Eric Ip and Trevor Wan et al on Harnessing the power of constitutional rights and legal frameworks to scale up public mental health implementation (The Lancet Psychiatry)

"Harnessing the power of constitutional rights and legal frameworks to scale up public mental health implementation"
Michael Ni, Candi Leung, Trevor Wan, Jonathan Campion, Neeraj Gill, Sandro Galea, Eric Ip
The Lancet Psychiatry
Published online: February 2026

Summary: Despite the existence of effective public mental health interventions, global coverage remains low. Only a minority of people with mental disorders receive treatment, far fewer receive interventions to address or prevent the associated impacts of mental disorders, and there is negligible coverage of interventions to prevent mental disorders or promote mental wellbeing and resilience. This implementation failure breaches the right to health and statutory legislation in some countries and results in population-scale preventable suffering, broad societal and individual impacts, and associated economic costs. Various reasons account for public mental health implementation failure, including insufficient policy and implementation according to population needs, and insufficient knowledge, resource, political will, and legal protection regarding the right to mental health. This Health Policy highlights a further reason for implementation failure is that only 12% of constitutions covering 3·5% of the world's population explicitly recognise a constitutional right to mental health, compared with 70% of constitutions recognising a constitutional right to health or physical health. A legal framework that includes explicit constitutional protection for mental health would mean the right to mental health would supersede all other laws. This would thereby provide a basis for legislation and support legal opportunities to challenge, advocate, and improve effective public mental health implementation by different sectors. This framework and associated opportunities would support the scale-up of implementation of cross-sector policy based on the public mental health needs of a population. Such a holistic, coordinated legal approach would support scaled-up coverage of public mental health interventions to treat and prevent mental disorders and promote mental wellbeing and resilience, as well as action to address inequities and protect the rights of those with mental disorders. Improved implementation would result in broad impacts across different sectors and associated economic benefits.

Daisy Cheung and Edward Lui on Conditional Discharge, Statutory Interpretation and the Mental Health Review Tribunal (HKLJ)

"Conditional Discharge, Statutory Interpretation and the Mental Health Review Tribunal"
Daisy Cheung and Edward Lui
Hong Kong Law Journal, Vol. 55, Part 1 of 2025, pp.29 - 48

Abstract: This article examines the Hong Kong Mental Health Review Tribunal’s powers in relation to the imposition of conditional discharge orders under s 59E(2) of the Mental Health Ordinance (Cap 136). The wording of s 59E(2) refers back to s 42B of the Mental Health Ordinance, the primary legislative provision governing the conditional discharge regime. There remains ambiguity, however, regarding the scope of the Tribunal’s powers in relation to such matters as the factors that the Tribunal is to consider when deciding whether to impose a conditional discharge order. Section 59E(3) of the Mental Health Ordinance, for example, provides additional factors beyond those contained in s 42B for the Tribunal to consider. In this article, we examine this ambiguity, presenting three different options as to how the interaction between ss 42B and 59E(3) might be interpreted. We then argue that the first of these options is the correct interpretation. We also examine the role that the s 59E(3) factors play within this interpretation, and in particular the implications that the s 59E(3) factors may in turn have for s 42B.

Daisy Cheung on The fatal shooting of a man with mental illness shows Hong Kong police need a better response to such crises (HKFP)

"The fatal shooting of a man with mental illness shows Hong Kong police need a better response to such crises"
Daisy Cheung
Hong Kong Free Press
Published online: October 2024

The recent incident in North Point involving the death of a man with mental disorder at the hands of police responding to an emergency at his home is tragic, but unfortunately not uncommon worldwide.

In jurisdictions all over the world, police often act as first responders in cases involving mental health crises, even though in most cases they severely lack training on how best to support such individuals. A quick search reveals the names of countless vulnerable individuals who met untimely deaths due to interactions with police over just the past year. 

As the number of such deaths increase, places around the world are beginning to take a long, hard look at the suitability of police involvement in situations involving people with a mental disability.

Many countries are calling for police reform, and in some cases, even the police themselves have concluded that they may not always be the most appropriate responders, since their presence may be an “escalating factor” itself.

What lessons can Hong Kong learn from the experiences of these countries? First, the issue of police inadequacy in the face of mental health crises must be recognised and squarely confronted, rather than swept under the rug as merely another incident where the fatality was unfortunate, but the use of force justifiable in the circumstances. 

Concerns about how police in Hong Kong deal with people with mental disability are not new. In 2015, an autistic individual was wrongfully charged with manslaughter......(Please click here to view full text.)

