Mental health law in the community: thinking about Africa

Traditionally, mental health law at both domestic and international levels has focused on institutional care, and particularly psychiatric hospitalisation. In this vision, the role of mental health law has been to ensure appropriate substantive and procedural standards prior to involuntary admission, and, more recently, to ensure standards of institutional care following admission.Historically, this approach to legislation corresponded to the policies regarding the psychiatric care of people with relatively severe mental illness, which had a central focus on detention in psychiatric asylums, often for extended periods. This paradigm of mental health law can however be seen as increasingly insufficient. The political emphasis in recent decades has moved from institutional to community care for people with relatively severe mental illness, and this shift is reflected in the new UN Convention on the Rights of Persons with Disabilities (CRPD). Unlike many previous international documents such as the UN Mental Illness Principles, the CRPD is not mere guidance: it is international law, with a formal review body to which countries that have signed the convention will be held accountable. The CRPD moves the focus of law away from detention and compulsion, to the provision of community services and the right of a person with disabilities (a term which expressly includes mental disabilities) to integration into the community. Clearly, a legislative focus on institutionalisation to the exclusion of community life is now out of step with the developing international law.Africa presents particular opportunities and challenges for this new legal paradigm. Its rates of institutionalisation tend to be very low by international standards: see additional file 1, table 1. In rich countries the move from an institutional model of care to a community model of care has been achieved through the development of decentralised community-based dedicated mental health care alternatives provide