Introduction to WNUSP human rights issues

1. Introduction to WNUSP human rights issues Tina Minkowitz

2. Who we are • “A user or survivor of psychiatry is self-defined as a person who has experienced madness and/or mental health problems and/or has used or survived psychiatry / mental health services.” – WNUSP statutes • Madness/mental health problems with or without help or intervention • Use (or former use) of services • Surviving (or having survived) or resisting forced intervention

3. Language • Psychosocial disability – functional domain, includes interface between self and society • Some prefer “psychiatric disability” – disabled by psychiatry • Not a personal identity so much as a way of explaining who we are in the disability community • Service user, ex-user, ex-patient, survivor of psychiatric assault, psychiatric survivor, person with psychosocial or psychiatric disability, person with mental health problems, mad person, etc.

4. Human rights violations • Denial of personhood – tying, confining, institutionalization, guardianship and deprivation of legal capacity, forced treatment • Subjection, humiliation, constriction of opportunities • Financial exploitation and discrimination • Society does not accommodate madness/ psychosocial disability • Fear and demonizing by the media

5. First-person perspective • Madness as developmental process – journey of transformation/ recovery • Self-ownership – choice about meanings, values and identity • Healing trauma – everyone can heal • Responsibility/ reasonable accommodation/ respite • First-person plural – collective affirmation and knowledge

6. CRPD issues • Principles of autonomy, non-discrimination, diversity (right to be different) • Article 4 – repeal/modify discriminatory laws • Non-discrimination (Article 5) • Legal capacity – right, principle and paradigm • Equal legal capacity – right to make decisions and have status of responsible person • Principle of autonomy reflected in all legal rights and responsibilities • Paradigm of autonomy plus support – support complements & facilitates autonomy but does not infringe on it

7. CRPD issues 2 • Liberty – no deprivation based on disability = no mental health confinement • See OHCHR Legal Measures Study paras 48-49, OHCHR Info Note on Detention & PWD • UDHR & ICCPR reach same conclusion • Non-discrimination applied to liberty: can only be on same grounds and same standards & procedures applied to general population

8. CRPD issues 3 • Integrity/ freedom from torture & ill-treatment/ free and informed consent in health care • CRPD Reporting Guidelines include no forced interventions in Article 17 • SR on Torture A/63/175 • Medical treatments of an intrusive and irreversible nature, lacking therapeutic purpose or aimed at correcting or alleviating a disability, may constitute torture or ill-treatment if enforced or administered without free and informed consent of person concerned – para 47 • Forced psychiatric interventions & institutionalization may constitute torture/ill-treatment – paras 61 – 65 • Deprivation of legal capacity can facilitate torture/ill-treatment – para 50 • Discrimination based on disability demonstrates both intent and purpose for CAT article 1 – despite “good intentions” of medical professionals – para 49

9. CRPD issues 4 • Living in the community, work, education, health, adequate standard of living • Article 19 supports complement/ overlap article 12, also Article 26 peer support (not rehabilitation but alternative) & Article 28 “respite” • Right to inclusive housing and unbundling of services (19 & 28) • Work & education disrupted – need remedy, non-discrimination based on gap in work history • Health – physical ill-health & adverse effects of psych drugs attributed to “mental illness” – discrimination/ “master status” as barrier to equal realization of health • Development/ poverty eradication need to target us as participants – not service recipients • Disability pensions structured for dependence, poverty, medical model compliance/supervision, all or nothing

10. CRPD & prison context • Articles 12, 13, 14, 15 • Insanity defense – alternatives to impunity/unimputability • Mens rea, reasonable accommodation • Access to justice – accommodation to participate in legal proceedings, dismissal in interests of justice as remedy if accommodations insufficient? • Same rights as other criminal defendants – no separate mental health courts that require guilty plea or allow psychiatric institutionalization/ compulsory treatment as disposition • Treatment in compliance with CRPD objectives and principles including reasonable accommodation – no forced treatment in prison, access to outside support networks, trauma-informed approach • Reject: “problem of undiagnosed and untreated mental illness in prisons” and consequent focus on substituting medical supervision for penal supervision – don’t mix treatment with control • Unpack and reframe from first-person perspective, human rights, trauma-informed

11. Children/ youth issues • Self-determination – ensure children & youth can refuse psychiatric treatment, access support of their choosing, practice their own spiritual beliefs/values (Article 7.3) • Right to education – ensure education provided to children/ youth even if they need respite/ time away from home • No institutionalization of children/ youth based on disability

12. Development • Need for services – what kind? • How can legal capacity paradigm be incorporated domestically – natural supports in family/community? • Globalization of broken medical model with its coercion/compliance framework and rule of (unjust) law – WHO • Medical model diagnosis & treatment are disabling – WHO’s own studies revealed better outcomes in developing countries • Social inclusion needed – but on what terms? • People with psychosocial disabilities as protagonists and decision-makers • International cooperation to share information on alternatives and advocacy – user/survivor movement as protagonist and not sidelined (can cooperate with CBR, others)

13. Mental health laws • Mental health acts exist to authorize and regulate institutionalization, later also compulsory treatment • Mental health acts are discriminatory legislation – violate CRPD article 14, usually also articles 12, 15, 17, 25 • Recent legislation has window dressing of entitlement to treatment, rights within treatment/institutional setting, but core is same • Need to ensure that compulsory institutionalization and compulsory treatment are prohibited • Is mental health act reform the way to prohibit institutionalization & compulsory treatment? Question of local strategy • Segregated legislation usually works against us • Inclusive design/mainstreaming in disability rights and general law • Be careful with targeted laws: what is the purpose and reasoning? Can it be used against us? • “Repeal mental health act, prohibit involuntary institutionalization and involuntary treatment, and ensure that all mental health admissions and treatment are based on free and informed consent of the person concerned”

14. References – UN • SR on Torture A/63/175 • OHCHR Legal Measures Study – A/HRC/10/48 • OHCHR Information Note on Detention and PWD (for Detainees Week Oct 2007) • OHCHR Guidance for Human Rights Monitors • CRPD Reporting Guidelines

15. Resources – IDA website • Principles for Implementation of Article 12 • Position paper on CRPD and other human rights provisions • Submission to OHCHR legal measures study • OPCAT monitoring guidelines for psychiatric institutions • Position paper on functional capacity

16. Resources – WNUSP • T Minkowitz, WNUSP Advocacy on the Disability Convention: the Emergence of a User/Survivor Perspective in Human Rights • T Minkowitz, The UN CRPD and the Right to be Free from Nonconsensual Psychiatric Interventions • D Webb, Psychosocial Disability and the Asia Pacific • EdahMaina, Psychosocial Disability in Kenya • NOUSPR, Mental Illness and Witchcrafts • NOUSPR, Ababosyi Group • WNUSP, Kampala Declaration • WNUSP, Human Rights Position Paper • WNUSP, Implementation Manual

17. Resources - Alternatives • NOTE: not all of these resources are completely reliable, may be mixed good & bad practice • P Stastny & P Lehmann, Alternatives Beyond Psychiatry • L Mosher, V Hendrix, D Fort, Soteria: Through Madness to Deliverance • Intentional Peer Support - http://www.mentalhealthpeers.com/ • Hearing Voices Network - http://www.intervoiceonline.org/ • Sister Witness International - http://www.sisterwitness.org/ • Trauma-informed care - http://www.samhsa.gov/nctic/

18. Contact and websites • tminkowitz@earthlink.net • www.wnusp.net • www.chrusp.org