The issue of involuntary treatment of persons
in psychiatric institutions, which became widespread, remain a matter of great
concern.
Consent to psychiatric treatment is
formalistic, in a psychiatric organization, people are deprived of their
liberty for gross human rights violations.
Court decisions are formal and superficial,
without sufficient grounds, they are in standard (template) formulations and
are not a guarantee for a person.
For example, last year's visit to Armash
Health Center revealed that the administration had filed a motion for 19
persons in two groups to initiate involuntary treatment; the judicial decision
of 7 of which were not yet available at the time of the visit.
As the National Preventive Mechanism, the
Human Rights Defender reviewed all the documents and notes that there were no
records of “medical commission conclusion” on the day of the conducting medical
examination or the period before or after that. In some cases, the results of
the commission's conclusion were added to the descriptions of the history of
the illness on an additional page, in case when the number of pages of
historiography had not yet been exhausted.
The medical history records also did not contain
accounts of persons with mental health issues refusing to be treated or
hospitalized. The medical examinations of the mentioned persons and the
relevant records continued to be performed at the accepted “format” once a month, and did not reflect the reasons
to start involuntary treatment for the patient.
Moreover, although it is mentioned in the
"medical commission conclusion" that person with mental health
problems, "… Poses a danger in outpatient treatment conditions…", or
"he is a great danger to his environment due to his mental state",
however, there were no records in the medical history records confirming the
above.
In
the pre and post motions period, the accounts in the medical history records of
the patient do not demonstrate a negative dynamic about their mental health
state; mainly, stable, and sometimes even a positive dynamic is recorded.
The
studied motions filed to the court to initiate involuntary treatment had a
typical nature, the main formulations were repeated, except for the first name
and the surname of the patients, and their diagnosis.
In
all the motions submitted to the court were recorded that “…criticism of their
illness is lacking, as a result of which they refuse inpatient treatment, and
the lack of treatment may worsen the mental state of the patient”, “they do not
have any criticism against their illness, the need involuntary inpatient
treatment and care”, “we ask to accept this application, and subject the person
to involuntary hospitalization and treatment in the psychiatric institution,
because they pose a real threat to themselves and their surroundings with his
mental state.”
As a
rule, neither the motions nor the medical history records of persons with
mental health issues contained a note where the patient refused an impatient
treatment. For example, according to the medical history record, the patient
was admitted to the Armash Health Center for voluntary treatment on May 26,
2020. However, on December 11 of the same year, the administration of the
Center submitted a motion to initiate involuntary treatment on the latter,
although the medical history of the patient regularly records that they “are
mostly in a state of mental calm”, “their consciousness is clear”, “can
communicate”, “replies ordinarily to inquires addressed to them”, and
“understands and upholds in-hospital rules and order.”
In
these mentioned cases, the medical history records do not provide for any legal
basis for initiating involuntary treatment. The stated circumstances raise
serious questions about the artificial and unfounded nature of this involuntary
treatment.
Instead
of properly receiving the informed consent to hospitalization and treatment,
motions are submitted to the court based on “medical commission conclusions” that
are highly problematic since they are presented without proper reasoning on
person’s risk assessment to pose a danger and the need for hospital treatment.
Particularly
concerning is the fact that a number of patients who were being treated
“voluntarily”, became “extremely dangerous to themselves and their
surroundings” in incomprehensible situations and during the same time period;
this is unsubstantiated by the notes made in the medical history records by the
doctors treating them.
The
fact that such motions have not caused confusion even among the judges who have
made judicial decisions to initiate involuntary treatment is deeply
worrying. On the contrary, the judicial
act is usually based on the standard statements made in the motions of the
psychiatric institutions, without sufficient arguments to substantiate them.
These
decisions differ from one another only in terms of patients’ first names,
surnames and diagnoses of the disease, which shows that the judicial acts on
initiating involuntary treatment are standard.
The
Human Rights Defender once again emphasizes that the necessity for the care of
persons with mental health issues, and the insufficiency or lack of respective
social services for ensuring it (the care) may not serve as a basis for
initiating an involuntary treatment.
The
state should guarantee community-based services, their diversity and
accessibility for persons with mental health issues.
The
lack of such services should not be an excuse for a state in keeping the
persons with mental health issues in psychiatric institutions involuntarily, or
for depriving reluctant persons of their liberty by using tools of involuntary
treatment.
The
Human Rights Defender as National Preventive Mechanism recorded similar issues
in other psychiatric institutions as well.
The
issue is presented in greater detail in the Annual Report on the activities of
the Human Rights Defender as the National Preventive Mechanism.
Հայերեն
