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Recommendations

International human rights law creates obligations on the government of Turkey to protect the rights of all children and adults detained in psychiatric institutions, rehabilitation centers, and orphanages. International law also recognizes the rights of all people with mental disabilities to live, work, and receive treatment in the community. It is the obligation of the government of Turkey to reform its mental health and social service systems to provide the community-based services necessary to permit full social integration of people with mental disabilities. It is up to the government of Turkey to determine which government agencies implement these rights. As mental health and social services are currently split between the Ministry of Health and the Directorate for Social Services (SHCEK), the following recommendations apply to both agencies. We encourage the government of Turkey to create a mechanism for collaboration between these agencies, since there is extensive overlap in the population of people who receive services from the two government agencies.

Immediate action should be taken to end the most egregious abuses and human rights violations taking place in institutions. These include:

1. 
   Ending the abuse of ECT
   

1. 
   Unmodified ECT should be banned in all circumstances; in the future, this practice should be criminalized.
   

2. 
   ECT should be used only with the informed consent of the patient and with the right to refuse the treatment.
   

3. 
   The use of ECT should be halted where there is no clinically proven justification in accordance with internationally accepted professional standards.
   

2. Protecting against inhuman and degrading conditions in institutions

1. 
   Stop the improper use of physical restraints, such as tying children to beds or cribs or taping bottles over their hands; professional attention and behavior programs should be provided to assist all children who are self-abusive.
   

2. 
   All children and adults shall be ensured adequate food and water; where necessary, additional staff must be provided to assist people who, because of their disability, are unable to feed themselves.
   

3. 
   Provide all necessary medical and dental care needed to protect the health and safety of institutionalized persons.
   

4. 
   Provide habilitation and rehabilitation services and low-cost interventions to provide freedom of movement, stimulation, human contact and rehabilitation; all people detained in institutions – but particularly children – should be provided
   

with regular activities and opportunities to leave the institution and participate in recreation, sports, cultural life, and other forms of stimulation in the community. Recruiting outside volunteers and non-governmental organizations to assist in these activities can be particularly valuable.

5. 
   Enforceable laws protecting a broad array of rights in institutions, such as protections against improper seclusion and restraint, should be established in accordance with international human rights standards; until such time as the Turkish parliament establishes such a law, both the Ministry of Health and SHCEK should adopt and abide by written human rights policies. These policies should be widely disseminated to staff and patients in institutions.
   

6. 
   All staff working within institutions should be provided with human rights training; non-governmental organizations (NGO’s), including representatives of people with mental disabilities and former patients and family members, should be involved as trainers.
   

3. Improper and arbitrary detention in institutions

1. 
   Cease plans to construct any more residential or long-term facilities for people with mental disabilities.
   

2. 
   Family supports and supported foster care programs should be established to help children remain in their families or live with substitute families; such programs must include oversight and monitoring to ensure safety and quality of care in the community; it should be possible to create such programs within six months; after this time, no new admissions of children shall be permitted in orphanages or rehabilitation centers.
   

3. 
   An enforceable mental health law consistent with international human rights standards should be adopted; this law should protect against arbitrary detention and should provide a right to a hearing in all cases of involuntary treatment.
   

Individuals should have a right to counsel at these hearings. Until such time as the Turkish parliament adopts this law, the Ministry of Health and SHCEK should adopt and adhere to written policies that protect these rights.

4. Oversight and enforcement

1. 
   All institutions should be opened up to public oversight in accordance with the requirements of Council of Europe Rec. (2004)10; an independent human rights monitoring agency should be created to:
   

1. 
   conduct on-site inspections day or night with no advance notice;
   
2. 
   inspect patient records;
   
3. 
   take photographic and video evidence;
   
4. 
   publish their findings;
   

5. 
   include people with disabilities and former users of Mental Health or SHCEK services in their work;
   
6. 
   report to an independent board that includes respected members of the community, including representatives of non-governmental organizations, including groups made up of people with mental disabilities.
   

2. 
   Human rights committees should be created at each institution that include current and former patients, as well as members of the community. These committees should have full access to all parts of institutions and should meet outside the institutions in a place where they can be assured privacy and independence.
   

Human rights committees should be provided with funding independent of the institutions.