UN to USA: Forced Treatment is Prohibited

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In July, the UN Working Group on Arbitrary Detention released its final report on a visit to the United States that took place in October 2016, and has stated clearly to the United States that “involuntary institutionalization of persons with psychosocial disabilities and forced treatment is prohibited.”

During the visit, the Center for the Human Rights of Users and Survivors of Psychiatry submitted information and arranged for Working Group members to meet with users and survivors of psychiatry in Washington, DC and in San Diego, CA. Their information was limited by the extent to which we were able to provide legislation from particular states (we did not have the capability to inform reliably on each of the 50+ separate legislations) and by their inability to visit any civil-confinement mental health facility (they visited a substance abuse treatment center at a prison, everything else was jail/prison or immigration-related). Nevertheless, our provision of the text of relevant legislation, with our commentary, and especially the in-person meetings with survivor advocates — some of whom spoke about their personal experience of involuntary hospitalization — were well received and moved the Working Group members and staff.

Emily Sheera Cutler coordinated the meeting between a group of survivors and the WGAD in San Diego, and presented powerful testimony. The testimony of another participant in the San Diego meeting, who prefers to remain anonymous, was responsible for drawing the attention of the Working Group to the problem that ‘voluntary’ hospitalization is often coercive and does not include informed consent, which the WGAD included in its report. This advocacy initiative led Emily and others to form the group Southern California Against Forced Treatment.

Some individuals also submitted information about particular cases of detention in the mental health system (involuntary commitment and forced treatment) to the WGAD for their individual complaints procedure. This procedure can result in a written decision and is available in all countries, irrespective of whether they have ratified particular treaties such as CRPD.

WGAD recommendation and its value for US advocacy

In addition to stating that involuntary institutionalization and forced treatment are prohibited, the WGAD report recommends that the United States “enact an enforceable right under legislation for persons with psychosocial disability to live in the community and be provided with health services that are free from coercion and restriction. Additionally, ensure that legislation and practices relating to hospitalization respect due process guarantees.”

The recommendation might have been stronger, but it is still usable. The reference to due process guarantees should be understood in light of the WGAD’s statement in paragraph 76 of the report that voluntary institutionalization needs to be subject to guarantees, and that involuntary institutionalization is prohibited. This inverts the usual approach to procedural safeguards in mental health law by treating voluntariness as the right to be protected, and not the supposed ‘appropriateness’ of involuntary measures. In this way the CRPD paradigm is upheld but doesn’t find full expression, as there is no explicit recommendation to do away with legislative provisions that authorize involuntary commitment in violation of the standard the WGAD has declared.

The recommendation of enforceable rights to live in the community with services free from coercion and restriction supports the enactment of the Disability Integration Act, with provisions specifying that community-based services are defined as those in which an individual has a right to be free from coercion and restraint (S. 910 in 115th Congress, section 3(a)(3)(A)(iii)). CHRUSP has endorsed DIA and I have promoted this bill as a meaningful step toward abolishing forced psychiatric interventions and creating supports that people find useful and not harmful. If enacted, it would be the first such step taken by the federal government since the National Council on Disability (From Privileges to Rights, January 2000) characterized involuntary measures as “inherently suspect” and recommended that federal policy move toward a totally voluntary mental health system.

The WGAD left no doubt that “people with psychosocial disability” refers to those of us who are labeled with mental illness, who might personally identify in any number of ways. They also left no doubt that by “involuntary institutionalization” they mean involuntary commitment as defined in our states’ mental health laws, which contain provisions meant to justify the detention such as a criterion of “danger to self or others.”

The WGAD position that involuntary institutionalization and forced treatment are prohibited can be used directly in advocacy despite not being characterized as a recommendation. It is significant that a UN human rights mechanism has examined the US mental health system and recommended the abolition of coercion. Unlike the recommendations from the Human Rights Committee in 2014, where the fine print negated the general principle of prohibition, this time the UN means it.

The current recommendations are the result not only of the work of US advocates but of a worldwide movement and global advocacy that started with the drafting and negotiation of the Convention on the Rights of Persons with Disabilities. As many of you know, I participated in that process as primary representative of the World Network of Users and Survivors of Psychiatry, and successfully advocated the inclusion of provisions in that human rights treaty that require the abolition of forced psychiatry and of all substitute decision-making based on the supposed ‘best interests’ of an adult. The Committee on the Rights of Persons with Disabilities has had primary responsibility for interpreting the treaty provisions and affirming that they do require abolition of these practices, but other UN human rights officials including the Office of the High Commissioner for Human Rights, the Special Rapporteur on Torture, the Special Rapporteur on the Rights of Persons with Disabilities, the Special Rapporteur on Health, and the Working Group on Arbitrary Detention also play significant roles. Even the World Health Organization, not a human rights mechanism but influential throughout the world, is now affirming that involuntary treatment and involuntary hospitalization have to be abolished. None of this would have happened without global-level advocacy from our movement, or without the support of allies who were able to respond to the need to remedy deep injustices.

