The introduction of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) and General Comment 1 on Article 12 (GC1) has generated considerable debate regarding the assertion that people with psychosocial disabilities (disabilities arising from mental health conditions) always possess decision-making capacity.
While there is debate over the feasibility and acceptability of supported decision-making, stakeholders interviewed for this study suggested that coercive treatment is heavily overutilized and that there needs to be more dialogue between holders of divergent positions.
There are a number of important unresolved questions relating to more complex cases and to whether the right guaranteed by the CRPD is absolute and immediate or subject to limitations.
Ensuring participation of all key stakeholders is essential to realizing the pluralistic vision of the CRPD, as is research focusing on implementation of supported decision-making regimes, particularly in low- and middle-income countries. Training on the provisions of the CRPD is also needed to ensure implementation, and addressing stigmatized beliefs among policy makers about the decision-making and cognitive abilities of mental healthcare users (MHCUs) is critical.
Faraaz Mahomed, Michael Ashley Stein, Vikram Patel
PLOS Medicine, October 18, 2018