confinement such as community-based treatment programmes, which are particularly
appropriate for avoiding hospitalization and for providing care for persons upon their
discharge from hospitals.
The Subcommittee has observed situations in which State agents represent
confinement as voluntary and present registries or legal decisions to that effect. It is
concerned that in some of those instances those safeguards were practised as a mere
formality. Confinement and institutionalization are voluntary only when the person
concerned has decided on it upon informed consent and retains the ability to exit the
institution or facility.
If involuntary confinement seems to be appropriate and proportional on a legal basis,
such confinement should never directly include the formal right for medication to be
administered without informed consent.
When a person who is detained by the State suffers serious mental disorders,
involuntary confinement may be judicially ordered to provide timely access to appropriate
expert care and specialist medical treatment. In such cases, placement in a psychiatric
facility may be necessary to protect the detainee from discrimination, abuse and health risks
stemming from illness, provided that all guarantees are respected and that the treatment
offered is equal to that offered to other patients and corresponds to the health needs of the
person and that the placement of the person is subject to constant judicial review. As
specified in article 14 (b) of the Convention on the Rights of Persons with Disabilities, the
existence of a disability should not be the justification for a deprivation of liberty.
Restraints, physical or pharmacological, are forms of deprivation of liberty and,
subject to all the safeguards and procedures applicable to deprivation of liberty, should be
considered only as measures of last resort for safety reasons. The State must take into
account, however, that there is an inherently high potential for abuse of such restraints and
as such these must be applied, if at all, within a strict framework that sets out the criteria
and duration for their use, as well as procedures related to supervision, monitoring, review
and appeal. Restraints must never be used for the convenience of staff, next of kin or others.
Any restraint must be recorded precisely and be subject to administrative accountability,
including through independent complaint mechanisms and judicial review.
Solitary confinement must never be used. It segregates persons with serious or acute
illness and leaves them without constant attention and access to medical services. It should
be differentiated from medical isolation. Medical isolation requires daily monitoring in the
presence of trained medical staff and must not deprive the person of contact with others
provided that proper precautions are taken. Any isolation must be imposed for the shortest
possible period of time, be recorded precisely and be subject to administrative
accountability, including through independent complaint mechanisms and judicial review.
In connection with deprivation of liberty and health-care settings, the Subcommittee
recognizes that States parties should revise outdated legislation and practices in the field of
mental health in order to avoid arbitrary detention. Any deprivation of liberty must be
necessary and proportionate, for the purpose of protecting the person in question from harm
or preventing injury to others. It must take into consideration less restrictive alternatives,
and must be accompanied by adequate procedural and substantive safeguards established by
Human Rights Committee, general comment No. 35 (2014) on liberty and security of person.