Edward Lui on First Aid Administrative Law: Patching the Conditional Discharge Regime (HKLJ)

"First Aid Administrative Law: Patching the Conditional Discharge Regime"
Edward Lui
Hong Kong Law Journal, Vol. 53, Part 2 of 2023, pp.701 - 731

Abstract: The conditional discharge regime – contained in s 42B of the Mental Health Ordinance (Cap 136) – is an important aspect of Hong Kong’s mental health law. It provides that patients falling within its scope may be discharged into the community, whilst being held subject to specified conditions. But this regime has been subjected to significant academic criticism, including in relation to its relative lack of substantive and participatory safeguards for the patients involved. This article argues that in the absence of statutory reform, the well-established principles of administrative law can offer a valuable mitigation of some of the problems observed under the regime.

Eric Ip and Daisy Cheung on Mapping the Legal Foundations of Planetary Mental Health (Global Mental Health)

"Mapping the legal foundations of planetary mental health"
Eric Ip and Daisy Cheung
Global Mental Health, First View , pp. 1 - 5

Abstract: Human health, including mental health, hinges on the integrity of the planetary biophysical environment and local ecosystems. Legal principles relevant to planetary mental health are currently scattered across the discrete bodies of human rights, health, and climate law, each of which go some way in creating twofold state obligations to take climate action for the purpose of attaining health and thereby mental health, and address mental morbidities resulting from the climate crisis. We argue that a ‘planetary mental health law’ already exists, albeit in preliminary form, and in great need of being developed into a clearer and more coherent regime. Prior to proposing fundamental changes to the international system, it appears to us that soft law should be resorted to as a complement to existing international obligations, whereas states should bolster their level of national commitment to defend the right to mental health on a healthier planet. Time is not on our side and the law must act now.

Lusina Ho on Assessing Capacity for Lifetime and Testamentary Dispositions (HKLJ)

"Assessing Capacity for Lifetime and Testamentary Dispositions"
Lusina Ho
Hong Kong Law Journal, 

2021, Vol. 51, Part 3 of 2021, pp. 853-874

Abstract: In recent years, there has been an increase in litigation on mental capacity in making wills and lifetime dispositions, because people have more complex family structures and live longer to reach an age when there is a greater statistical risk of dementia. Currently, the capacity tests vary depending on the type and complexity of the transaction in question. This article argues that the size and complexity of a transaction tell us only in which direction these criteria correlate with the requisite level of capacity and not what level is actually set. The requisite information required in individual cases should also take into account the underlying interests in the cases. Doing so ensures that similar cases are treated alike and the law of capacity assessment develops in a coherent manner.

Kelley Loper & Carole Petersen on Legal Capacity and the UN Disabilities Convention: An Alternative Framework to Promote Law Reform in Hong Kong and Beyond (J of Comp Law)

"Legal Capacity and the Convention on the Rights of Persons with Disabilities: An Alternative Framework to Promote Law Reform in Hong Kong and Beyond"

Kelley Loper & Carole J. Petersen

Journal of Comparative Law

2021, Vol 16, Issue 2

Abstract: Although widely ratified, the Convention on the Rights of Persons with Disabilities (CRPD) has proven challenging for governments to implement. This article focusses on the right to legal capacity, which is protected by Article 12. According to the UN Committee on the Rights of Persons with Disabilities (CRPD Committee), Article 12 requires governments to abolish all forms of substitute decision-making and provide, instead, mechanisms of supported decision-making for those who need assistance implementing decisions that reflect their own will and preferences. Rather than try to meet that standard, it appears that many governments are choosing not to engage in the process of reforming laws governing adult guardianship, compulsory treatment, and detention on the ground of disability. Hong Kong provides an excellent example of such a jurisdiction. Although bound by the CRPD since 2008, the government has not implemented Article 12 and largely ignored the issue in its 2018 report to the CRPD Committee. Meanwhile, the problems in Hong Kong’s legal framework have become critical. This is partly because the political unrest of 2019 and the crackdown by Beijing in 2020-21 have contributed to a mental health crisis in the territory. Fortunately, the CRPD Committee has requested more detailed information on the right to legal capacity for its upcoming review of Hong Kong. It is, therefore, an ideal time to consider what Hong Kong and other jurisdictions can do to better meet their obligations. This article recognises that the right to legal capacity is a contentious area of law and policy and that it is unrealistic to expect governments to immediately abolish all forms of substitute decision-making. We therefore propose an alternative theoretical framework for interpreting Article 12, one that we hope will promote law reform. Although our approach differs from that taken by the CRPD Committee, it is consistent with the holistic approach to rights that is the hallmark of the CRPD and with the doctrines of interpretation for human rights treaties.

