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The United Nations Resolution 46/119, Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, is the most detailed and comprehensive statement about the rights of the mentally ill. No other statement covers the variety of topics that this resolution does. The resolution recognizes: 1) the right to informed consent, 2) the right to the protection from harm, 3) prohibition of arbitrary or unnecessary isolation or physical restraint, 4) the right to live, work, and receive treatment within the community, 5) recognition of the patient's cultural background in order for there to be a more comprehensive reintegration into society, 6) use of the least restrictive environment available to treat the patient in, and 7) Treatment of the mentally ill patient must be towards maintaining and furthering the independence of the patient as well as promoting the patient's participation in the community.

I visited Uruguay in 1993, 1995 and 2003 as member of a human rights mission with Mental Disability Rights International (MDRI). Services were provided in long-term institutions called Colonias, which served as human warehouses very far from the urban center of Montevideo. The physical accommodations for patients were rudimentary, and patients were inactive during the day. Record-keeping was scanty with a lack of documentation for most aspects of care, including diagnostic assessment and treatment planning. There was no opportunity for support from families and the community, which were often many miles away. I geared my presentation to making the following points: the need for accessible services within the community; the importance of bringing support from families and the community to patients; the need for documentation and quality assurance and, most importantly, provisions to safeguard the human rights of the mentally ill individual.

Subsequent to the team's talks, the mental health administration brought about a change in the mental hygiene law. The old law represented the largest stumbling block to the human rights of the mentally ill, as it deprived the mentally ill of judicial protection. Through our work, and that of local human rights activists, a new law was enacted. This law has a progressive approach to the protection of human rights of the mentally ill and strongly encourages services within the community. The legislative body and the Department of Health began developing funding streams to facilitate community reintegration and to improve services with the mentally disabled.

Last year at the invitation of the Uruguay government, we returned and were able to verify that positive changes were happening. Changes consisted of the closure of a hospital, reduction in hospitals' censuses in the Colonias, bringing academia into the service settings of the Colonias, and having community programs run by consumers and others by families.

My second example involves a series of visits to Mexico in 1999 and 2000. In our visits to the different institutions, there was evidence of inhuman and degrading conditions. A situation similar to that in Uruguay prevailed there. In Mexico, the long-term institutions were called Granjas. Rudimentary restraints were used to exert control, restraints in which patients could languish for days with no time out. People in the Granjas experience a total lack of privacy and basic control over the most minute and personal decisions of daily life.

In 1999, MDRI, as it had done in 1996 and 1998, continued to document filthy living conditions, unhygienic treatment practices, lack of appropriate medical and dental care, improper use of physical restraints, and shortages of blankets and clothing.

Treatment in the Granjas is primarily aimed at providing minimal care while keeping people in the institutions. Such custodial care is generally not directed toward rehabilitation or assisting a return to the community. The majority of people remain in a facility for a year or more, often for a lifetime. Treatment practices are primarily geared toward controlling symptoms through psychotropic medications. Little or no effort is made to promote reintegration into the community.

A large number of people placed in long-term facilities are officially labeled abandonados-people who are fully capable of living in the community, but have no family or no other place to go. In November 1999, the directors of two institutions estimated that 75 to 80 percent of people in their own facilities are abandonados. In 1998, the director of the National Commission of Human Rights estimated that the number is roughly 70 percent on the national level. The detention of abandonados in institutions-without any individualized determination that they meet civil commitment standards or that they are dangerous to themselves or others-is a violation of international human rights law.

After the MDRI Mexico Report was shared with the media in February of 2000, the Mexican authorities have proceeded to close one of the Granjas, the Fernando Ocaranza Psychiatric Hospital. A cluster of villas has replaced the hospital where 12 patients live per unit. This type of community has become the model for future service delivery system. We look forward to the future plans that Dr. Julio Frenk has described in his interview with The New York Times. He said that by the year "2006 the government hopes to establish similar mental health systems in every state and close its 18 government hospitals."

It is part of our job to teach those in power-the community leaders and politicians-what our people need and how they can help us to provide it for our people.