Human Rights of Users and Survivors of Psychiatry Tina Minkowitz
Paradigm Shift • Old paradigm: • Took for granted the “need” for coercive measures • Human rights meant standardizing and subjecting to the rule of law • New paradigm: • Coercive measures are incompatible with equality and inherent dignity • Human rights means abolishing coercion and creating new types of support
Paradigm Shift 2 • Old paradigm associated with “Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care” (non-binding UN declaration) • New paradigm associated with Convention on the Rights of Persons with Disabilities • CRPD supersedes MI Principles to the extent of conflict, e.g. on involuntary treatment
What Changed? • Non-discrimination as central principle • Social model of disability – change society and not the person • Participation of users and survivors of psychiatry as part of international disability community
Concept of Legal Capacity • Old paradigm: • Capacity for rights vs. capacity to act • “Having” vs. exercising legal capacity • Legal capacity vs. mental capacity/competence • New paradigm: • Legal capacity as right to make decisions and be held responsible for one’s acts • Universal; cannot be denied based on disability • Limitations in ability met with support
Basis of New Paradigm • Equality • Human development requires agency • Social solidarity and interdependence • Abuses in guardianship and incapacity framework: • Civil and social death • Enforced powerlessness facilitates victimization • Acknowledgement of human imperfection
What about “Best Interest”? • PWD have equal rights as others to make decisions with risky or harmful consequences • Forgoing medical treatment even if condition worsens or death results • Use of mind-altering drugs • Extreme sports • Sexual and relationship choices including unsafe sex and pain infliction, by mutual free and informed consent
Engagement • Harm reduction is more effective if non-coercive • Domestic violence – shelters, responsive law enforcement, counseling • HIV/AIDS – anonymous testing, needle exchange • Drugs/alcohol – availability of rehab, learn by example, change social surroundings • Why is “mental health” different?
Engagement 2 • Old paradigm: • Medical diagnosis/labeling • “Evidence-based” treatment • Mechanistic approach to mind by treating the brain • New paradigm: • Human engagement – curiosity and interest • Judicious use of drugs when desired for particular results, feedback, low dose and shortest duration
Engagement 3 • How to do support or create mental health alternatives: • Peer support • Residential models • User-run respite/crisis hostel • Soteria • Counseling and psychotherapy successful for people labeled with schizophrenia • “Open Dialogues” approach – use with caution as it can be authoritarian
Gender and Race Perspectives • Avoid stereotyping about social interactions and qualities • For example: women “are” or “should be” emotional and like to interact socially • Escaping gender and race stereotypes may be seen as risky by others • Intersecting discrimination – whose abilities and competencies are mistrusted?
Creating New Legal Frameworks • Abolish mental health and incapacity laws – stereotyping, discriminatory, violate CRPD • Systematically reform all laws dealing with capacity or competence • Identify what is the risk protected against • Use disability-neutral alternative • Provide access to supported decision-making and prevent abuse of such support
Remedies • Torture prevention framework – international and national • CAT articles 1 and 16 may prohibit forced psychiatric drugging and electroshock, psychiatric detention • Special Rapporteur on Torture Manfred Nowak, 2008 Interim Report to UNGA
Participation • User/survivor participation in implementing new paradigm essential • Expertise by experience, mutual support, lifelong advocacy • CRPD requires close consultation (Article 4.3) • Human rights education for user/survivor communities
Information • email@example.com