C. Exercise

1. Group work method

Number of groups: Three groups, each consisting of 7 to 10 participants.
Time: 30 minutes.
Task: Answer the questions at the end of the case study and then share the results of your work with all participants in no more than 7 minutes, either as a group or through a nominated spokesperson.

2. Case Study

Wafa is 35 years old and has a psychosocial disability. She suffers from schizophrenia. Wafa is undergoing cognitive and drug therapy, as prescribed by her doctors. Wafa decided to stop taking her medication because it was making her very lethargic, and as a result, she relapsed and started showing some suicidal tendencies and violent behaviours. Her family decided to forcibly place her in a mental health hospital on the outskirts of the city. Doctors obtained the family's written consent for the use of treatments, including electroconvulsive therapy and placement in a padded and protected isolation room if necessary. Wafa stayed in the hospital for about six months. Upon her discharge, she filed a complaint with the Public Prosecutor demanding that her family, hospital management and doctors be prosecuted for violating her right to make her own choices and decisions and live independently and for subjecting her to involuntary hospitalization and forced treatment. The Public Prosecutor dismissed the complaint because the Public Health Act and the Criminal Code in force authorised such practices. Wafa sent a complaint to the United Nations Committee on the Rights of Persons with Disabilities under the Optional Protocol ratified by her Government. The Committee examined the complaint and concluded that:

Wafa's right to exercise her legal capacity had been violated by denying her free and informed consent to hospitalization and subjecting her to forced treatment involving a method that undermines and violates physical and psychological integrity through the use of electric shocks, all in breach of Articles 12, 15, 16, 17 and 25 of the Convention;
Failure to provide mental health services in non-residential health institutions and within local communities constitutes a failure to meet the obligations contained in Article 19 of the Convention. Furthermore, forced institutionalization constitutes a violation of this Article and other Articles, including Article 3 on general principles and Article 4 on general obligations.

The State responded by rejecting the contents of the Committee's conclusions, arguing that:

The complainant is considered a "psychiatric patient" and therefore not a person with a disability according to the definition adopted by the State, which holds that disability is "any long-term physical, mental, visual or auditory impairment that prevents a person from carrying out day-to-day activities and limits his or her ability to learn, work and undergo training";
Since the complainant falls under the category of "psychiatric patient" (schizophrenia), she is incapacitated and cannot give consent or make her own choices, so these matters have been entrusted to her family;
The "patient" is in a state of relapse and has become "a danger to herself and others", which justifies her placement in a mental health hospital until she experiences "psychosocial recovery" whereby "her condition becomes stable and she no longer represents a danger to herself or others";
The hospital treatments provided for the complainant's condition are approved and used in many countries of the world, including electroconvulsive therapy and placement in protected isolation rooms. The treatment does not constitute a breach of the patient's rights.

3. Group work questions

Is Wafa really classified as a "patient" rather than a person with disabilities and, if so, why?
Was it really possible for Wafa's consent to hospitalization and treatment to be obtained, as indicated in the Committee's report, and if so, how?
How can mental health services be provided effectively and in community-based formats, as outlined in the Committee's report?
Do you have other comments about the case study?