UN Meeting on Human Rights in Mental Health: A Response

Tina Minkowitz, Esq.
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On May 14 and 15, the UN Office of the High Commissioner for Human Rights (OHCHR) held a meeting on human rights in mental health, responding to Resolution 36/13 of the Human Rights Council. The meeting was webcast and archived videos are available in three parts: day 1 morning, day 1 afternoon, and day 2, following this agenda; the main page also has links to written presentations and speaker bios.

The event represented tensions in the United Nations between the promotion of mental health and the promotion and realization of the human rights of people with psychosocial disabilities under the Convention on the Rights of Persons with Disabilities (CRPD). Development-focused agencies and member states have emphasized mental health promotion, which has of course always included force and coercion and legislation to restrict our rights and regulate the restrictions. Before the CRPD, human rights in mental health meant the regulation of rights restrictions, and providing access to tribunals to challenge the restrictions. CRPD brought in an entirely different regime that calls for an absolute prohibition of deprivation of liberty in mental health services and absolute prohibition of forced treatment; this is underpinned by recognition of legal capacity as a universal right to make decisions that, at least with respect to adults, cannot be restricted.

Speakers at the recent meeting were mixed as to where they fell. Those who are people with psychosocial disabilities or users and/or survivors of psychiatry uniformly came with the message that our human rights do not belong inside the context of mental health — we have a right to autonomy and full inclusion in our societies, and the laws allowing for restriction of our rights need to be repealed; coercion cannot be reformed, it must be abolished. YeniRosa Damayanti spoke from civil society in the opening panel, Bhargavi Davar in a panel on ‘mental health as a human rights issue’, Olga Runciman (speaking as a psychologist and acknowledging her lived experience) and Michael Njenga spoke in a panel on human rights based services and supports. Jolijn Santegoeds, Mette Elingsdalen and Kristijan Grdan spoke from the floor, also Erich Kopfmel from the autistic community. Their messages were strong and clear, but were at odds with the general framing of the day, which felt to me, listening to the webcast, like a debate that was primarily about us without truly listening to us or allowing our leadership to set the agenda.

Some, like Nils Melzer who is currently the Special Rapporteur on Torture, proclaimed outdated pre-CRPD standards such as the legitimacy of deprivation of liberty in mental health contexts to protect public safety or the person’s own safety. This approach is directly in opposition to CRPD Article 14, which prohibits all deprivation of liberty based on disability and not only that based ‘solely’ on disability as Melzer said. Similarly, Roberto Mezzina from Trieste, Italy, put forward Italy as an example of good practice, since they abolished large psychiatric institutions and have involuntary treatment as a last resort based on health and not danger. It is interesting to note that those two speakers had diametrically opposite justifications for the continuation of acts of medical violence on the bodies of people with psychosocial disabilities — and it does not matter to us which justification is used because the violence is the same. (Mezzina might have tried to suggest moving towards full abolition of coercion at one point, but it was not very clear.) A UK government delegate spoke from the floor and promoted their mental health act review, suggesting a narrow focus on challenging detention, and detailed Scotland’s mental health act which he thinks is fantastic for its great procedural safeguards.

Many in the mental health sphere focused on what they could do that they believe to be pragmatically useful. Michelle Funk from WHO spoke about training materials and processes that she says are having a real impact in changing practices. Vincent Girard, a French psychiatrist, spoke well about a Housing First program that doesn’t require medication compliance, respects autonomy and provides support services (I hope the person can choose to refuse any services they don’t want). Dganit Tal-Slor from New York’s Community Access spoke well criticizing the dominant medicalization and force in our law and practice in NY, including forced outpatient treatment, and also supported Housing First. Sashi Sashidharan from Scotland, while he wanted to focus on ‘easy’ changes, made one really excellent point from work he did with Human Rights Watch in Indonesia. There is a practice of restraint in community called pusung; one mother was persuaded to take her son to a new psychiatric hospital and she was horrified, because they were doing pusung in the hospital too and he was also starved, beaten and abused. Sashidharan explicitly called out psychiatry for doing the same practices and said it is equally bad. (However, I realize he didn’t say anything about forced drugging, which might be considered a harder issue.)

