|published in: "Forum The Declaration
of Madrid and current psychiatric practice: users' and advocates'
views", in: Current Opinion in Psychiatry, Vol. 12 (1999),
No. 1, pp. 6-7; and in: Voiceless Movement (Ed.): Deprived
of Our Humanity The Case against Neuroleptic Drugs,
Geneva: Association Ecrivains, Počtes & Cie. 1998, pp. 159-162
Commentary to: WHO Quality Assurance in Mental Health
Care: "Draft. Human rights of people with mental disorders"
We list here some remarks and points that should be added, in
our opinion, to the Declaration of Madrid.
Psychiatrists have to reflect that their measures can only suppress
symptoms with medical methods because treated persons
regularly suffer from emotional problems of social nature and
not from bodily diseases. To call all subjects infirm
To base ethical behaviour on the psychiatrist's individual sense
of responsibility allows him or her to act arbitrarily. Ethical
psychiatric behaviour should be based primarily on the treated
person's individual ethic, on the Universal Declaration of Human
Rights and other United Nations documents, especially the right
of freedom from bodily harm, and on the civil and criminal law.
At any given facility, there should be sufficient space for the
number of inmates or patients admitted. There should be phone
boxes for inmates or patients in every psychiatric ward. There
should be easily visible coin- operated telephones at the entrance
hall of each psychiatric institution. In each psychiatric ward
there should be an easily visible notice stating that inmates
or patients can get writing paper, envelopes and stamps if wanted.
There should be notice boards in every ward on which local, regional
and national organisations of (ex-) users and survivors of psychiatry
can put uncensored information. For each inmate or patient there
should be the offer to have a daily walk in the open air for at
least 1 h. On each ward there should be a kitchen where inmates
or patients can prepare food and drinks around the clock. The
nonsmokers' right to have good air to breathe should be guaranteed.
The smokers' right to smoke as long as they want should also be
guaranteed. Meals served to inmates or patients should meet recommended
minimum nutritional requirements. The needs of people who want
special diets should be met.
Psychiatrists should provide not only relevant information to
empower individuals to make a rational decision; they should give
all information about the risks of treatment which are possible
and not to be excluded.
It should be acknowledged by psychiatric associations and/or
by reforms of the law that advance directives (made during non-doubted
states of normality) about wanted and unwanted treatments have
to be respected.
Psychiatrists who treat without informed consent should lose
their medical approbation. The national psychiatric associations
should have a section particularly dedicated to human rights.
No decision should be made without the consent of national organisations
of (ex-) users and survivors of psychiatry.
(Ex-) users and survivors of psychiatry should be involved in
the education (including the boards of examiners) of psychiatrists
meaningfully and on a well paid level. Organisations of (ex-)
users and survivors of psychiatry should be acknowledged as organisations
of individuals with a high level of expertise. There should be
ombudsmen and ombudswomen who are (ex-) users and survivors of
psychiatry at national levels.
There should be bodies including (ex-) users and survivors of
psychiatry specifically charged, at national levels, with monitoring
the respect of human rights of people with mental disorders or
who are said to have mental disorders. The task of these bodies
should include the registration of new treatment measures and
decisions of ethics' commissions in research fields. Help and
support should be made available by staff to family members, friends
and persons of trust.
Treatment, if ethical, should be primarily based on nonpharmacological
measures such as psychotherapy. Psychosurgery and other intrusive
treatments which may possibly cause irreversible damage, such
as psychiatric drugs, electro- and insulin shock treatments, should
never be carried out on an involuntary inmate or patient without
informed consent. Sterilisation, abortion or any treatment that
can be harmful for the inmate's or patient's (future) children
should never be carried out on people with mental disorders or
who are said to have mental disorders.
Clinical trials and experimental treatments should never be carried
out on an involuntary inmate or patient without informed consent.
The institutions and persons carrying out these trials should
be obliged to prove that resultant damage is not a result of these
Information obtained in the treatment relationship should principally
be kept in confidence. Written records should be appropriately
maintained for all inmates and patients, who should be entitled
to access their own records at any time and without justification.
Copies of records should be available. Inmates and patients should
have the right to revise records or to add commentaries.
, Chair, European Network of (ex-) Users and Survivors