With respect to the WGAD in particular, CHRUSP and others had input into their general standard “UN Basic Principles and Guidelines on Remedies and Procedures on the Right of Anyone Deprived of Their Liberty to Bring Proceedings Before a Court” issued in 2015, which similarly states that detention based on psychosocial disability and forced treatment are prohibited (see principle 20 and guideline 20). At that time one version of the Basic Principles and Guidelines contained contradictory footnotes that raised doubt about what standard the WGAD would apply in practice in the case of mental health system detention. However, that question now seems to be resolved, both with the report on the USA visit, and with the Working Group’s participation in an Urgent Appeal to Norway in a case of forced psychiatry issued a few months ago.  

The Urgent Appeal in the Norwegian case demonstrates even more forcefully the potential for UN human rights mechanisms, including the WGAD, to respond with great sensitivity to the injustice of forced psychiatry. The information in that case was submitted to the WGAD by a skilled advocate and the UA reflects careful work and attention by all concerned.

Advocates in Japan have taken note of the WGAD’s interest and sensitivity to forced psychiatry, and have established a center to bring cases to the WGAD communication procedure.

Step by step, the global advocacy and national advocacy support each other as part of a worldwide movement, much of our work done without any funding, to abolish forced psychiatry using the UN human rights framework. Will you join?

Text of relevant sections of WGAD report on US visit

Here is the text of the Working Group’s section related to confinement in mental health settings, and their recommendation:

Involuntary hospitalization and treatment of persons with psychosocial disabilities

75. The Working Group received information on mental health laws in several jurisdictions, including Washington, D.C., and California, which authorize involuntary hospitalization based on an actual or perceived psychosocial disability, and mental health treatment without obtaining the free and informed consent of the persons concerned or providing the appropriate support to enable them to exercise their legal capacity. This form of confinement is justified using criteria such as danger to the confined person or others and/or the need for care and treatment, which is inherently discriminatory since it is based on the person’s actual or perceived impairment. The Working Group received testimony from individuals who had been subjected to prolonged periods of detention in psychiatric institutions in violation of their human rights. In some cases, individuals were subjected to “voluntary hospitalization”, but without their informed consent to treatment and without the ability to leave at any time.

76. The voluntary institutionalization of persons with psychosocial disabilities needs to take into account their vulnerable position and their likely diminished capability to challenge their detention. If such persons do not have legal assistance of their own or of their family’s choosing, effective legal assistance through a defence lawyer is to be assigned to act on their behalf and the necessity of continued institutionalization is to be reviewed regularly at reasonable intervals by a court or a competent independent body in adversarial proceedings and without automatically following the expert opinion of the institution where the persons are held. The persons are to be released if the grounds for hospitalization no longer exist. Involuntary institutionalization of persons with psychosocial disabilities and forced treatment is prohibited.

Conclusions

89. The Working Group found that an increasing number of people were subject to a relatively hidden and unknown form of detention through civil confinement proceedings or involuntary hospitalization in relation to suspected substance abuse and mental health issues. Both forms of detention discourage the seeking and provision of appropriate health services to those who have given their informed consent to receive treatment and often lack basic due process guarantees such as legal representation, the ability to present contradictory evidence and periodic review. Such detention is often based on discriminatory grounds such as gender and disability.

Recommendations

94. In relation to detention on health-related grounds, the Government should:

… (c) Enact an enforceable right under legislation for persons with psychosocial disability to live in the community and be provided with health services that are free from coercion and restriction. Additionally, ensure that legislation and practices relating to hospitalization respect due process guarantees.

In addition to mental health settings, the WGAD addressed involuntary confinement of pregnant women suspected of substance abuse, under health-related grounds. They also took up the issue of people with psychosocial disability in the criminal justice system and perhaps their recommendations are not harmful, though they need to be taken in light of the prohibition on involuntary treatment, which was not specifically mentioned in the prison context but is certainly applicable. The WGAD did not directly address information on police and jail personnel killing people with psychosocial disabilities, which we provided to them, and are responding to other advocates who come from a more conventional mental health paradigm.

Detention of persons with psychosocial disabilities in prisons

68. The proportion of prison inmates with a psychosocial disability has grown significantly throughout the United States, despite findings that incarceration can cause or exacerbate mental health problems. Several interviewees described the situation as the “criminalization of psychosocial disability”. State prisons and county jails hold as many as 10 times more people with serious psychosocial disabilities than state psychiatric institutions. Prisons serve as the largest mental health providers in 44 of the 50 states, at significant cost to the state. For instance, one third of detainees at Cook County Jail self- identify as having some form of psychosocial disability. On any given day, approximately 20 per cent of prisoners undergo mental health treatment, making that facility one of the largest de facto mental health facilities in the country. By 2015, almost one in three people in Texas jails had at least one serious psychosocial disability. Apart from the fact that prisons and jails are often ill-equipped to provide appropriate care to inmates with psychosocial disability, submissions to the Working Group indicated that such inmates are more likely to be abused by other inmates.

69. In order to address this situation, the Sheriff of Cook County has led the development of a mental health template for United States jails. In addition, the Cook County Jail has implemented mental health assessments at two stages, i.e. at the pre-bond and post-admission stages. This allows officials to place detainees in an adequate housing and treatment plan and to supply inmates with the tools needed to succeed outside the correctional institution. There is also a voluntary outpatient treatment programme available (the Mental Health Transition Center) for detainees with substance abuse disorders or psychosocial disabilities. Detainees interviewed by the Working Group expressed positive views about the programme.