There was a lot of talk about stigma, about the burden of mental health, about people suffering from mental health conditions. Some speakers addressed social determinants of mental health, especially in context of gender, and the UNICEF representative highlighted a study that showed that 14-15 year old girls were depressed much more than boys, while there was no sex difference at age 11-12, likely due to pressure to conform to gender roles as they enter adolescence. A Bolivian delegate spoke about indigenous values that need to be incorporated into our thinking, and said that market values go against human dignity.

Dainius Puras, the Special Rapporteur on Health, took an intermediate position and has positioned himself deliberately to promote a way forward based on developing alternative practices “with a view to eliminating coercion.” This is itself contrary to the message expressed by survivors in the meeting — as Mette Elingsdalen said, the harm from coercion does not go away when you encounter a good practice.

Two of the panels had no survivor participants: those on system-wide changes in mental health and, astonishingly, on improving practices to combat discrimination, stigma, violence, coercion and abuse. The latter appeared to be a place to invite speakers from various UN mandates that may or may not link with mental health, in addition to Kriti Sharma from Human Rights Watch. That panel was disheartening and odd to listen to. I can’t help but infer that the organizers would have imagined it too threatening to the delicate structure they had attempted to build, to invite survivors to address this area in which our movement has indisputable expertise.

The concluding panel was composed of the three special rapporteurs: Melzer (torture), Puras (health), and Catalina Devandas, Special Rapporteur on the Rights of Persons with Disabilities, who also spoke earlier and supports the abolition of involuntary treatment and commitment. It was chaired by Kate Gilmore, UN Deputy High Commissioner for Human Rights. Most interesting to me was Gilmore’s sense of being impressed that the current situation is unacceptable, and saying that activists whose rights have been deprived are leaders and her office will proceed that way going forward. Dainius Puras got the last word, criticizing the ‘hierarchy of rights’ idea by which psychiatrists want to ‘fix the disorder’ of the person before respecting their human rights: “To have a monopoly of power is not healthy; it’s in the interest of psychiatry to share power and responsibility with others.”

And that, I think, will remain the bottom line for how the UN will continue to lurch towards what it thinks to be the paradigm shift — but it is not the way forward pointed by survivors. And then the cycle will continue whereby we are silenced and then others in the disability and human rights sector imagine that we are not politically powerful because we lack support; then we will say no, it’s because the state and psychiatry are not willing to give up their power and we need allies to make them give it up. And this will be too hard for most of them who also want to keep their jobs and speaking gigs and relationships, and the cycle continues.

So as not to end on a negative note, the state of development of the survivor/user/people with psychosocial disabilities movement as human rights advocates and practitioners is wonderful, something to celebrate and nurture. We have allies in growing numbers all the time. The Working Group on Arbitrary Detention, a UN human rights mechanism not represented at the meeting, has started to do significant work in cases of psychiatric detention and forced treatment, upholding an abolitionist standard that views these practices as discrimination. The High Commissioner for Human Rights himself, Zeid Ra’ad Al Hussein, spoke in the opening panel and clearly enunciated the CRPD standard of abolition, while also speaking to promotion of mental health. We are always reaching out to people in the human rights system who are open to learning. Portugal, one of the country sponsors of the meeting and the Human Rights Council resolution, has come out publicly in opposition to the Oviedo Protocol, a draft treaty in the Council of Europe that is entirely about authorization of forced interventions in a mental health context. The Council of Europe representative herself spoke against the Protocol in this meeting, but said they were unable to convince the Council of Ministers to abandon it. People like Olga Runciman, Bhargavi Davar, and Michael Njenga will continue to develop good practices and promote them; Peter Stastny from INTAR spoke from the floor and announced a forthcoming meeting or conference in Kenya co-organized with the user/survivor group there. Litigation and law reform, opposition to new legislation that continues authorizing coercive practices and deprivation of legal capacity, calls for reparations, drafting of a model law of inclusion, research and promotion of our paradigm by survivors in scholarly conferences and academia, all will continue and our initiatives will keep on challenging the UN as a whole to keep up with us.

