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.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.