In the United States, the families of people with serious mental illnesses eventually organized the National Alliance for the Mentally Ill (NAMI) to lobby for better care and to modify the 1970s' laws and provisions that prevented patients from receiving treatment. The American Psychiatric Association spent years canvassing its members and preparing a model statute that balanced legal rights and needs. The U.S. Supreme Court and other federal courts have backed away from their earlier support of the radical rights-driven approach. The experts who prepared the draft have dismissed the efforts of NAMI and the APA. They have considered none of the negative consequences of the reforms they propose. And they have ignored the changing legal climate in the United States courts that is most familiar with the rights-driven model. This is not the way the most important health organization in the world should behave.
It is difficult to justify the WHO's decision to allocate its own limited resources to this ill-conceived project of formulating mental health codes for the entire world, but perhaps it can be explained. There is growing international solidarity around the ideal of universal human rights. That progressive effort deserves support and recognition by everyone. However, even John Stewart Mill, the patron saint of human rights, recognized that children and (those he called) the "insane" posed a special problem for any universal notion of liberty and human rights. The U.S. lawyers of the 1970s unfortunately refused to believe in the reality of insanity or mental illness. Instead of recognizing the special problem Mill described, they declared the mentally ill as the paradigm victims of human rights abuse. Success in protecting a client with schizophrenia from appropriate and efficacious treatment was, in their biased view, as much a victory for autonomy and human rights as protecting a political dissident from improper and inappropriate treatment. But delusions and hallucinations are not a manifestation of human autonomy; they are symptoms of a serious malfunction of the human brain. So these legal victories were not a victory for patients with schizophrenia or their families, or for anyone else who recognizes the realities of mental illness. Given the advances in neurosciences and our understanding of the biological dimensions of mental illness, psychiatrists should recognize the fallacy of that outmoded approach. Yet it is the misguided view of these biased lawyers and the outmoded legal precedents they set that the draft is mistakenly following in the name of human rights.
The director general of WHO has recognized that, around the world, most people with serious mental illnesses are not being provided treatment. There is documentation that conditions in some mental hospitals in India and elsewhere are truly appalling and appropriate legal change should begin there. The proposed Manual on Mental Health Legislation should be rejected. It will add to the woes of those suffering people and will divert precious resources away from their care.