U.N. Questions U.S. on Forced Psychiatric Drugging

Tina Minkowitz, Esq.
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Last week was the culmination of more than a year’s worth of advocacy towards the U.N. Human Rights Committee on the issue of forced psychiatric drugging in the United States.  The Human Rights Committee is a committee of independent experts elected to review compliance with the International Covenant on Civil and Political Rights, a treaty to which the U.S. is a state party.

Aubrey Shomo, Patricia Bauerle and I spent the week talking to Committee members and holding side events to give information and personal testimonies beyond what we presented in the written shadow report, including global perspectives.  We were joined in side events by our colleagues from the World Network of Users and Survivors of Psychiatry, Hege Orefellen from Norway and Jolijn Santegoeds from the Netherlands, as well as Richard Pearshouse from Human Rights Watch and moderators Facundo Chavez Penilla, Disability Adviser to the Office of High Commissioner for Human Rights, and Jorge Araya, Secretary of the Committee on the Rights of Persons with Disabilities.  Our international team did amazing work, and was supported by the Geneva-based secretariat of the International Disability Alliance, of which WNUSP is a member.  I will write more about what I am learning about shadow reporting, and we will also be sharing video and audio from our presentations, but now I want to report on what happened on Friday in the Interactive Dialogue of the Committee with the United States.

On Friday March 14, 2014, Human Rights Committee member Ms Zonke Majodina from South Africa questioned representatives of the United States government on forced psychiatric drugging.  While we await the video archive and transcript, here are my notes of what she said:

Regarding the nonconsensual use of psych medication in psych institutions:

We are told that U.S. constitution constrains the government’s use of nonconsensual treatment & clinical investigations.  That they are permitted only in carefully controlled situations & also constitutional safeguards such as federal PAIMI program, and regulations on use of restraint on patients in mental institutions.

On the other hand, information from nongovernmental organizations shows that there is ample evidence that state & local governments routinely apply and allow neuroleptic medications and electorhosck to be applied without informed consent & against their will.  It is not limited to psychiatric institutions but allowed in nursing homes for older persons especially those with dementia and people in situations of particular vulnerability such as children in foster homes and prison inmates.  New York law permits compulsory treatment of persons confined against their will, in particular where consent lacks capacity to make a reasoned decision.  The law also allows for forced drugging in prison and even after release from prisons.

Scientific literature reveals neuroleptic drugs have serious side effects.  They are mind altering, and cause shivering, trembling, contractions and all kinds of other physical side effects.

The Special Rapporteur on Torture recently called for an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptics, the use of restraint and solitary confinement, for both long- and short- term application.

Furthermore the U.S. National Council on Disability recommended, “Laws that allow the use of involuntary treatments such as forced drugging and inpatient and outpatient commitment should be viewed as inherently suspect, because they are incompatible with the principle of self-determination. Public policy needs to move in the direction of a totally voluntary community-based mental health system that safeguards human dignity and respects individual autonomy.”

Against this background, I pose the following questions:

Is the U.S. government concerned about this widespread use of nonconsensual psych medication, electroshock and other coercive practices?

Has the U.S. or another state given consideration to imposing ban recommended by the Special Rapporteur on Torture?

What have states done to reform criminal law and procedure, policies and practices against people labeled with psych disabilities including drugging as a condition for release?

Has the President or Congress taken any action regarding the recommendation of the National Council on Disability?

The U.S. representative from the Department of Health and Human Services, Dr Wanda Jones, answered as follows (also my notes):

Ms Majodina asked about nonconsensual medical treatment.

Although US federal law prohibits nonconsensual treatment, it can be provided without consent for life threatening interventions.

This is governed by state law, which cannot violate constitutional provisions on due process, privacy and equal protection of individuals.  Professional organizations may also have guidelines on practice.

We are concerned.  We established the Protection and Advocacy for Individuals with Mental Illness program, which operates in all 50 states, DC, all territories and in consolidated Indian territories.  PAIMI supports state-designated projects that are specifically designed to investigate allegations of violations in mental health settings, including seclusion & restraint.

The program reported over eighteen thousand complaints and closed thirteen thousand.   About ten thousand were substantiated, of which about a fifth were abuse and a fifth neglect.  There were over 6200 rights violations.  2500 cases were not substantiated.   Where intervention was substantiated, they achieved positive changes in environmental community or living arrangements.  We are constantly working on getting better.