70. The Working Group observed a strong correlation between reported psychosocial disability and substance abuse among persons interviewed during the visit, and received information that as many as 55-69 per cent of individuals with substance abuse disorders had a co-occurring mental health problem. Furthermore, 60 per cent of those with a mental health condition had a co-occurring substance abuse disorder. The Working Group was informed that Corcoran II State Prison in California was addressing those issues through its substance abuse and mental health treatment facilities.

Conclusions

88. The Working Group identified systemic problems within the criminal justice system which placed defendants at a high risk of arbitrary detention, including: … the housing of inmates with psychosocial disabilities in prisons….

Recommendations

93. In relation to detention in the criminal justice system, the Government should:

(i) Ratify the Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities, as well as other international human rights instruments to which it is not a party, and review all reservations with a view to withdrawing them; [my comment: CRPD ratification should have been in general section, not criminal justice]

(j) Expand access to the treatment of psychosocial disabilities outside the criminal justice system and develop pre-arrest and pretrial intervention programmes aimed at preventing the incarceration of persons in need of mental health treatment. Additionally, develop protocols to protect inmates with psychosocial disability from abuse and provide training to law enforcement and corrections officers on de-escalation skills when inmates suffer mental health crises. Ensure appropriate follow-up so that individuals are able to access mental health treatment upon release.

Final remarks and takeaway

The advocacy that we did with the Working Group on Arbitrary Detention specifically for this visit and report only scratched the surface. We know that every jurisdiction in the US — every state and territory — has laws that allow involuntary hospitalization and involuntary treatment in mental health settings. We know that there are thousands (tens of thousands, hundreds of thousands? who has the numbers?) of cases where people’s human rights are being violated right now by these practices.

The WGAD can receive information about specific cases and issue opinions, which can contribute to exert pressure on the country to release the individual and change its practices even though the decisions are not enforceable.

It takes dedicated personnel and effort to submit cases and present them well, to compile all relevant information and make sure that all facets of the case that the person wants to bring forward are well expressed. Similarly, to systematically compile good and comprehensive information on the mental health legislation, including the criminal procedure legislation that relates to forensic mental health detention, and laws or cases relating to forced treatment, and statistics on how many people are formally on involuntary status and under formal involuntary inpatient or outpatient treatment, and then to estimate how much involuntary hospitalization and treatment is hidden under formally voluntary statuses.

We need to work closely and collaboratively, in projects led by psychiatric survivors — really led, not as figureheads or consultants — and involving lawyers who may or may not be survivors, researchers who may or may not be survivors, and anyone else who wants to pitch in. We will need funding for some of this, and it’s not going to come from SAMHSA or state mental health agencies.

The experience with the WGAD’s visit to the US is a watershed for our work against forced psychiatry in this country. We should be inspired and gratified by the success, by the concrete evidence that the UN will apply human rights standards to the United States to urge the abolition of forced psychiatry.

It may seem delusional (yes I use the word advisedly) to think that we have a prayer of abolishing forced psychiatry in a country where the proponents of all-medical-model-all-the-time, all-coercion-all-the-time, have gotten to be in power. But there is always a choice about how we define the terms of our resistance. Will we limit ourselves to trying to bring back a status quo before the most recent attacks — a status quo in which many of us had been locked up and abused, subjected to the human rights violations of arbitrary detention and torture?  Or will we put in that effort instead to make the leap to a fight for total abolition?

I think the Disability Integration Act is a meaningful step because it takes abolition, the paradigm of no-force, as a starting point, and then elaborates positive entitlements to support on that basis, while containing no actual exceptions. This is what we did in the CRPD, that led to more explicit articulation of the prohibition of forced psychiatry as its logical implication and interpretation. There are differences: CRPD as a human rights treaty is subject to different interpretive approaches than US legislation, and the language was stronger for the purpose in CRPD. But DIA, like CRPD, can put it on the table at the level of official law and policy — do you really mean we should let mental patients go free, yes we do, and here’s why — and people start to think about it for themselves and understand there’s a new way of thinking that is win/win, nobody is being harmed and we are reducing social conflict and distress.

It’s time for an independent, collaborative framework — independent from any mental health funding — that is able to bring together all those in the United States who want to seriously work for abolition of forced psychiatry, utilizing the UN human rights framework along with other relevant tools. I am talking specifically about forced psychiatry as a legalized system that gives state authorization for the violation of our physical and mental integrity and for discriminatory and unjustifiable deprivation of liberty. In other words, what the UN CRPD Committee has started to call “regulatory” institutionalization and forced treatment, which subjugates us to psychiatry not merely as a patriarchal capitalist institution of social control but as an authorized functionary of state repression directed against our individual minds and bodies. As a victim and survivor, I believe that it is necessary to abolish the specific state permission that allows these practices to exist with impunity, and prevents us from defending ourselves against them. It matters to me that I was tortured, and that friends are being tortured now and I cannot stop it. So with all due respect to those who promote abolition of psychiatry as a whole, that is a related struggle, but the abolition I am talking about is focused differently.