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41 COMMENTS

  1. Thank you Tina for this report. I was interested to see what the person from the UK had to say. But it looked like he had wandered into the wrong meeting. As you say, he was just promoting the current legislation/review. He even talked about having been given a statement (who by? I don’t know much about how these things work). And said twice that his father is a forensic psychiatrist. And what is so marvellous about the Scottish Mental Health Act? A few facts he didn’t mention: increasing numbers of people in Scotland (population 5.3 million) detained (5422 in 2016/17); increasing numbers of people given drugs without their consent for more than two months (1559); increasing numbers of people given ECT without their consent (176 of whom 71 per cent were “resisting or objecting”, in theory all are supposed to lack capacity). And the safeguards? That just means they have to get another psychiatrist to approve it and they don’t often say no and, if it is similar to the system in England, it is a lucrative business.

  2. Thanks for the update. Question:

    …the cycle will continue whereby we are silenced and then others in the disability and human rights sector imagine that we are not politically powerful because we lack support; then we will say no, it’s because the state and psychiatry are not willing to give up their power and we need allies to make them give it up. And this will be too hard for most of them who also want to keep their jobs and speaking gigs and relationships…

    This highlights the difference between “failing” and being defeated, i.e. your efforts are under attack not for lack of success in your organizing and educational pursuits, but because of oppressive and heavy-handed opposition from the psych establishment and its many tentacles. Rooting out and exposing examples of this dynamic might be helpful, especially if you can demonstrate collusion with or deference to corporate psychiatry.

    I know nothing of how U.N. decisions are made. How many higher levels of power are there beyond the “rapporteurs” which can reverse resolutions made at a grassroots level, and who/what do they answer to?

  3. Wow….Maybe we should see this as a step back, or perhaps a challenge we have to face…but of course it’s not failure. After all, the dialogue is ongoing, not over.

    Tina, something was forwarded to me regarding making an appeal to the UN. I was literally tortured in a medical facility, Massachusetts General Hospital, via water deprivation in mid-2011. This was their “protocol,” so this is scary because it’s still ongoing, that is, they still have this universal strict “protocol” and they watch you so you cannot cheat. I believe it was pure stupidity that caused them to do this to me, but this was MGH! The greatest hospital in the USA! Stupidity and discrediting of the patient that would have killed me! I now suffer trauma due to my life having been threatened.

    In the mailing you had mentioned two choices and now, in light of this new development, what would you recommend I do? Two ways to bring this torture to the attention of the UN. I would love an investigation into this “program” that MGH does not even advertise. I would love for MGH to end their water restriction policy as they told me there was no medical reason for it whatsoever. Just a universal policy. I feel the policy poses a threat to patients because they do not make exception for those that may have diabetes insipidus, and the possibility is very real, even undiagnosed, as mine was undiagnosed 27 years (I was told I was “faking it”).

    I’ve been called psychotic over and over. And this really did happen. But you cannot argue when they call you crazy. It is senseless.

    I had anonymous hired online bullies for two years bullying me over this, too. And they even abused me in another hospital (2013) to try to silence me and get me locked up permanently.

      • Mary, this is their little-known “eating disorders protocol.” Any ED patient in their inpatient “program” is automatically restricted to 32 oz per day. They monitor this very carefully. They won’t allow soup nor tea. They also watched me in the bathroom even while I was toileting, totally illegal in MA, and insisted they’d have to watch me shower. They claimed I would drink the shower water. I refused to shower with someone watching. I was very very thin then. I became desperate for water within a very short time. I begged and begged. Pleaded with them. I realized I would likely become dangerously dehydrated as I’d been upon admission if this continued. My normal intake for over 30 years now has been at least six liters per day in 68 degree weather. In summer or if I am exercising, that could double. I do not get an electrolyte imbalance from drinking my usual amount of water.