Medicare conditions of participation for hospitals including psychiatric hospitals detail restrictions on the use of restraints including drugs and medications when used to manage behavior or restrict freedom of movement.  This implements standard that is set in regulation, monitored by Center for Medicare and Medicaid Services.

The Department also supports the training and development of consumer/peer mental health workers, designated to assist those who are receiving services to access needed services.

We expanded comprehensive community mental health services to children and families, and expanded program of cooperation with the justice system, transitioning into civil society.

The Affordable Care Act will mean one of the largest expansions in substance abuse and mental health treatment services in a generation.

SAMHSA has had a significant impact on culture of treatment environments.  Many facilities funded through state grants have reduced traumatizing practices, facilitated recovery and consumer directed care.

Regarding medication and treatment of federal prisoners including those with mental disabilities, a strict set of federal regulations governs the extent to which medication can be administered involuntarily, including an administrative hearing, except in emergency circumstances.

Ms Majodina followed up by saying (from notes taken by a staff person from the secretariat of the International Disability Alliance):

On non consensual medical treatment, I understand there are special rules and appreciate efforts on monitoring at the state level.

But I am still surprised that states have been left to devise their own rules. I’m wondering whether any states have considered the ban which has been recommended by the Special Rapporteur on Torture made February last year, available on the UN website of documents.  So given that it is really at state level that there is no compliance with the requirement to prohibit coercive treatments especially in mental health settings, I think the matter cannot just be left, there should be some form of good faith undertakings by federal government that these recommendations by UN bodies is taken seriously also at state level.

The final step will be the Committee’s adoption of Concluding Observations and recommendations for the United States.

 

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27 COMMENTS

  1. Tina,

    I agree with Dr. Cornwall. Your dedication to this frustrating but crucial cause is amazing and I greatly appreciate your efforts on behalf of all those whose human rights, dignity and health have been threatened by the predatory biopsychiatry/Big Pharma cartel for profit and social control agenda.

    Do you think that Dr. Jones is sincere? Do you think those in the federal government are any better than states regarding these human rights violations?

  2. “Although US federal law prohibits nonconsensual treatment, it can be provided without consent for life threatening interventions”.

    Therein lies the problem.

    As positive sounding at her closing remarks were…I remain skeptical that they will ever implement the full recommendations made by the UN Special Rapporteur – because I think the general public (and most lawmakers) simply don’t know what else to do…locking people up, and drugging them up to the eyeballs, is always so much easier than having to come up with something genuinely helpful.

  3. Oh, actually, upon reading the full report of the UN special rapporteur (not just the text of his statement):
    “Deprivation of liberty on grounds of mental illness is unjustified if its basis is discrimination or prejudice against persons with disabilities. Under the European Convention on Human Rights, mental disorder must be of a certain severity in order to justify detention.87 The Special Rapporteur believes that the severity of the mental illness is not by itself sufficient to justify detention; the State must also show that detention is necessary to protect the safety of the person or of others. Except in emergency cases, the individual concerned should not be deprived of his liberty unless he has been reliably shown to be of “unsound mind”.88 As detention in a psychiatric context may lead to non- consensual psychiatric treatment,89 the mandate has stated that deprivation of liberty that is based on the grounds of a disability and that inflicts severe pain or suffering could fall under the scope of the Convention against Torture (A/63/175, para. 65). ”

    The language above seems to contradict what was written in his statement, where he said that involuntary treatment cannot be justified even on the basis of preventing harm to “self or others”…

    What is the UN’s actual view? Did I completely misread it?

  4. I want to be excited about this. I want to find it comforting. The problem is several things: 1st one of the few memories I do still have from the nearly five years I spent hospitalized as a child is that, within the first week, we all learned to sit very carefully. We weren’t allowed to speak, but it didn’t take long for you to learn to tuck your feet under you at all times and sit in the center of the bed. If one foot got too close to the edge, an alarm would sound, staff would come from all over the complex, we would be placed in a five point hold, and shot full of halparadol. I mention this because the UN (with us included) found that the halaparadol administered in order to gain compliance equated to torture in 197’0’s. Of course, that was Russia using it on prisoners and not a group of mentally ill girls. Then, I get to the bigger question: How does such a modern society willfully ignore this sort of abuse for so long without questioning it’s own humanity? It isn’t a secret, but we have to wait for a UN delegate to point out what should be painfully obvious. That’s why I can’t be happy to hear the UN’s demands. You see, in my mind, that means that the general public is more comfortable with the idea of the mentally ill being tortured than they are with the possibility that we think, feel, and respond just like they do.

