Berlin Manifesto for Humane Psychiatry Released

Jann Schlimme
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The Berlin Manifesto for a Humane Psychiatry draws on the combined expertise of individuals with lived experience of mental distress and/or experience with psychiatry, their family members, and psychiatric and community mental health professionals. At meetings I initiated in Berlin during August and September 2019, a broad alliance of organizations and individuals (the Trialogical Action Group of the Berlin Manifesto of a Humane Psychiatry) drew up a catalog of demands with the aim of changing the untenable conditions of the entire mental health and psychosocial support system in Germany as quickly as possible.

The Trialogical Action Group presented the Berlin Manifesto on October 10 at Potsdamer Platz in Berlin. The Manifesto presents five general ideas that should form the basis of all psychosocial support and mental health care structures, making them more acceptable and accessible. The goal is to enable persons in mental distress to recover in their own individual way and to develop their environment accordingly. It should also support their family and friends to remain or become more helpful along this journey of recovery. Changing the mental health and psychosocial support system in Germany requires public debate about the ways our society should help and support people in mental crisis and with chronic mental health problems. We believe the driving force behind all help and support should be humanitarianism and respect for inalienable human rights. It is this public debate that the Berlin Manifesto seeks to ignite.

Berlin Manifesto for a Humane Psychiatry

When examining the situation of psychiatry in Germany today, the picture is alarming: More and more psychotropic drugs, more use of electroshock, many avoidable coercive measures, the expansion of hospital, residential and forensic beds, and often inaccessible and inadequate outpatient services. In addition, there is an overabundance of bureaucratic and economic requirements in all areas of psychiatric care. These are some of the deficiencies that prevent care for people in psychological crises to — always — respect human dignity.

The consequences are serious and damaging. The long-term recovery rates of people with psychosocial disabilities have not improved over the last 20 years. The mortality rate of people who are given psychiatric diagnoses and who receive conventional treatments remains very high. Psychotropic drugs are prescribed far too often, for far too long, and in far too high dosages. This has a negative effect on all involved: persons with mental health problems, their family members, and those working in psychiatric services. From a human rights perspective, the reform of mental healthcare and support services is progressing far too slowly! This contradicts the UN Convention on the Rights of Persons with Disabilities (UN-CRPD), which provides a legal framework for all forms of support for individuals in mental distress. The convention has been ratified by Germany in 2009.

A growing number of people do not want to accept this intolerable situation anymore. This manifesto has been drafted by individuals with lived experience of mental distress, family members, and psychiatric professionals as well as formal caregivers from Berlin. We have drawn up the following demands as guiding principles for a reform of the entire mental health and psychosocial support system in Germany. To bring these ideas to life is not only the responsibility of mental health professionals, of family members and users/consumers/survivors of psychiatric services; it’s everybody’s business and a task for the whole of society.

Guiding Principles for a Humane Psychiatry

People in their pursuit of happiness and well-being are the measure of our actions. The human rights principles established in international conventions such as the UN-CRPD must feed into all mental healthcare and support structures. A broad public debate including all stakeholders in the mental healthcare and psychosocial support system is necessary. The debate should avoid and counteract the stigmatization of people with psychological impairments.

Our demands are as follows:

1. Autonomy and self-determination

A humane psychiatry in accordance with the UN-CRPD guarantees the right of users/consumers/survivors to decide for themselves which type of psychiatric and psychosocial support services they want to use and how to do so. In crisis situations, if and when it is more difficult to determine the person’s own preferences, intensive individual support must be offered. Supported decision-making also helps to avoid coercive measures. Any support provided to better coordinate the use of services must remain “help for self-help.”

2. Economic security

Care should not address the individual alone, but must also take into account the social and economic situation of users and their respective environment. Income security and adequate housing are a prerequisite for any therapeutic success. It is a common experience that individuals who have limited working capability or who receive reduced-earning-capacity-pensions due to their impairments frequently fall into precarious economic situations. By contrast, measures to guarantee economic security must always be adjusted to the person’s needs.