Urania Chiu and Daisy Cheung on Claiming Wrongful Diagnosis under the Mental Health Ordinance: The Impossibility of Building a Reasonably Arguable Case (HKLJ)

"Claiming Wrongful Diagnosis under the Mental Health Ordinance: The Impossibility of Building a Reasonably Arguable Case"

Urania Chiu and Daisy Cheung
Hong Kong Law Journal, 

2020, Vol. 50, Part 3 of 2020, pp. 837-850

Abstract: In the recent Court of First Instance decision Bhatti Bhupinder Singh v Hospital Authority, the judge refused to grant leave under s 69 of the Mental Health Ordinance (Cap 136) (MHO) to the claimant for his wrongful diagnosis and wrongful detention claims against the Hospital Authority. This article considers this decision in detail, arguing that the judge’s reasoning was highly flawed due to its lack of consideration of a crucial factual context of the case, as well as its lack of scrutiny of the decisions made by the various medical professionals involved, in particular in relation to whether the criteria specified by each relevant section of the MHO was satisfied. The resulting approach demonstrates an unacceptable level of deference towards the judgment of medical professionals, to the extent that it is difficult to see how a reasonably arguable case could ever be mounted under s 69 of the MHO — a problematic outcome, given the implications of s 69 on the important right to access to courts. Given that compulsory admission and treatment is a highly draconian regime involving deprivation of liberty and the administration of powerful, mind-altering drugs, the court cannot simply be a rubber stamp and must exercise its supervisory role in a much more meaningful manner.

Daisy Cheung & Eric Ip on COVID-19 Lockdowns: a Public Mental Health Ethics Perspective (Asian Bioethics Review)

"COVID-19 Lockdowns: a Public Mental Health Ethics Perspective"

Daisy Cheung & Eric Ip

Asian Bioethics Review
Published in August 2020

Abstract: States all over the world have reacted to COVID-19 with quarantines of entire cities, provinces, and even nations. Previous studies and preliminary evidence from current lockdowns suggest that emergency measures protecting the public’s physical health by dislocating individuals, families, and social networks could well be causing a devastating public health crisis of mental ill-health in the months and years to come. This article is the first to take a public mental health ethics perspective in examining these lockdowns, the lodestar of which is the right to mental health, rooted in the concept of human dignity. Even the strictest lockdowns are not necessarily unethical but are prone to damage mental health disproportionately, with vulnerable and disadvantaged populations being at particular risk.  Click here to read the full article.

Daisy Cheung: Magistrates Must Improve Approach to Mental Disability in the Courtroom (HKFP)

"Magistrates must improve approach to mental disability in the courtroom"

Daisy Cheung

Hong Kong Free Press

June 22 2020

I have read with great disappointment and concern reports of two recent magistrate cases dealing with the topic of mental disability.

    The first involved a schoolteacher who was found guilty of assault on June 12 at the Fanling Magistrates’ Court. It was reported that the magistrate had questioned the mental state of the defendant on the basis that his testimony was full of lies, that he showed no remorse, and that his testimony about the police wanting to throw him off a bridge was so outlandish that she suspected he had both mental and personality disorder.

     She further commented that she did not think his mental state was such that he could continue to teach. The defendant was remanded to Siu Lam Psychiatric Centre until June 26, where two psychiatric reports would be obtained.There are clearly many concerns with the magistrate’s cavalier usage of technical medical terminology (in an area in which she has no apparent expertise) and perhaps with her decision to remand the defendant to Siu Lam Psychiatric Centre on the basis of his testimony in court, but I would like to focus in particular on the unnecessarily stigmatising effect of the magistrate’s words.

    First of all, anyone with courtroom experience will know that lack of remorse and testimony that appears untruthful or difficult to understand can be shared by many defendants, and that by itself, these behaviours are not indicative of mental or personality disorder.

    What the magistrate is doing here is equating undesirable human behaviour with mental illness, which is incredibly stigmatising for individuals with mental disability, already one of the most vulnerable and stigmatised groups in society. ... Click here to read the full text. 