We need pilot projects specifically related to the human rights framework of abolition of forced psychiatry, and supports that respect the person’s autonomy, will and preferences. We need litigation strategies for US courts, to raise international human rights standards as persuasive authority (see e.g. In re Dameris L., an early use of CRPD in a guardianship case that is noteworthy despite the result not being as far-reaching as total abolition) and/or to develop analogous doctrines within US constitutional framework. We need concerted advocacy campaigns at state and federal levels, to investigate the possibilities for putting the human rights no-force paradigm into our domestic law and figuring out how to make it happen. We have powerful enemies, just as the disability movement has powerful enemies in the nursing home industry yet has managed to have a lot of success in getting people out of those institutions despite not yet achieving total abolition (DIA and also single payer health care can help in that area).

Maybe we will get angry enough to be militant and not be scared of the stereotype of the angry mental patient — somehow even writing this I find it necessary to specify that I mean confrontational civil disobedience as ADAPT does, or the Standing Rock water protectors, setting aside the idea of punching actual Nazis or anyone you decide is a Nazi-equivalent. Militance as standing in your own authority and justice against the violence of the state. We will be characterized as angry mental patients whatever we do that is noncompliant with their control, so let’s take the discussion in a different direction. Yes, we are militant and we have good cause.

We need a collaborative framework, and we need enough honesty among ourselves to not play petty politics, if that is possible. But as a start we also just need to start small, as many of us as possible start something along these lines, as the Southern California group has done, as my Norwegian colleague has done with a pro bono law project, as the Japanese activists are doing with their project to submit cases to the WGAD, as my Korean colleague has done bringing constitutional court cases and creating a regional project to draft a model law on inclusion for Korea, Japan and Taiwan. Those of us working in this area can develop our own capabilities and also develop trust in collaboration over time.

It has to be worth it, as we start to transform our own lives and the lives of everyone around us, and collectively become more and more willing to believe that another way is possible.

***

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.

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30 COMMENTS

  1. Wowee! Southern California has it’s own organization against forced treatment, with a website, and all of that. Where does that leave the rest of the USA? I wouldn’t want to think that the only way I could fight for the freedom of people oppressed by coercive psychiatry was to move to LA. I think we are going to have to get people on board nationally and internationally in a big way if we are going to end forced treatment (i.e enforce the law). The SCAFT is a start, but a small start. People in Boondocks USA must be pleased as punch.

    “The stereotype of the angry mental patient”? As long as we’re not talking Norman Bates, I think I missed something. As for “angry mental patient”, that becomes an I wish. There’s all this rhetoric from people in the system about not wanting to be negative. I guess that makes the system positive…Not so far as I’m concerned. People in the system are dying at an incredible rate. It would be redundant here to say that somebody should look into it.

    Thank you from me for all the good work you’ve done through the CHRUSP and the CRPD on behalf of people who have faced, and are facing, coercive treatment. If there’s anything I can do, let me know, and I will do what I can. We have to make this thing count, not only at the local level, but at the national and international levels as well.

    • Not sure what you are saying in your first two paragraphs. Re the Southern California organization, it’s a great initiative and could be copied by people in any other states or cities. The early movement if you remember was organized small scale, with city-based organizations. We have national and international organizations and campaigns that are already on board, and that has helped people to connect more locally.

      And ‘angry mental patient’ – maybe you haven’t encountered that stereotype directed against you? I sure have, and it has been combined with gender stereotypes that women aren’t supposed to express anger, in my case. That stereotype is embodied in the ‘danger to self and/or others’ standard in commitment laws, which the UN has repeatedly condemned (because we have brought it to their attention). It is also embodied in the discriminatory and cynical gun-control laws that we have called psychiatric profiling, and in the readiness of police to shoot to kill people, mainly people of color, whom they consider to be ’emotionally disturbed’.

      Re suggestions of what to do, there is quite a lot going on internationally, some of my international work is done now through the Absolute Prohibition campaign, see http://absoluteprohibition.org which also has a Facebook page. Nationally there is a challenge for organizations and independent activists to work together, and I am hoping to connect with those who want to collectively figure this out. It’s not rocket science really, just setting a few things in motion and seeing where people are already starting to move in good ways.

      • Some of us don’t live anywhere near New York City nor Los Angeles. I’ve lived in the southern US all my life, and usually at a remove from that yankee enclave, Atlanta. I linked up with the early movement by going to the mountain (i.e. city) rather than having the mountain (i.e. city) come to me. I figure there are a lot of people who don’t live anywhere near LA. I hope that means there is a potential for expanding any movement we might have against coercive psychiatry into places where there is no such movement, nor consciousness of the need for it, at the present moment in time.

        As for the “angry mental patient”, yes, when they would fault the “patient” for negativity while at the same time ignoring and excusing the negativity of a destructive and destroying system of maltreatment, and social control, mislabeled therapy. If one’s “mental patient”hood (i.e. consumerdumb) doesn’t survive a little righteous and healthy anger, so much the better. Of course, mental health authorities could always construe that anger as symptomatic as well, and thus actually make resolution a near impossibility.

