has “Policy guidelines on seclusion and restraint of health care users” that guide practitioners on the use of these methods to contain only severely disturbed behaviours (i.e., where other techniques have failed) that are likely to cause harm to the self and others, including property (for more detail, see DOH, 2012).

References:

DOH. (2012). Policy Guidelines on Seclusion and Restraint of Mental Health Care users. Available from: https://www.knowledgehub.org.za/system/files/elibdownloads/2019-07/Policy%2520guidelines%2520on%2520seclusion%2520and%2520restraint%2520of%2520mental%2520health%2520care%2520users%25202012.pdf