Helsinki Citizens’ Assembly-Vanadzor

On June 5, 2024, the draft order of the president of the Urban Development Committee of the Republic of Armenia on approving RA Construction Norms 31-03.07- "Healthcare Organizations: Buildings and Structures of Hospital Care (Inpatient) Facilities" was presented for public discussion.

HCA Vanadzor, consistently emphasizing the need for a rights-based approach by the competent bodies responsible for drafting and adopting legal acts in the field of mental health, has reviewed the Draft and identified problematic regulations in certain articles.

• The Draft suggests defining the term "health" as a state of complete physical, mental, and social well-being, rather than merely the absence of disease or disability.

This definition seems to be taken from the charter of the World Health Organization (WHO), but due to the wrong translation, it has acquired a different meaning. According to the WHO charter (1946), [“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”]։  In fact, the WHO does not use the term disability. 

Moreover, accepting the definition of health proposed in the suggested Draft will contradict the UN Convention on the Rights of Persons with Disabilities.

Thus, the Convention defines disability as an evolving phenomenon, resulting from the interaction between individuals with health problems and the attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others.Therefore, disability cannot be considered within the definition of health.

The definition of health is of great importance in the development of policies and implementation of programs in the field of healthcare. It should be adequate to the sectoral problems and challenges.

Although the definition used by the WHO is often criticized by various experts, and even during the drafting of Article 12 of the International Covenant on Economic, Social, and Cultural Rights, the Third Committee of the General Assembly rejected the definition of health enshrined in the preamble of the WHO Constitution, it continues to remain the only definition expressing international consensus. 

Therefore, we suggest reviewing the definition proposed by the draft and formulating it as follows: health as a state of complete physical, psychological, and social well-being. 

• According to the draft, psychiatric organizations are singled out in the regulations regarding organizations providing medical inpatient care and services.

Thus, for example, the 83 clause of the Draft stipulates that “the capacity of the rooms of medical intervention in day inpatients should be no more than 10 places. The psychiatric wards should be equipped  with a maximum of 6 beds.”

The regulations of clause 83 of the draft refer only to psychiatric organizations. Meanwhile, they should be built considering the nature of the implementation of the psychiatric care and service, as well as the adopted policy of  deinstitutionalization.  Psychiatric organizations should not have a specific state, while psychiatric care and service should be carried out on an equal basis, regardless of the type of institution. 

Taking into account the above-mentioned approach, we suggest replacing the word "psychiatric hospitals" with the expression "psychiatric department of organizations providing medical inpatient care and services". 

In addition, a number of articles refer to the Order N01-N of the RA Minister of Health of January 4, 2022, which defines the conditions necessary for the stay of a person with a mental health problem in a psychiatric institution. 

We suggest not to refer to this order, so that the regulations spread on the organizations providing  medical inpatient care and services.