        I’m just saying I’m here, and I’m not endorsing nor excusing that destructive and destroying system I was alluding to above in any way, shape, or form. If anyone has anything that I can do to help rid ourselves of that system, for good, I’m happy, and more than willing to help in any fashion that I can.

  2. More militant? Why not? Being nice and trying to dialogue isn’t working. Dialogue is pointless if the opposition refuses to acknowledge your humanity.

    I’m still physically sick from withdrawal; I understand it will probably take a year or more to work again. And I have that damn SMI label hanging over me. Worse than any felony record! My own family is ignorant that I joined the anti-psychiatry movement; I’m afraid to tell them. Dad thinks only Scientologists disbelieve the magic of psych drugs. (I wonder if he’ll accuse me of secretly leaving the Church of Christ for L. Ron Hubbard’s teachings.)

    Right now I feel like hiding. I’m that scared. What’s to prevent them from scooping us all up and locking us up without a trial?

    • It’s hard to get free when there are people who hang these labels on you and are still in your life.

      I think that together we are stronger. Some survivors are lawyers and we have lawyer allies as well; it can make a difference to have somebody willing to step in and go to bat for you when you are vulnerable, once in my experience just knowing that a friend of mine would be able to help in this way allowed me to calm myself and get out of a bad situation. In political organizing and activism, in civil disobedience we would be taking risks but a psychiatrizing response would likely backfire on the state because it would show the social control use of psychiatry for what it is.

      That’s one avenue, and there can be many others. We don’t have to take any action we don’t feel right about or prepared for, and even if we are hiding, there are ways to contribute e.g. to participate in a collective advocacy campaign by helping to write or come up with ideas.

      • What can this group do with regard to our beloved elderly, who do not have “mental illness” and do not have dementia, but are being pharmaceutically raped when they are penetrated with a hypodermic needle full of dangerous and powerful antipsychotic drugs by predatory healthcare workers? This heinous crime is being played out all across the United States, killing over 15,000 elder victims each and every year in skilled nursing facilities alone with NO accountability~! We won’t see positive change unless and until these medical predators start doing time in prison for their despicable abuse of our beloved elderly.

      • Tina, can you please speak with me? I need help for my family member. Weaponization of a diagnosis, psychological abuse and domestic violence, a custody battle where the father and abuser is leading the witch hunt and the innocent victims, Mother and son, are being dragged through the system for months and potentially a lifetime of misery at the mercy of this jerk who always takes her to court after he triggers a traumatic response. I need someone like you on our side. Thank you for anything you can offer, and thank you for what you do, you are a hero.

    • Hang in there Yet Another Account! I am so sorry to hear about your family not respecting your perspectives and beliefs. Have you thought about leaving educational literature around your dad’s house and de-indoctrinating him with homeopathic micro doses of data? I’ve heard that sometimes you have to walk away from family. I am very fortunate, insofar as my husband is proud of my association with MindFreedom and ditto with my own father. There is a strong anti-authoritarian strain that runs through my extended family.

      But the members of my family who make their living in the medical industrial complex are slower to grasp the data showing harm of long term drugging. both cling to the belief in the appropriateness of involuntary treatment for people who have the odious label, “SMI”. I gave a copy of Robert Whitaker’s ‘Anatomy of an Epidemic’ to my sister-in-law, a pharmacist and my brother, an MD. They both failed to read the book but we left the issue alone for many years and continued to remain cordial to the greatest extent possible. But as I continued to share with them my personal experiences supporting an adult child through the day to day challenges of psychiatric drug withdrawal, their icy resistance to considering data about the risks and potential harm of long term drugging began to thaw. My sister-in-law even offered to titrate my daughter’s medication in her lab. If NAMI were only in the business of offering parents an array of perspectives, most importantly, the voices and stories of experts by experience–individuals who identify has being harmed by involuntary treatment–there wouldn’t be so many close minded parents and TAC wouldn’t enjoy the authority it currently does. Alas, history took a wrong turn somewhere when NAMI colluded with the APA to promote a specific narrative. Thank goodness for the courageous and selfless work of activists like Tina Minkowitz, Frank Blankenship, and other activists/leaders in this field. Activism is moving the needle slowly.

  3. Wow, thank you for your work on this. Forced hospitalization and forced treatment can take many forms, including “if you don’t agree to a course of ECT we will have you committed…” it’s like POWs being forced to sign “confessions” or face more torture, except in this case (for me) it was forced torture or face months, years incarcerated against my will.
    How on earth can you protect vulnerable terrified people from that?

    It is going to take forces external to this country now to make the US the “beacon” of freedom that it claimed to be for so long.

    • Thanks for your comment.

      I believe that when we abolish forced treatment, and commitment, as a legal matter, when we make it illegal, it will be much harder to threaten anyone into complying with these tortures. This can come in any number of ways, legislative repeal/abolition, judicial decisions, and/or more policy-oriented administrative or programmatic approaches.