3. Taking into account individual social networks

Mental or emotional crises as well as long-term impairments always arise and exist within a social arrangement and have an impact on it. Therefore, the inclusion of the person’s social network is necessary and must be guaranteed throughout the whole process of care and support. This requires the improvement and extension, as well as a greater variety, of crisis support services (e.g., crisis rooms, crisis pensions) that are low-threshold, accessible, and outside psychiatric hospitals. Outpatient and community care must take precedence over in-patient treatment. This requires, among other things, a bed reduction in acute psychiatric services, especially in large, overcrowded, and confusing mental health wards. These steps are necessary to open all mental healthcare and support structures to the whole society.

4. Transparency of mental health support systems

Users/consumers/survivors need comprehensive information about their rights as well as about available support services. This applies in particular when a variety of mental health care and support services are available locally. Being able to choose how and when care and support are provided complies with the human right of individuals that their will and preferences are respected while at the same time taking into account the realities of their lives. Transparency and diversity of services must be guaranteed for all phases of the recovery process. Psychiatric and psychosocial support systems should be financially transparent and their organization should be clear. Compliance with human rights principles in the whole mental healthcare and support system should be monitored regularly. Violations must be sanctioned effectively.

5. Participation

We need more participation at all levels. This requires a paradigm shift from a medical treatment model towards a support model. Mental health professionals cannot produce recovery; they can only accompany and facilitate it. In accordance with the principle of helping individuals to help themselves, users/consumers’ autonomy must be strengthened. Professionals should be experts in raising awareness and building capacity to take self-responsibility. Participation, however, is more! Ultimately, psychiatric and psychosocial support systems cannot be planned without experts with lived experience, as stated in the slogan “Nothing about us without us.”

Many of these demands have been discussed among experts for years. They are part of successful models and are included in the recommendations of the council of experts of the Federal Ministry of Health (in Germany). It is astonishing that they do not yet constitute the foundation of our mental healthcare and support systems.

To achieve this, we need commitment at all levels of society. Fundamental issues concerning public services as well as social and health policies are at stake. The “Psychiatrie-Enquête,” the German expert commission’s Report on the State of Psychiatry, initiated significant improvements in psychiatric care since 1975. However, against the background of a bureaucratization and marketization in mental health services, these reform approaches have been worn down and lost in many aspects.

It is time to change this!

We invite you to support our efforts to achieve a more humane psychiatry in Germany. In signing the Berlin Manifesto you can call for the inviolability of human dignity in all areas of psychiatry!

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Sign the Berlin Manifesto for a Humane Psychiatry at www.change.org/berliner-manifest

Further information can be found at www.berliner-manifest.de

E-Mail: [email protected]

Members of the Trialogical Action Group who together authored the Berlin Manifesto in August and September 2019 and/or translated it into English in October 2019 (in alphabetical order): Stephan B. Antczack, Gamma Bak, Burkhard Bröge, Uwe Brohl-Zubert, Julia Eder, Dietlinde Gogl, Sabine Haller, Jacob Helbeck, Ingrid E. Johnson, Ute Krämer, Thomas Künneke, Anja Lehmann, Peter Lehmann, Tina Lindemann, Ule Mädgefrau, Yvonne Mahling, Peter Mast, Katrin Nordhausen, Jann E. Schlimme, Uwe Wegener, Stefan Weinmann, Gudrun Weißenborn, Claudia Wiedow, Jenny Ziegenhagen.

43 COMMENTS

  1. Dr. Schlimme, I highly commend you for putting forth this Manifesto and Petition. It is encouraging to know there are still psychiatrists out there in the world who have integrity, compassion and a conscience. It takes integrity for a professional to acknowledge and speak out on the destructive disaster psychiatry is. It seems most psychiatrists are too power hungry, or insecure, to ever let go of the whole power and control thing and are mostly concerned about their status, ego, privilege, etc. Thank you for your humanity! I truly hope your endeavours in Germany are successful!

