Support in Crisis to Replace Forced Psychiatry

1. Support in Crisis to Replace Forced Psychiatry Tina Minkowitz Center for the Human Rights of Users and Survivors of Psychiatry

2. Article 12 and forced psychiatry • Dual regime of substitute decision-making and arbitrary detention – forced psychiatry has a dual nature of paternalism and social control • Different from most other issues under Article 12 • Needs multi-pronged comprehensive and integral approach under social model of CRPD to both name the problem and solve it • Cannot be deferred to health sector or to discourse of ‘human rights and mental health’

3. Why focus on ‘crisis situations’? • Those who disagree with us see crisis situations as ‘hard cases’ where CRPD paradigm (in their view) falls short • No debate about eliminating long-term institutionalization • Peruvian reform demonstrates feasibility of meeting political and technical challenges to substantial compliance with Article 12/GC1 • However even that landmark achievement retained possibility of mental health detention on ‘emergency’ basis, regulations define as 72 hours • ‘Danger to self and others’ trope still holds sway despite CRPD Committee’s Guidelines on Article 14 and repeated recommendations in country reviews

4. Demedicalization • First, we need to remove psychosocial crisis from the framework of medical emergency • Requires unlearning of carefully-constructed narrative of ‘chemical imbalances successfully treatable with drugs’ which cannot be supported with evidence and is not proper scientific hypothesis • To remain within that framework is a disservice to narratives of people with psychosocial disabilities who have much richer descriptions - see e.g. webinar series of RedEsferaLatinoamericana de DiversidadPsicosocial (in Spanish, hopefully English subtitles to come) • Implication: support to make decisions in psychosocial crisis does not equate to ‘support to decide about mental health treatment’ – rather we are looking at support to make the decisions that resolve the crisis itself

5. Crisis • Crisis is by nature a dilemma – we don’t know what to do • Pressures from economic and social issues – housing and income are major stressors • Relationships with intimate partners, family, community, co-workers, activist comrades • Patterns of abuse, violence, discrimination, ongoing and past issues re-emerging • New life experiences and challenges • New perceptions and feelings • Each person’s self-care, construction of self and relation to world, inwardness and subjectivity

6. Support in crisis • Support can help us manage immediate sense of urgency and address actual urgent needs like shelter and food, while allowing ourselves to experience intense emotions and perceptions • This requires support for two phases of decision-making: discernment and decision (inward-looking and outward-looking) (Art 12) • and practical support to meet immediate needs – to remove the pressure of external crisis so that the process of decision-making can evolve (Art 19) • This is support for the person’s own process of decision-making that is manifesting in a way she experiences as a crisis • No imposition of any particular narrative or timeframe

7. Relations and conflict • In crisis situations there is often pre-existing conflict that gives rise to crisis • Also, one person’s crisis affects those around them • Can be several people experiencing crises of their own and needing support • CRPD rejects ‘danger to self and others’ and requires non-discrimination by police and justice systems with respect to any acts of violence or abuse, by or towards persons with disabilities • De-escalation of conflict and avoiding violence needs to be routine obligation of police • Mediation or communication assistance from someone who can be trusted by all parties to a conflict can also be also useful • Sensitivity to and acceptance of diverse manifestations of distress and crisis, which are not the focus of the interaction

8. How this replaces forced psychiatry • Rejects ‘incompetence’ and ‘danger’ narratives that are enshrined in regime of substitute decision-making and arbitrary detention • Rejects institutionalization even for short time • Safety is addressed from point of view of the person concerned – shelter, freedom from violence and abuse, comfort, choice of surroundings and interactions, choice about risk and vulnerability • Safety is also addressed interpersonally as impartiality, without assuming that person in crisis is the cause of conflict – we need for aggression against person in crisis to be taken seriously • Rejects medicalization of both personal distress and interpersonal conflict • Accepts diversity of transitory states and person’s ownership of her own evolving life and self-narrative

9. Questions? Comments? Presenter resources: • tminkowitz@earthlink.net • www.chrusp.org • http://absoluteprohibition.org • http://tastethespring.wordpress.com • https://www.madinamerica.com/author/tminkowitz/ • https://uio.academia.edu/TinaMinkowitz