      It has been very effective so far to work with and through the UN. The negotiation of the Convention on the Rights of Persons with Disabilities provided a global forum and a fulcrum to gain leverage over the political/legal issues in all countries at the same time. The UN for better or worse, and whatever its flaws, is a place where at times governments come together with high aspirations and want to do the right thing. Even if they are still violating those standards at home, when they come together they learn from civil society (ordinary folks and advocates who come) and they get inspired. They send their human rights-oriented people to these meetings. So that was an amazing first step, and then the UN human rights system has a number of independent expert mechanisms that helps to hold the governments accountable for what they signed up to.

      It’s a long haul, but we have comrades in many countries working for the same things, and it is worth it.

      • Do you know of anyone in Australia who has taken up the baton? I’m pretty sure we signed, but as others have said, the threat of legal force means that people sign up `voluntarily’. Even the removal of that threat legally will take a long time to filter down to the highly distressed `patient’ and the determined staff. Still, it’s a start though I wonder how the general population will respond, indoctrinated as they are by the `murderous madman’ fallacy? As long as the `chemical imbalance’ theory of mental illness, or, if you’re upset or angry, `he’s off his meds’ concepts now buried deep in the public mindset, I expect. The psychiatric guild has done VERY well for itself.

  4. Excellent article, Tina – and you are a good human to take a stand and to foster interest and support.
    I don’t mean to be an alarmist, but this whole scenario brings to mind the Hitler regime and his method for handling people with mental health issues that spider-webbed out to include a whole bunch of people that had other health issues. He initially labeled them as being “hereditarily ill” to infer that anyone labeled as such contained inferior genes that shouldn’t be replicated. On July 14, 1933, the Nazi government issued its “Law for the Prevention of Progeny with Hereditary Diseases.” People with so-called ‘hereditary illnesses’ had to be sterilized, even if they objected. And the list of persons classified as hereditarily ill included those suffering from “congenital feeble-mindedness, schizophrenia, manic depression, hereditary epilepsy, Huntington’s chorea, hereditary blindness, hereditary deafness, and serious physical deformities.” People with chronic alcoholism could also be sterilized. The law established some 200 Genetic Health Courts at which teams of lawyers and doctors would subpoena medical records in order to choose candidates for sterilization. The Court proceedings were secret, and the decisions could rarely be reversed. Throughout Germany, doctors were being trained in “race hygiene.” They were identifying and zealously reporting those in their communities who had any of the so-called genetic diseases and would be candidates for sterilization. In the six years before World War II, the Nazi doctors sterilized some 400,000 people, mostly German citizens living in asylums.

    But it gets worse than that. By the late 1930s, the Nazi government was using propaganda movies to persuade the public that those who were hereditarily ill – and therefore, “dangerous to the health of the nation” – should be exterminated rather than kept alive as “neutered beings.” The targets for extermination were objectified as “beings of lesser worth,” “life unworthy of life,” “ballast existences,” “useless eaters.” We all know how successful the regime was for achieving their goals. When we hear of horror stories like this, we always tend to presume, “that couldn’t happen here.” But I say we should always be vigilant because the cunning of the fox can be as dangerous as the violence of the wolf – and we should guard equally against both. I say this here and now because I live in California and am quite familiar with the turncoat ways of Governor Brown – I don’t trust him. He consistently writes laws that are not in the best interest of American citizens. and he has repeatedly puts the welfare of illegal immigrants before Americans. Examples: he recently hiked our already-high gas tax up 42% and our vehicle registration fees a whopping 121% – to pay to support illegal immigrants! He stated that’s what the increases were for! He’s made California a “Sanctuary State” and is actively harboring illegal immigrants, which is a violation of Federal Laws. Now he wants to give them free college tuition – but Americans can’t get it and he expects us to pay for their college! He’s about to sign an agreement to allow cellular phone towers to be installed, like, every mile or something – in residential neighborhoods – everywhere – which will put us in serious harm’s way cause of the unprecedented radiation exposure. AND, he wants to pull California out of the Union to be separate from the rest of the United States, and you can bet it’s not in our best interest. So it would not surprise me at all if he would jump on the institutionalization bandwagon and corral us all up for some made-up crazy reason.

    This article written so eloquently by Tina should be circulated by all of us to everyone – because there is such an extraordinary force behind the curtains running this country – and the ‘Powers That Be’ want America bad. Love him or hate him, Trump refused to join up with the Global union, which was a very good thing that he did – because if we acquiesce and join the One World government – I hope you all understand that our Constitution and Bill of Rights will no longer protect us, because we will be ruled by the Global government’s rules by rulers we don’t even know who are across the world – and we will no longer be under the umbrella that protects our rights now. This matters – and there is a concentrated effort to bring Trump down by the people who supported Hillary and who want to give America up to the Globalists. If that happens, there will be no “human rights laws” to protect us. Agenda 21 will kick into play, and that’s all bad. It should be noted that in the Globalist world, the name “United Nations” is referred to as “United Nations Systems” as if to infer it’s a different entity with different rules that govern it. My purpose for mentioning all this is to educate those who are not familiar with the Globalist agenda, and I can’t help but think that the forced institutionalization agenda is in alignment with the globalist agenda. I’m not saying this from a political perspective, but folks – we gotta stand behind Trump and support him in staying out of the globalist world. We must remain the America that is governed by our Constitution and our Bill of Rights which I feel will protect us from the forced institutionalization Tina spoke of here. If you doubt the veracity of which I speak, watch this video that explains Agenda 21, as I think it relates to Tina’s article:
    https://www.youtube.com/watch?v=govL-fUAwMA

    • I think that your post is a derail from my subject, and is not at all what I have in mind.