  2. This sounds a lot like the posters on the walls at the hospital who subjected me to 7 hours of torture after lying to police and having me snatched from my bed after I was drugged without my knowledge. “We Value” and “Mission Statements” such as showing dignity to “patients” and having processes in place for complaints.
    And then when you make a complaint, it’s investigated and found that the complainant was wronged your told by the Operations Manager that they will Fuking Destroy you if you keep complaining. Then they begin with slandering you with fraudulent documents which 8 years later are still being relied on by the current Minister for Health to further slander you in order to ensure their reputation is not harmed by exposing their criminal conduct and human rights abuses. What reputation? If it weren’t for the fact they are terrorizing our community they would know what is being said behind their backs. Mock executions and threats of pack rape seen as being ‘coercive methods’ and ‘poor choice of words’ by our police. “We don’t have a copy of the Criminal Code” at a large metropolitan police station. (And i’m supposed to believe that Sargent?). Though it does ensure that the organised criminals giving instructions to police are enabled. Call him a doctor if you like Sargent but you might want to check the documents before doing what your told. Save having to say later when I tell you about the failed attempt to unintetionally negatively outcome me that “it might be best you don’t know about that”. With no Criminal Code though failing to perform your duty might not be a crime either? Pervert? Nah, off to another kangaroo court called the CCC
    As far as these United Nation declarations and stuff goes my country is throwing them out as we write. The CRPD made a statement that the Mental Health Laws in my country were a violation of human rights and that the treatments may constitute torture. That statement was neutralised by writing new Mental Health Laws that now permit teens to consent to ECTs and whilst they failed with the ability to sterilize children without parental consent, i’m sure they have a loophole they can rely on working.
    Our Prime Minister is currently making the claim that we do not want International bodies telling us what we should do, something that has always been popular rhetoric (and i’m sure those who remember German history would recognise). Enabling human rights abuses and torture always sounds good until its you being subjected to it. Anyway, we should have our Euthanasia Bill rushed through parliament in record time soon. They took longer over the Animal Welfare Act. Still, horse racing is the sport of Kings eh?
    Under our laws the punishment for abusing an animal is double what it is for the abuse of a mental patient. And they have actually prosecuted cases of animal abuse, something that can not be said of abuse of mental patients. This despite people being left in their own faeces for hours on end to punish their ‘bad behaviour’. They even took her leg braces away so she couldn’t get out of the bed. Horror stories galore and not one prosecution.
    Lets hope these are not more empty words

  3. Thank you for speaking out against the staggering in scope harm, and murders, in which the psychiatrists are participating. As one who works with people labeled as “psychotic,” I hope you will be honest with your clients, fellow psychiatrists, and educate others that both the antidepressants and antipsychotics can create “psychosis,” via anticholinergic toxidrome poisoning.

    https://en.wikipedia.org/wiki/Toxidrome

    The ADHD drugs, other pharmaceutical drugs, and of course street drugs can also create what gets called “psychosis.”

    https://www.nbcnews.com/health/kids-health/common-adhd-medications-may-cause-psychosis-study-finds-n985616

    The psychiatrists also need to learn that “psychosis” is NOT a “lifelong, incurable, genetic” issue. It does go away, once one has been weaned from the psych drugs, and once one’s brain heals from the damage done by the neurotoxic psychiatric drugs.

    Truly, we do need the psychiatrists to end their ongoing crimes against humanity. Their modern day, all Western civilization, psychiatric “holocaust” has been going on for decades.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    Thank you for speaking out, as a psychiatrist. But it’s a shame the majority of psychiatrists learned nothing from the Nazi psychiatric holocaust, and have been claiming to know nothing about the common adverse effects of the drugs they prescribe for decades. Best wishes in your endeavors. Change is most definitely needed.

    • Oxymoronic language like “virtually spotless”, “light yet filling” and “military intelligence” have become standards. Phrases are redefined like “recession” to “necessary downturn”, “crude oil on a beach” to “moose”, “civilian death” to “collateral damages” and “being killed by your own army” is now called “Friendly Fire”. (Disposable Heroes of HipHoprisy Television, the drug of the Nation).
      Good point Oldhead. The language being used is important. “Unintended Negative Outcomes” lol. They were snapping peoples necks during ‘restraints’ Doc. One i’ll add to my list.

    • “Time keeps on circling, circling into the future.”