        While I was there I noticed my face was beginning to have that “sunken in” appearance of dehydration. My eyes became scratchy, my lips cracked, my skin became dry. I had headaches which they claimed were from fluorescent lights. I told them that had never happened before. Then, they said it was “caffeine withdrawal” and allowed me a cup of coffee in addition to the four 8-oz bottles of water they allowed me. They denied I was suffering from what was essentially life-threatening to me, and very very scary and upsetting. They were also verbally and physically abusive to me, and they intentionally listened on to all my phone conversations, illegal in MA.

        I continued to ask, “Why? Why? Why are you limiting my water?” They repeated, “Protocol.” I have hated the word protocol ever since.

  4. Come to the conclusion that – in the context of neoliberal globalism – all this is a waste of time. It’s up to us to educate within our own communities: online, email, skype, in-person, whatever. Personally I do it by helping people off the drugs, and not just psych drugs. It’s a hell of a battle, wish I could find a way of shortening it and removing the terrible fear. You have to repeat the same things for many months. And to think that a GP (SSRI, benzo’s) /psychiatrist (antipsychotics/lithium) has spent 10mins prescribing and has set many thousands – throughout their career – on a course of – financially incentivised – destruction. What a disgrace.

    • Streetphoto: The mental health system isn’t just a pill mill. It’s a system of incarceration. It removes people from society or ghettoizes them, essentially de-voicing them or refusing to allow them to participate in society and denies them rights to make their own decisions. It removes them from the workforce, creating a tiered society, a society based on elitism, the haves who are supposedly capable who have rights, and those who are considered incapacitated, whose rights are taken away, sanctioned by laws in many countries. Drugs compound the matter, they are part of it, but they they aren’t the big picture.

  5. This invitation of the UN council for human rights is based on an illusion. They invited in good faith antagonistic functionaries, obviously by
    these UN special rapporteurs:
    – Ms. Catalina Devandas Aguilar, Special Rapporteur on the rights of Persons with disabilities
    – Dr. Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
    – Mr. Nils Melzer, special Rapporteur on torture and other cruel, inhumane or degrading treatment or punishment

    In strong contradiction is this invited representative of the WHO:
    – Dr. Michelle Funk, Coordinator, mental health Policy and service development, World Health Organization (WHO)
    This invitation displays the paradox of the event because the WHO runs torture, it operates or supports and covers coercive treatment and coercion. Logically the WHO belongs to the criminals, the perpetrators of torture!
    Since when have torturers been invited to human rights advocates?
    Since when are rapists invited to meetings about women’s rights?
    Absurd!

    This shows the dilemma the UN is now in.
    The UN tries to escape the dilemma by using an interesting rationalisation. In the preparatory document it is mentioned that the Human Rights council decided in the Resolution 36/13 (therefore click here on “E” for English: http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/RES/36/13) see quote from article 7 second sentence:
    While, in recognition of resource constraints, the right to health is subject to progressive realization, the freedom element in the right to health is subject to neither progressive realization nor resource availability.

    We do not have this dilemma, because we demand the right to illness.
    Contrary to us, the UN sticks to the old human rights demand of a right to health. This is dogmatically defended as it is an article of the human rights since the beginning in 1948.
    In our view, it is conceptual nonsense, because it is like including the right to an eternal life as any illness is defeated, even no fatal accident can occur – a very, very religious promise. (But this should not play any further right role in this explanation.)
    The UN tries to escape the abovementioned dilemma by a definition that the right to health includes freedom, see article 7 the first sentence, quote:
    The right to health contains freedoms (such as the freedom to control one’s health and body and the right to be free from interference, torture and non-consensual medical treatment) and entitlements (such as the right to a health system that provides equality of opportunity for people to enjoy the highest attainable level of health).

