informed consent of persons with disabilities before any treatment is given. 316 This is based on legal capacity taking on special importance when these persons have to make fundamental decisions with respect to their health. 317 Accordingly, for the IACHR free and informed consent is a fundamental element for guaranteeing the right to health; in particular, in the area of mental health coercive measures perpetuate skewed power relations between patients and their caregivers, facilitating situations of abuse, stigma, and discrimination. 170. In addition, the states should train the personnel of those institutions and provide inclusive care that meets the specific needs of persons with disabilities in which their wishes are taken into account. 318 The CRPD Committee has held that forced treatment by psychiatrists and other health and medical professionals constitutes a violation of the right to integrity 319, insofar as that practice denies the legal capacity of a person to choose the medical treatment he or she is to receive. 320 171. Since all medical and health personnel must ensure appropriate consultation directly with the person with a disability 321, such staff should also ensure, to the extent they are able, that the caregivers, family members, or persons in charge or providing support do not replace persons with disabilities when it comes to their own decisions, and that they not have undue influence over them. 322 Accordingly, they should ensure that (i) accurate and accessible information is provided on the options of available services; (ii) non-medical alternatives are offered; and (iii) access is provided to independent support. 323 2.5 Analysis of the instant case 2.5.1 On the institutionalization of Luis Guachalá 172. In the instant case the IACHR notes that Luis Guachalá is a person with a mental disability, on taking into account: (i) the medical reports that identify a mental deficit; and (ii) the socioeconomic barriers he faced. The Commission also notes that Mr. Guachalá, who at the time was 23 years old, was institutionalized at the Julio Endara Psychiatric Hospital on January 10, 2004. The IACHR observes that it is not disputed that Mr. Guachalá was hospitalized without his consent, as all that was required to do so was the signature of his mother, Rosario Chimbó. 173. In this respect, the IACHR recalls that in October 2014 the CRPD Committee issued its observations with respect to the report of Ecuador on implementation of the CRPD. In that report the CRPD Committee found that the Ecuadorian State maintains a model of substitute decision-making, in violation of Article 12 of the CRPD, which establishes the right to legal capacity of persons with disabilities. The CPRD Committee indicated that it requested information of the State as to the existence of an initiative to transform the model of substitute decision-making by the system of support in decision-making; nonetheless, Ecuador did not present information in this respect. 324 174. The CRPD Committee added: United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 42. 317 United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 8. 318 ONU, Committee on the Rights of Persons with Disabilities. Concluding observations on the report of Brazil, September 4, 2015, paras. 46 and 47. 319 United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 42. 320 United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 42. 321 United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 41. 322 United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 41. 323 United Nations, Committee on the Rights of Persons with Disabilities, General Comment No. 1. Article 12: Equal recognition before the law, May 19, 2014, para. 42. 324 See: United Nations, Committee on the Rights of Persons with Disabilities. List of issues in relation to the initial report of Ecuador, August 7, 2014. 316 31