A/HRC/40/54 15. Involuntary commitment to mental health facilities for short or long periods of time is the most recognized form of deprivation of liberty on the basis of impairment. Unfortunately, such acknowledgement has not resulted in its abolition, but instead has led to the enactment of legislation setting out criteria for the detention and procedural safeguards. Indeed, a majority of countries regulate involuntary commitment through mental health laws. In 2017, 111 States reported having a stand-alone law on mental health.6 In addition to the threshold criterion of being diagnosed with a “mental illness” or “mental disorder”, common criteria include alleged risk to oneself or others and/or alleged need for care and treatment, as determined by medical professionals. In most jurisdictions, involuntary commitment leads to forced medication or other interventions. 16. Involuntary commitment is commonly purported to be a last-resort exception, but evidence shows that this is not the case. Despite the overall reduction of inpatient beds in mental health facilities globally, compulsory admission rates seem to be rising across regions, particularly in high-income countries. For example, a significant increase is reported in several European countries.7 Involuntary admissions are also increasing in many countries from the Americas, the Middle East and East Asia. 8 Even when admissions are formally voluntary, in most countries “acute inpatient psychiatric wards” are locked and individuals cannot leave the facilities at will. Moreover, voluntary admissions may not truly reflect the individual’s free and informed consent as they may be expressed under the threat of involuntary commitment. Long-term hospitalization of 12 months or longer is still prevalent in some countries.9 17. Institutionalization is another widespread form of deprivation of liberty targeting persons with disabilities. The need for “specialized care” is often the justification for this type of placement. A major study that included 25 European countries estimated nearly 1.2 million persons with disabilities are living in institutions, most of them without their consent and without opportunities to challenge their placement. 10 Social care institutions for persons with disabilities are also still prevalent in many countries of Africa, Asia and Latin America. Where public institutions do not exist, charity-run and traditional or religious centres operate. For example, “prayer camps” led by traditional and faith healers are common in a number of African countries. In such centres, persons with disabilities frequently live in extremely unsanitary conditions, often shacked or secluded, under the complete discretion of a “faith healer”.11 18. Although institutionalized settings differ in size, name and set-up, they share certain defining elements. Among these are: isolation and segregation from independent life within the community; lack of control over day-to-day decisions; lack of choice over whom to live with; daily schedule and routine irrespective of personal will and preferences; identical activities in the same place for a group of persons under a certain authority; a paternalistic approach in service provision; supervision of living arrangements; obligatory sharing of assistants with others and no or limited influence over whom one has to accept assistance from; and usually also a disproportion in the number of persons with disabilities living in 6 7 8 9 10 11 World Health Organization, Mental Health Atlas 2017 (2018), p. 18. A. Turnpenny and others, Mapping and Understanding Exclusion: Institutional, Coercive and Community-based Services and Practices across Europe (Mental Health Europe and University of Kent, 2017). M. Lebenbaum and others, “Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study”, British Journal of Psychiatry Open, vol. 4, No. 2 (2018), pp. 31–38; J.A. Bustamante Donoso and A. Cavieres Fernández, “Internación psiquiátrica involuntaria. Antecedentes, reflexiones y desafíos”, Revista Médica de Chile, vol. 146 (2018), pp. 511–517; A. Bauer and others, “Trends in involuntary psychiatric hospitalization in Israel 1991–2000”, International Journal of Law and Psychiatry, vol. 30, No. 1 (2007), pp. 60–70; and A. Kim (2017), “Why do psychiatric patients in Korea stay longer in hospital?”, International Journal of Mental Health Systems, vol. 11, No. 2. Turnpenny and others, Mapping and Understanding Exclusion, p. 41. J. Mansell and others, Deinstutionalisation and Community Living – Outcomes and Costs: Report of a European Study, Volume 2: Main Report (Canterbury, University of Kent, 2007). Human Rights Watch, “‘Like a death sentence’: abuses against persons with mental disabilities in Ghana”, 2 October 2012. 5