Chinese version: 

<<法庭必須改善對於精神障礙的態度與處理方法>>

Daisy Cheung 

眾新聞

June 25 2020

近日兩個涉及精神障礙的裁判法院案件報道令人非常失望。
     第一個案件涉及一名於2020年6月12日在粉嶺裁判法院被裁定襲警罪成的小學教師。據報導，裁判官斥被告大話連篇、無悔意、以為警察會扔佢落橋的證詞十分荒唐，以至於質疑被告的精神狀態及懷疑被告心智及人格有潛在障礙。
     裁判官進一步質疑被告的精神狀態是否足以使他繼續教書，並將案件押至6 月26 日判刑，以索取兩份精神科報告、心理及背景報告。期間被告還押小欖精神病治療中心。
     當然，裁判官對醫學術語的草率引用，以及她僅根據法庭上的證詞即將被告還押小欖精神病治療中心的決定，顯然是令人擔憂的。但於此，我希望特別關注裁判官措辭中的不必要的污名化作用。
     首先，任何有法庭經驗的人都會知道，許多被告均表現出無悔意或作出難以理解的證詞，僅這些行為本身並不能表示被告具有心智或人格障礙。
    裁判官將不良行為與精神疾病等同起來，這種做法嚴重污名化患有精神障礙的人士——況且他們已是社會上最弱勢和最被污名化的群體之一。 ... Click here to read the full text. 

Eric Ip & Daisy Cheung on Global Mental Health Security—Time for Action (JAMA Health Forum)

"Global Mental Health Security—Time for Action"

Eric Ip & Daisy Cheung

JAMA Health Forum 

Published in June 2020

Global health security has been concerned predominantly with organizing transnational collective action to prevent the risks of bioterrorism and infectious disease outbreaks, such as the Ebola crisis of 2014-2016.1 One confounding omission in global health security has been mental health. The Global Health Security Agenda (GHSA), currently a partnership of more than 60 sovereign states plus the World Health Organization (WHO), other international institutions, nongovernmental organizations, and private companies, is committed to “a world safe and secure from infectious disease threats.” Of its 8 Action Packages, from antimicrobial resistance to biosecurity to zoonotic disease, none pertains directly to mental health. The WHO’s Global Preparedness Monitoring Board, which gauges global preparedness not just for outbreaks but also health emergencies, makes no meaningful reference to mental health in its first annual report, released in September 2019.2 None of the 6 indicators on the Global Health Security index, developed by the Johns Hopkins Center for Health Security, the Nuclear Threat Initiative, and The Economist Intelligence Unit, even mentions mental health... Click here to read the full article.

Daisy Cheung & Eric Ip on a Public Mental Health Ethics Perspective on the Covid-19 Lockdowns (Journal of Medical Ethics blog)

"What are the obligations of the state? A public mental health ethics perspective on the Covid-19 lockdowns"

Daisy Cheung & Eric Ip

Journal of Medical Ethics blog

Published in May 2020

The Covid-19 crisis has led to the unprecedented and widespread use of lockdown measures all over the world. With such drastic measures being imposed so widely and on such short notice, the concern is that the Covid-19 precedent, which has allowed the suspension of a wide range of human rights in a desperate attempt to curb the spread of the pandemic, is a dangerous one. Insufficient thought is being given to the effects of policies being put in place. In particular, the effects of these measures on the right to mental health are being overlooked, next to the harm done to the freedoms of movement, residence, assembly, and association.

     What is the right to mental health? Legal obligations aside, it can scarcely be disputed that governments have an obligation to advance the common good and public interest, including to eliminate grave and preventable risks not only to the physical health but also the mental health of their people. There are two important reasons for this. First, without a minimally tolerable level of mental health, citizens will be unable to meaningfully exercise civil and political rights like the freedom of speech and the right to vote. This means that the unwillingness of governments to fulfill basic mental health needs will directly impede democracy-enabling rights. Secondly, neglecting the right to mental health will in one way or another lead to neglecting the right to physical health. There is a broad consensus that mental disorders are risk factors for communicable as well as non-communicable diseases, as well as being contributory factors to accidental as well as non-accidental injuries.

     How might this right to mental health be violated by the state? What we are concerned about, in a paper we are currently developing, is the failure to take necessary and appropriate steps to protect public mental health during an emergency. In the context of Covid-19 lockdowns, the primary concern is that in implementing an ill-planned, drastic response to the emergency, the response itself may result in harms to public mental health. While we cannot be sure of the precise psychological effects of the lockdowns, past studies of quarantines provide us with useful insight into the types of effects that lockdowns may have on mental health. For example, in a review of such studies, it was found that most of these reported a series of adverse psychological effects, the impact of which was wide-ranging, substantial and in some cases, long-lasting.

