A Disability Rights Tribunal for the Asia Pacific

1. A Disability Rights Tribunal for the Asia Pacific Australian Federation of Disability Organizations & Tokyo Advocacy Law Office Melbourne, Australia 13 August 2010 Psychosocial Disability and the Asia PacificDavid WebbWorld Network of Users and Survivors of Psychiatry (WNUSP)

2. Mental Health Laws in the Asia Pacific • unlike Australia, many Asia Pacific countries do not have specific mental health laws • these countries are asking whether they should introduce MH laws to protect the rights of people who experience psychosocial disability • e.g. at the CBR Congress in Bangkok last year • but MH laws such as we have in Australia do not protect the rights of people with psychosocial disability • rather, they take away our rights

3. Mental Health Laws in the Asia Pacific For instance, in Victoria: • 5,000+ people on CTOs in Victoria (population 5 million) • equates to 128,000 people in Japan • every week over 100 involuntary patients are given ECT NB – the WHO Mental Health Division says: • ECT without consent should be prohibited – no exceptions • same as direct/unmodified ECT (with or without consent) • does not occur in Australia but does in several Asia Pacific countries, such as Thailand

4. CTOs around the world There are striking variations in rate of use across jurisdictions and this leads to criticism that their use is arbitrary and poorly linked to clinical need. Broadly speaking, rates are low in Canada, high in Australasia and mixed in the USA ... ‘Outpatient commitment’, in the USA, varies enormously from less than two per 100 000 in New York, to 22 in North Carolina ... to 26 in Nebraska, and even higher in Washington DC. In Australasia, rates vary from 55 per 100 000 for Victoria, 44 for New Zealand, 43 for Queensland, 37 for New South Wales, down to 10 in Western Australia. Editorial in 'Psychological Medicine' (2009), Vol 39, pp 1583-1586

5. WHO and ECT Although significant controversy surrounds electroconvulsive therapy (ECT) and some people believe it should be abolished, it has been and continues to be used in many countries for certain mental disorders. If ECT is used, it should only be administered after obtaining informed consent.WHO Resource Book on Mental Health, Human Rights and Legislation (2005, page 64) http://whqlibdoc.who.int/publications/2005/924156282X.pdf

6. Mental Health Laws in the Asia Pacific The full implementation of the CRPD will protect the rights of people with psychosocial disabilities • including the right to supported decision-making, if needed, as required under the CRPD • and the right to the supports we need to achieve our other CRPD rights • specific mental health laws are not needed except (perhaps) for positive discrimination • e.g. affirmative action legislation

7. Medical Colonisation of Psychosocial Disability • in many western countries, the excessive medicalisation of all aspects of life (not just MH) is causing great concern (sometimes called disease-mongering) • medicalisation of MH in Australia (and the west in general) is now virtually complete and causing great harm, not just to individuals but to society as a whole • this has occurred despite any good scientific evidence that psychosocial disability is a medical “mental illness” • in stark contrast to the very good evidence that the medical interventions offered are (a) not very effective and (b) often very harmful

8. Medical Colonisation of Psychosocial Disability • unscientific medical prejudices are the primary excuse used to impose medical interventions on people with psychosocial disability without their consent • in partnership with society’s prejudices that people with psychosocial disability are dangerous (also not supported by any scientific evidence) • we now have good evidence that the medicalisation of psychosocial disability is actually disabling people • i.e. creating/causing long-term disability • see “Anatomy of an Epidemic”, Robert Whitaker • also the “Americanization of Mental Illness” http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?_r=1&emc=eta1

9. Mental illness and violence “Bivariate analyses showed that the incidence of violence was higher for people with severe mental illness, but only significantly so for those with co-occurring substance abuse and/or dependence. Multivariate analyses revealed that severe mental illness alone did not predict future violence; it was associated instead with historical (past violence, juvenile detention, physical abuse, parental arrest record), clinical (substance abuse, perceived threats), dispositional (age, sex, income), and contextual (recent divorce, unemployment, victimization) factors. Most of these factors were endorsed more often by subjects with severe mental illness.” “Because severe mental illness did not independently predict future violent behavior, these findings challenge perceptions that mental illness is a leading cause of violence in the general population. Still, people with mental illness did report violence more often, largely because they showed other factors associated with violence. Consequently, understanding the link between violent acts and mental disorder requires consideration of its association with other variables such as substance abuse, environmental stressors, and history of violence.” Longitudinal study with 34,653 subjects. Eric B. Elbogen & Sally C. Johnson, The Intricate Link Between Violence and Mental Disorder, Arch Gen Psychiatry. 2009;66(2):152-161

10. Medical Colonisation of Psychosocial Disability The western, medical model of “mental illness” is being aggressively promoted in the developing world • WHO etc but also some major Australian organisations: • Asia Australia Mental Health • Melbourne Uni, St Vincents Mental Health, Nossal Institute) • Mental Health First Aid International • born in Melbourne, now exported to Hong King, Singapore, Japan, Cambodia and Thailand • beyondblue – China • Nossal (again), in partnership with Basic Needs

11. Medical Colonisation of Psychosocial Disability • this is the developed west once again colonising the developing east, this time with the very western, very medical model of psychosocial disability • with it comes widespread psychiatric labelling of psychosocial distress, with all its stigma and discrimination, and widespread (expensive) drugging of many people • also widespread human rights violations – incarceration, forced treatment etc – on the basis of this model • a Disability Rights Tribunal could help resist this colonisation

12. Social Model of Disability, the CRPD and Mental Health Human Rights • mental health systems need to be based on the social model of disability • recognise the social determinants that contribute to disability • and the disabling consequences of the medical model • must include full implementation of the CRPD, especially • supported decision-making model now mandated by the CRPD • the right to the supports needed to achieve other CRPD rights • and also, of course, the CRPD’s full protection of the human rights of people with psychosocial disability on an equal basis with others in society

13. Conclusions:Reconciliation, an Apology, and a Tribunal Dr Janet Wallcraft is a pioneering psychiatric survivor academic in the UK who has called for a public apology for the wrongs done to us in the name of psychiatric treatment. • as the first, essential step towards reconciliation • must also include reparations and compensation for past wrongs before we can move forward in genuine partnership • Janet uses South Africa’s post-apartheid Truth and Reconciliation Commission as one example of the kind of process that is required

14. Conclusions:Reconciliation, an Apology, and a Tribunal A familiar scenario to us in Australia – the Stolen Generation • gross human rights violations occurred against Indigenous Australians, causing great harm and suffering • by a privileged elite in partnership with a prejudiced majority • on the basis of nothing more than the arrogant assumption that it was “for their own good” • the same arrogant assumption that psychiatric force is “for their own good” lies at the heart of Australia’s mental health system and the current medical colonisation of psychosocial disability throughout the world

15. Conclusions:Reconciliation, an Apology, and a Tribunal • the perpetrators of psychiatric human rights abuses are usually well-intentioned • same as the perpetrators of the Stolen Generation • but as the UN Special Rapporteur on Torture has said, good intentions are no excuse for human rights abuses • Janet Wallcraft concluded her talk in Manchester with: I suggest that the apology should be negotiated internationally – through our representatives at EC and UN level.

16. Conclusions:Reconciliation, an Apology, and a Tribunal A Disability Rights Tribunal in the Asia Pacific could play an important role in the region to achieve what Janet and many other people with psychosocial disabilities all over the world are calling for – and have been for many years. • an end to psychiatric force • protection of the rights of people with psychosocial disabilities • reconciliation and genuine partnerships to move forward Nothing About Us Without Us