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Support in Crisis to Replace Forced Psychiatry. Tina Minkowitz Center for the Human Rights of Users and Survivors of Psychiatry. Article 12 and forced psychiatry.
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Support in Crisis to Replace Forced Psychiatry Tina Minkowitz Center for the Human Rights of Users and Survivors of Psychiatry
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’
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
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
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
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
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
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
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