      If it weren’t for inhumane psychiatry there would be no need for humane psychiatry. Problem. When inhumane psychiatry has marginalized and disenfranchized, one might say, subhumanized and decitizenized, a segment of the population, humane psychiatry is going to bring it back into the fold again? Let me say that I have serious doubts about the matter. Once inhumane psychiatry targeted a population, humane psychiatry is still targeting them but in a different way. If you really wanted a humane psychiatry, you would automatically and directly address the need to end forced treatment. Leaning on the potential for international law to do so, you’re first point, is a way of addressing the problem obliquely rather than directly. I get the idea, through this, that you are more interested in promoting your profession than in maintaining and protecting human rights. Here’s more ‘incremental change’ chicken feed. Someday, sometime in the future, perhaps…in a universe far, far away…we will be ready to dispense with forcing unwanted treatments on people. Uh huh. When it comes down to it, in my view, there’s no day like today for doing so.

      • When inhumane psychiatry has marginalized and disenfranchized, one might say, subhumanized and decitizenized, a segment of the population, humane psychiatry is going to bring it back into the fold again?

        Nice bit of random insight.

        Someday, sometime in the future, perhaps…in a universe far, far away…we will be ready to dispense with forcing unwanted treatments on people.

        Of course, just be patient…don’t you want to be “practical”?

  4. Thank you for this article. I have a question though about the first point, “autonomy and self-determination”.

    What will happen when a person chooses to end their suffering for good and is found out to be preparing therefor? Will their decision-making capacity and refusal of “help” even matter? Will those who do not perceive said suffering get to decide that the person has to live through their pain for the former’s emotional benefit? “Intensive individual support” doesn’t answer the question to me.

    • I agree with Lloyd, I’m not sure the suicide question is answered (I choose to use that scary word!). I personally believe a person has the right to end their own life, but some religions forbid it. By all means a person shouldn’t be criminalized for wanting to commit suicide, or thinking about it, or planning it, or toying with the idea. Oh let me add one more crime: writing a poem with the word “Death” in it.

      If these principles were closely and strictly followed, psychiatry would go broke very fast. No one would voluntarily choose to be marginalized, drugged, and labeled. No one would choose organ failure and early death. No one would choose forced unemployment. Oh dear, poor shrinks. They’d moan about losing their jobs or not getting paid enough. They would complain because now, they have to be honest (if it were enforced). Oh dear! Maybe some of them can try out psychiatric disability. After all, you don’t have to work, right? They did it to us. Why don’t they try it out?

      • A bit like the one day they are chemically castrating and ECTing homosexuals and the next day they are cured and no longer require ‘treatment’, my government is going to allow people to be euthanased given certain conditions are met (ie that they fill out the forms with a ‘verbal’, and we know what will be done about that, nothing). I am assuming that one will need to obtain the stamp from a psychiatrist in order to have the ‘prescription’ filled.
        I did ask a few pharmacists about how they were going to get around the supply of chemicals used for killing people and was told the ‘blind eye’ method. Pretty much standard fare for government here anyway. Torture people and then turn away from anyone who complains.

  5. The history of psychiatry in Germany is utterly appalling. Their methods of mass killing were taken up and used by the Nazis. The German psychiatrists were not under the boot of Hitler indeed even Hitler tried to stop the killing but it continued in the ‘hospitals’ even after the war and as far as I’m aware none of them were brought to justice… Their courts couldn’t decide if killing the patients was the right or wrong thing to do and that was right up into the 1970’s . Psychiatry needs to be buried not reformed.

  6. This year I have witnessed a patient being beaten up by the police in their psychiatric cell, why? They had called the police very many times, so the police came to confiscate their mobile phone. Why did they call the police? They were being viciously abused in the so called hospital. Patients being beaten up by other patients, patients being beaten up and viciously verbally abused by the so called carer’s and nurses. I witnessed one teenager in a secure unit escape his abuse over a high wire fence and be brought back by the police and right back to his abusers many times. Many times he escaped, many times he was brought right back to the same hell. Psychiatry needs to die.