    By that the UN is trying to escape a fatal hierarchization of human rights: health is a prevailing right to freedom, which logically would be a health dictatorship, so that would be of course inacceptable for the UN human rights. (Basically that was a Nazi society.)
    If now the UN is seeking and demanding freedom in health, well, we can accept that 🙂
    For our project, it is not necessary to surrender the right to health to the right to illness.
    So we can use the conclusion of the UN: no health without freedom in our rhetoric.

    rene talbot
    Berlin
    Germany

      • It seems like the bigger problem is the erroneous belief that “mental health” refers to “health” instead of natural emotional suffering or coping styles deemed “antisocial” (non-conforming, non-productive, disruptive). Human rights violations against people experiencing mental distress are predicated on the assumption that “mental illness” has robbed people of their natural, normal judgment processes; hence, they need saving from themselves.

        • Steve S, I concur. Also, many people who are in state of emotional distress might need or want “help” but the help they get, if it’s from the System, invariably is rarely what they are asking for.

          I remember each time I left a facility, or ended with a therapist, I asked myself, “Why do I feel such a terrible sense of disappointment?” But then, I learned I was not alone.

          I have known people who ended up in “therapy” for physical pain, due to joblessness, due to overall impoverished conditions, or because they’d been crime victims or subject to bad circumstances such as being hit by a drunk driver. Therapy leads to a psych diagnosis, and that is the gateway to drugging, marginalization, and worse.

          “But that is not what I asked for.” Sadly, I hear this too much.

  6. That is not what I said. My criticism is that a right to health is a false promise (as I explained above).
    Instead, what only could be said is that there is (or should be) a right to obtain medical/professional help. Such a claim is compatible with our demand for the right to illness.

    By the way, the right to illness has a good parallel in the demand for the right to lazyness.
    The right to lazyness would be fulfilled with the basic income, e.g. see here: http://basicincome.org
    “A basic income is a periodic cash payment unconditionally delivered to all on an individual basis, without means-test or work requirement.”
    rene

  7. Forced psychiatry is an absolute crime Because she replaces by yourself enforcement. Disease is not a crime. Therefore in disease can not incriminate. And the disease can not be imposed. But psychiatry does just that – incriminate disease. According to the psychiatric concept, the patient does not realize, does not understand the quality of his intentions and actions. And so his rights should not be respected. It can be coerced and it is possible to do with it what they, psychiatrists, experts in the psyche will find necessary. Psychiatry appropriates imagine right, fight sick, as with criminals. And she admits one more sacrilegious cunning. – Suppression, destruction of those “sick” she interprets as treatment and giving help them. That is, literally – psychiatry helps those whom it destroys. Such blasphemous hypocrisy can not be found in other examples!
    In reality, it is necessary to adopt the unshakable postulate – No such patients who do not consider themselves sick. And there are no such diseases from which the “sick” themselves do not want to be cured.

  8. Meanwhile, this is happening in NH:
    ‘Pilgrimage’ for Andrew Butler From Prison to Federal Court Set For Thursday in Concord

    Andrew Butler, a 21-year-old resident of Hollis, was committed to the New Hampshire Hospital, the state’s psychiatric hospital, in the fall of 2017. From there, he was sent to the Secure Psychiatric Unit at the prison.
    “He is held as a mental health patient without being in an accredited hospital, denied contact visits with his father, denied contact visits with his attorney, forced to wear prison clothing,” his attorney Sandra Bloomenthal wrote in the habeas corpus petition filed in federal court. “He is locked down 23 hours a day. He has been tasered. The treatment he has received is cruel and unusual punishment without having been convicted of a crime and with no pending criminal process.”

    http://indepthnh.org/2018/05/23/pilgrimage-for-andrew-butler-from-prison-to-federal-court-set-for-thursday-in-concord/

    ” The walk is scheduled to coincide with a hearing inside the courthouse on Andrew Butler’s habeas corpus petition demanding to be transferred to a psychiatric hospital because he isn’t charged with or been convicted of a crime.”

  9. cris jones May 28, 2018 at 8:37 am
    Breaking News, latest treatment . No more electrocution ,chemical lobotomy etc.
    Decapitation its cheep,quick, painless relieves suffering instantly .

    But Seriously ,IF psychiatry ever went so far ,and one protested against this ,would one be called anti psychiatry?
    Please excuse the word treatment,ooopss.
    CJ