      I do not share your views on immigration, and if you reference the Nazis you should know that their targeting of Jews and others they considered non-Aryan was similar to the hostility against immigrants that is being fomented here and in Europe – by groups including prominently the neo-Nazis. So I consider your reference to that era dishonest. Yes, they targeted people labeled with psychiatric diagnoses and other people with disabilities who were institutionalized first, or rather got the idea for extermination camps from the deliberate killing of people with psych labels and other pwd by psychiatrists. But you are twisting it around to make it seem like we are endangered by other people who are actually victims and not at fault.

      Frankly I think the moderators should delete the comment as it is really inappropriate, but that is up to them.

      • How can a reference to a ruler who coerced the society he was ruling, to wrongly view members of the society as “hereditarily ill”, be “dishonest?” I sought only to remind us how out of control that situation got; and how the society allowed themselves to be persuaded by a maniacal man who had a hidden agenda. I have no vested interest here, and I certainly am not a dishonest individual and I find your accusation very offensive. You didn’t even demonstrate the common courtesy to acknowledge my commendation of you for taking a stand on this issue. The Holocaust bears no similarity to the issue of illegal immigration in the United States – the immigrants who chose to enter America unlawfully are not being sought for the purpose of extermination, and that you could possibly suggest that they are, is most inordinate and just plain wrong. In California where I reside, they are the recipients of more benefits than Americans are, and thus, are far removed from being “victims” – and understand this clearly: I never said we are endangered by them. When an individual chooses to sneak into a foreign country instead of abiding by the laws that govern lawful entry, they indeed are at fault for the choice they made. By entering illegally, they don’t go through the health screening process to insure that any untoward diseases enter with them. People have a moral duty to respect the laws of any country they enter. It is a “privilege” to live in America, not a “right.” It truly escapes me how you could draw an analogy between the Holocaust and the current-day issue of immigrants entering America unlawfully – they are two distinctly different situations.

  6. Hi Tina,

    having grown up on the Right, there is nearly a hatred and definitely a mistrust of the UN. But since I began to help my wife heal from the severe abuse she suffered as a child, my views have definitely moderated on a lot of things… So…I’m just wondering if you think there is ANY chance the USA would respect this ruling when there are so many people like I used to be?

    • The USA is not monolithic, I’d say. Some state legislatures and municipal governments have enacted legislation to support human rights treaties and work to comply with them at that sub-federal level. Also right now the federal government is not in good shape, but I know that ADAPT and others promoting the Disability Integration Act have not given up. I haven’t been able to really keep up with the things going on in federal administration, so couldn’t say if within any relevant agencies there are people who are approachable.

      It’s also not only the Right, there has been even in Center politics an attitude towards human rights treaties that takes the US as an example for the world to follow rather than one participant among a vast number of others who are all subject to the same standards, and that fails as often as any other country does. There’s a very skewed attitude towards human rights here, especially noticeable when compared with other countries at a similar level of economic development.

      In any case, there are a growing number of organizations that are promoting human rights and using human rights mechanisms, and we have been part of that. US Human Rights Network both does its own advocacy and plays a coordination role in some of the UN processes, and folks from our movement who have participated in that have made some connections and helped to raise awareness with those other activists. So a lot of work, and worth to keep doing. Thanks for your question.

  7. Thank you Tina for posting this.

    Remember also, never cooperate or promote anyone advocating Therapy or Recovery as the remedy for forced treatment.

    And any ‘treatments’ done on a minor when that minor is not currently being represented by an attorney in court, is forced treatment and should be considered crime against humanity, with the most severe of penalties.

    • I started a long reply to you last night and then closed my browser by mistake and lost it all.

      Therapy or recovery is not a remedy for forced treatment, the remedy is abolition and a full and comprehensive effort to make reparations to victims/survivors. Governments may never make reparations as they should, which is not just individual compensation but a comprehensive approach to looking at the harm that has been done by human rights violations, to individuals and society as a whole, and working on whatever needs to be done to repair, at the economic, social, cultural, communal and individual levels. But we are working on that repair, through our human rights advocacy, I have come to understand this recently. The first step of reparations is to stop the violations and guarantee that they won’t continue, and in addition we need to allow all of us to come forward and say what we need once the harm has stopped and we are not threatened with it any more.

      Individual healing from the traumatic effects of psychiatric violence as well as the effects of psychiatric drugs and procedures is part of what some of us need, and for some people it may take the form of therapy. For others of us, it is inconceivable to go to the profession that harmed us to help with healing.

      In general, therapy is something that some people find useful as a space to explore what they need to do to change their lives and heal from trauma or destructive life patterns, others go to 12 step programs or peer support or use psychiatric drugs or have a spiritual practice or muddle through. No disrespect to any of these ways, they are all valid and also all can have their down sides and don’t work for everybody. Therapy in particular can be criticized as giving up power to another person, but that may be really the Freudian analysis paradigm, and a lot depends on the individual needs of a particular person, their situation, their personality, and the person they end up with as a therapist. For me therapy is not an option so my understanding of it is theoretical at this point.