  5. Thank you, Tina Minkowitz, Hege Orefellen, UN and other NGO allies for fighting the good fight! I’m reminded of Eli Wiesel’s words on why the world was engulfed by WWII, why evil is let loose, because good people, as bystanders, let it happen… You are keeping us awake.

  6. Thank you, Tina, Aubrey & Patricia for your work on this!

    I find Dr. Jones’ answers do not directly address the questions posed, or even the tenor of the dialogue, as indicated by her language change from ‘nonconsensual psych medication, electroshock and other coercive practices’ to ‘nonconsensual medical treatment’. There are no states within the USA that have given a single jot of consideration to imposing bans recommended by the UN Special Rapporteur on Torture; I would fall over in a dead faint if any state BH policy makers in this entire country are even aware that such bans have been defined. To suggest that the nation’s sequester-slammed PAIMI programs oversee consensual treatment issues demonstrates a lack of understanding of PAIMI funding guidelines, outcome targets or typical case studies. Colorado has an especially stellar protection & advocacy program, successfully resolving cases that range from prisoner lawsuits within the notorious ADX facility in Florence, Colorado, to helping a woman keep her companion animal in her apartment as guaranteed by ADA law. I am vice-chair of the Colorado PAIMI, in addition to holding several roles reviewing managed care grievances & complaints spanning the last decade statewide, and have never seen one single case of a person grieving a medication compliance judgment.

    Of course, my personal experience is in Colorado, where the CSX movement is so co-opted that few individuals question any form of treatment; we were so thoroughly trained to ignore national & international communities and that ‘advocacy’ means to beg for more beds. So, compliance is not exactly on the table here, which brings up a very large over arching issue of informed consent. People do not question their treatment modalities if they do not know the risks and are not told that even obvious iatrogenic problems were drug-related. I also have a difficult time reconciling Dr. Tom Insel’s announcement that the same week these talks are taking place in Geneva, the National Institute of Mental Health launched its experimental medicine approach in which interventions serve not only as potential treatments, but as probes to generate information about the mechanisms underlying a disorder. NIMH continues to chase the elusive biomarker, a complete guess that fails in the face of common sense, now at the expense of just about everything else unless it features a knife, a laser or a conductor. I can’t consider this a moral approach, and wonder how can this be legal, even here?

    Finally, as far as I can see, Mental Health Courts and Addiction Courts continue to flourish with strong community support. I wonder myself at the very blurry line between law and health in these rooms and question if participants really receive legitimate due process when confronted with the choice of prison or treatment. With adequate informed consent…. yeah, maybe, but I am not seeing any professionals telling folks they are about to enroll in a sweeping reform-driven national experiment.

  7. The government where I live has simply flipped the UN the bird.

    Doctor’s without psychiatric qualifications will given the powers of a psychiatrist, and expanding the numbers of people who can be forcefully treated.

    We have a Mental Health Act that has holes one could drive a truck through, and the complaints process is a zero accountability model.

    At least we’re quick to react to human rights violations in other countries.

    Thankyou for your valuable work Tina.

  8. As I have said before, it is possible to have detention for people who are demonstrating dangerous behavior without allowing any forced treatment at all. I really think these two issues need to be separated, and I hope that issue can be raised with this commission.

    Thanks, Tina, for your exceptional courage and hard work in championing this issue on an international level. You are heroic!

    — Steve

  9. I would be more open to your arguments if I heard you talking from the trenches. I would be more open if my prison advocate amigos were singing your praise, if the pages about the sins in Colorado and California in particular were full of you actions. Until then, I have to consider you a talk talk group, not a fighting group. Do you have suits for prisoners you can cite? have you sued any Dept of Corrections, a warden, etcetcetc? If so, I will consider a change of opinion.