    • Streetphotobeing, it would be great if someone could submit this story to the UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CIDTP) Nils Melzer, who is collecting submissions until November 25, for a report he plans to submit to the Human Rights Council in March 2020. I will also submit my story from my involuntary hospitalization at the New York Presbytarian/Weill Cornell Medical Center in New York City in 2014/2015 as well. My story is not as dramatic, but I do see what happened to me as a violation of my human rights. More information on how to submit you can find here: https://www.ohchr.org/EN/Issues/Torture/SRTorture/Pages/Call.aspx.

      • Thank you for that info ingride. Am in the UK and it is worse than that, I made it conservative for fear being moderated. The cells were crawling with ants, for 6 months everyday and night this went on. They changed the doors on the cells to being opened by swipe cards but would not give the patients a swipe card to get into their cell, everyone else had a swipe card even the cleaners, but not the patient, this meant that when verbal abuse/violence kicked off they couldn’t lock themselves into their cell for safety. They could afford the many thousands for the doors but not get rid of ants, plus they immediately found a way to use the new doors to inflict more abuse by withholding a swipe card.

        • Commenting as moderator: Just so you know, I will never moderate you for including accurate descriptions of your experience, no matter how ugly it was. Moderation is only for things that attack or distract, not for things that are true but uncomfortable. Sharing the true but uncomfortable is a lot of what this site is all about!

      • Not sure about the US ingridejohnson, but there have been moves here in Australia to make it a crime to report to the United Nations. Details on the Lawyers for Human Rights website was where I read about it. (https://alhr.org.au)
        The torturers don’t want anyone escaping the system that is set up to ensure any complaints are not dealt with by anyone except the State governments via ‘refoulment’ of the victims. Even our Prime Minister has pointed out how the rort is working via the kangaroo courts of corruption watchdogs. (His words not mine) We have a tourism industry to protect and having people who wish to cuddle Koalas know that they might be subjected to torture in our hospitals is a no no lol

  7. We saw the same sort of things occurring during the Royal Commission into Institutional responses to Child Sexual Abuse streetphotobeing. A young boy who had been repeatedly sexually assaulted escaped and went to police, only to be returned to his abusers and be locked in a cage he couldn’t stand up in for a week and repeatedly assaulted.
    These “character flaws” of the individuals doing the assaulting were not seen as being criminal offences by police. Thus they exercise their discretionary powers and choose (important word in this context) not to take any further action. Thus certain individuals find themselves above the law, and are free to use police services in their criminal conduct.
    I’ve been threatened with arrest for having documents that prove I was tortured and kidnapped. And it has been positively amazing how many people turn their backs on you for fear of being targeted by our police. “It never happened” i’ve heard from witnesses threatened by police, when they know they are lying to my face. What goes around comes around though. We know who they are and they are now compromised.

  8. The most vulnerable in psych ‘hospitals’ are not able to wash and look after themselves. They end up smelling because nobody helps them, what then happens is that the other patients initially complain to ‘nurses’ then it goes to the ‘ward management’ they say to the complaining patients… ‘we can’t do anything it would go against their human rights’…then they add… ‘but you can’. That is the green light for the vulnerable patients to be abused and I witnessed horrendous verbal and physical abuse while the so called ‘carers’ ‘nurses’ and ‘management’ looked on.

  9. Hi Jann, I read your article and I ‘soul’ searched. I get turned off at anything psychiatric, I fear searchers and more studies and talk of changes. The world is saturated with psychiatry, worse than religion ever was. Every time I have tried to seek out the nicest seeming person remotely related to the illness model, or the “there is something WRONG with you” model, I walk away disappointed. But you know what? I am pleased that you as a psychiatrist has the integrity and guts to actually realize that something is very wrong about psychiatry. I know as a psychiatrist you are limited as to how bold you can become as far as fighting for change. If changes do not happen, do me a favor and be the best human you can be within your field, so that at least a few of your visitors can benefit from your care. I always wonder how the psychiatrists when hitting that end of a long road, feel about their contributions to mankind’s wellness. We cannot keep reducing people to disorders, diseases, labels and poisons. We can recognize people need support. I hope you manage to make enough change that at least your clients are not seen as ill or sick….I have a question. What made you want to create change?
    Here is a link, utterly boring but is the type of thing that makes me nauseous https://www.psychologytoday.com/us/blog/psychiatrist-large/201203/psychiatry-and-society