     Apart from the increased mental health risk to all citizens subjected to lockdown measures, however, the more troubling aspect is perhaps the disproportionate effect that the violation of the right to mental health will have on vulnerable and disadvantaged populations. Low-income families, for example, are often confined to very small spaces for lengthy periods at a time. The psychological risks of living within tight spaces would likely be gravely exacerbated if one has no choice but to remain in that small space, often with family members, for most of the day, with no end in sight. For these families, school closures may also mean that their children are no longer receiving the school meals that they heavily depend on, likely a source of anxiety for parents and children alike. Those with pre-existing mental disorders are also particularly vulnerable in these circumstances. Fear of hospitals and clinics will likely affect the willingness to access timely mental healthcare. Individuals with mental disorders will not be able to engage in many of the usual recommendations for maintaining good mental health, such as socialisation, which will then detrimentally impact their mental state.

     There are many other similarly vulnerable and disadvantaged groups. Lockdowns have kept those with abusive family members confined in the same living space as their abusers. The elderly and the disabled may be more likely to suffer difficulties procuring essential supplies such as groceries and masks, in particular during panic-buying, due to issues with mobility. Single parents are left with very few alternatives when faced with the closure of childcare facilities and schools while continuing to work from home. These predicaments are all likely to leave these groups with a range of adverse psychological reactions: fear, anxiety, anger and frustration... Click here to view the full text. 

Daisy Cheung and others on the Future Direction of Law Reform for Compulsory Mental Health Admission and Treatment in Hong Kong (Int'l J L & Psychiatry)

"Articulating future directions of law reform for compulsory mental health

admission and treatment in Hong Kong"

Daisy Cheung, Michael Dunnb, Elizabeth Fisteinc, Peter Bartlettd, John McMillane, Carole J. Petersen

International Journal of Law and Psychiatry

Published in November 2019 online
Introduction: This article builds on the work of an international conference on the topic of compulsory mental health admission and treatment in Hong Kong (the ‘Conference’) and explores the pathways for reform in this area. A number of jurisdictions around the world are currently re-viewing their mental health laws, in part because of the requirements of international treaties that seek to protect the rights of persons with disabilities. The challenge in the review and reform process is aligning local mental health needs, frameworks and traditions with overarching commitments to treat people with mental illness in ways that safeguard their control over their own treatment, reduce coercive interventions, and protect against arbitrary deprivations of liberty. In outlining four possible pathways for potential law reform in Hong Kong, we intend to also provide a blueprint for regulatory change in other jurisdictions that seek to draw a balance between local needs and international norms. The comparative value of this piece lies not in its direct applicability to other jurisdictions, but in its demonstration of how an exercise like this might be undertaken, and the kinds of considerations that should be taken into account when addressing relevant features of each of the four pathways in alternative local contexts.

     Our article proceeds as follows. Part II presents a brief overview of the mental health system and legal framework in Hong Kong. Part III considers Hong Kong's international commitments for the protection of human rights, in particular the International Covenant on Civil and Political Rights (‘ICCPR’) (which is incorporated into Hong Kong's do-mestic legal system) and the United Nations Convention on the Rights of Persons with Disabilities (‘CRPD’), which has applied to Hong Kong since 2008. Part IV summarises the key local challenges that Hong Kong faces in any attempt at reform. We then set forth, in Part V, four dif-ferent strategies for reforming mental health law in Hong Kong: (i) theabolition pathway, (ii) the risk of harm pathway, (iii) the mental ca-pacity pathways, and (iv) the consensus pathway. Part VI provides abrief conclusion for the article... Click here to read the full article.

Daisy Cheung on Mental Health Law in Hong Kong: The Civil Context (HKLJ)

"Mental Health Law in Hong Kong: The Civil Context"
Daisy Cheung
Hong Kong Law Journal
Vol. 48, Part 2 of 2018, pp 461-484

Abstract: This article takes the first step in addressing the paucity of research on mental health law in Hong Kong, in particular the civil context. It argues that the state of civil mental health law in Hong Kong is in dire need of reform due to its archaic nature and insufficient protection of patients’ rights. This article focuses in particular on the following four key areas: (1) compulsory mental health admission and treatment, (2) compulsory mental health treatment in the community, (3) voluntary and informal mental health patients and (4) the concept of mental capacity. It is argued that the law needs to be reformed in each of these areas to ensure that it reflects both modern trends of mental health law, as well as Hong Kong’s commitment to the protection of fundamental human rights.