      The recovery approach I have been looking into a little bit as it appears in the WHO training modules (http://www.who.int/mental_health/policy/quality_rights/guidance_training_tools/en/) and I think it has some value for transforming conventional mental health services; primarily in opening up the possibility that people can change their lives and that the focus can be on what the person wants to do and not on what someone can label as being ‘wrong’ with them. But it’s not for everyone, we can’t assume that recovery-based mental health services are the answer to what everybody needs in a time of distress or life problems or altered consciousness. So the challenge is to find ways to create proactively a framework for the kinds of services people want and need in various circumstances. I have been thinking about this in context of the work of the CRPD Committee that recently produced a General Comment on Article 19, living independently and being included in the community (http://www.ohchr.org/Documents/HRBodies/CRPD/GC/CRPD_C_18_R_1.docx), to which I made submissions initially and on the first draft of the GC. I am planning to write a blog post on this General Comment as it has helped to clarify some of my thinking about various elements both more mainstream and what I’ll call utopian, in the sense of thinking about ideal ways I’d want society and life to be organized rather than particular alternative practices.

      I’ll close here, re your comments about treatments being done on a minor, I agree with you that there should be some kind of oversight to ensure minors aren’t being given medical treatment with destructive effects. CRPD says that children have a right to have their views about any matter concerning themselves be given due weight in accordance with the child’s age and maturity, without any discrimination based on disability. Also the CRPD Committee has said in concluding observations that children should not be subjected to involuntary psychiatric treatments. It could make sense in addition to have safeguards to protect the minor’s ability to stand up for him/herself and ensure that explanations are given in a way that she/he can understand to express his/her will and preferences.

  8. Tina, Thank you for replying to me, and I appreciate the work that you are doing. It is so much better to be talking to lawyers than therapists. And I completely agree with your statement,

    “Therapy or recovery is not a remedy for forced treatment, the remedy is abolition and a full and comprehensive effort to make reparations to victims/survivors.”

    The matter is gravely serious. Consider this guy:

    http://www.mercurynews.com/2017/10/23/opinion-if-counties-invested-more-in-treating-mental-illness-public-safety-would-improve/

    You also wrote, “The first step of reparations is to stop the violations and guarantee that they won’t continue…”

    Of course I agree fully. But this opens the door to seeing the further ramifications, so long as survivors are being lectured to about Recovery, Therapy, Healing, Peace of Mind, and Happiness, they are still being abused.

    No one heals from the effects of living in an unjust world, while they are still living in it. Rather, the source of the harm is still there and still active.

    The middle-class family would not exist if it were not empowered to and expected to maim and scar children.

    So there is never anything like healing as long as this goes on. And therapy and 12-step grops are simply agents of this middle-class family and its value system.

    So no, if you live in an unjust and abusive world, you either find ways to fight back, or you become a colaborator with the abusers.

    A woman walks into a police station to report that she was raped. The desk officer asks her if she has looked at all the ways that she might have caused this. Then she is told about therapy, healing, recovery, 12 step groups, and about how all of this will help her to have peace of mind and happiness.

    This is what anti-rape activists have long and correctly called second rape. Talk about therapy, recovery, and healing are exactly the same things.

    So we must oppose them.

    So you fight against force psychiatric procedures, do you go along with someone who suggests therapy?

    NO!

    How about Recovery and Healing and self improvement?

    NO!

    How about religion and salvataion?

    NO!

    How about Peace of Mind and Happiness?

    NO!

    How about Heroin, Psychiatric Medications, Methamphetamines, and Marijuana?

    NO!

    The only things you to along with are penalties for the perpetrators and reparations to the survivors.

    My replies to Chalya and Steve
    https://www.madinamerica.com/2017/10/child-abuse-mental-health-mental-illness/

  9. Dear Tina:
    Thank you for your unpaid, high level work on this important issue!

    What is WGAD stand for? Do you know how we can put pressure on Congress/Senate to ratify CRPD?

    I visited this organization’s website
    https://dredf.org/ and in 2013, in their archives, they announced that a call in day for CRPD on November 12.
    https://dredf.org/2013/11/07/second-crpd-hearing-delayed/

    Do you know of any national campaigns in this area?

    Finally, I read your comment with interest:

    “Their information was limited by the extent to which we were able to provide legislation from particular states (we did not have the capability to inform reliably on each of the 50+ separate legislations) and by their inability to visit any civil-confinement mental health facility”

    What do you think can be done at the grassroots level to obtain the data showing how many people are involuntarily committeed, drugged, shocked, etc. in the U.S.

    Some states may have better options than others for this kind of data, Here in Oregon, we have the Psychiatric Security Review Board (PSRB) for people who plead guilty, or are convicted of a crime (no matter how minor) but who plead ‘guilty except by insanity’ PSRB is a highly restrictive board that manages forensically committed individuals, many are restricted for life. I think PSRB would have very good data for at least the state of Oregon but does one have to file a FOIA to obtain the data from PSRB? Can an agency use HIPAA to prevent journalists and researchers and activists from obtaining this data?

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