Canadian Mental Health Legislation and the CRPD

Irit Shimrat
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A group of psychiatric survivors in Canada started the Mad Canada Shadow Report Group (MCSRG) in 2017, in order to tell the UN that Canada is not complying with the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We want Canadian lawmakers to start doing what they promised to do, which includes having persons with “psychosocial disabilities” lead the change from psychiatric oppression to supports that people actually want. Erick Fabris and I, on behalf of MCSRG, co-authored a more legalistic version (to be sent to legislators, policy-makers and other Canadian officials) of the following.

What is the CRPD?                                                                  

The CRPD is an international agreement designed to eliminate discrimination on the grounds of disability. It states that disabled people have the same human rights as everyone else, and instructs governments on how to ensure that disabled people are able to enjoy those rights in practice.

The CRPD was adopted by the UN on December 13, 2006, and Canada ratified (become bound by) it in 2010. Canada also agreed, in 2018, to abide by the Optional Protocol (OP) to the CRPD. The OP allows Canadians whose rights have been violated on the grounds of disability to make complaints directly to the UN Committee on the Rights of Persons with Disabilities (the international committee of experts that monitors CRPD implementation).

How does the CRPD define disability?

The CRPD supports a social and human rights-based view of disability: that the challenges faced by people with disabilities are caused not by their own individual limitations but rather by barriers such as physical obstacles and discriminatory behaviour, practices, policies, or legislation. Under the CRPD, people with disabilities must be recognized as holders of human rights, rather than as objects of pity, charity, or the decisions of others with respect to their lives.

Why do people with psychosocial disabilities specifically need protection under the CRPD?

In Canada, as elsewhere, the  standard societal response to emotional, social or individual differences or difficulties is to impose biomedical and institutional interventions. But this response discriminates against us and violates our human and civil rights. The kinds of social and peer-based support systems that are actually helpful are almost non-existent, and attempts to set them up generally receive little or no funding.

The human cost of rights violations

People in extreme distress often languish in restraints or isolation for days or weeks, deprived of fresh air, freedom of movement, and human contact (other than the few minutes a day required for the provision of food and the administration of drugs), before a psychiatrist decides we’re ready to be released into the general population of the ward for further “treatment.” Imagine what this does to our sense of self, and to any expectation that we might be treated with care, respect and responsibility when we actually need help.

And the violation of our rights may not end even after release from hospital. “Community treatment” (outpatient committal) legislation permits “treatment teams” to monitor and enforce medication compliance. Many outpatients go through a humiliating ritual of “witnessed meds” at a local pharmacy, being made to take tranquillizers while a pharmacist watches us swallow. And “treatment team” members regularly invade patients’ privacy to medicate us against our will in our own homes, under threat of being returned to hospital if we fail to comply.

The degree of our willingness to acquiesce to a “treatment” regimen may determine eligibility for housing or other basic human rights. What does this do to our perceptions of human relations and civic society? How can we hope to complete our education, or find employment, when forced to take often incapacitating drugs?

All of these egregious human rights abuses, which, again, are standard procedure in Canada (as elsewhere), violate the obligations of our country as a state party to (country that has agreed to abide by) the CRPD.

What protections must be enshrined in all provincial and territorial mental health legislation?

It also acknowledges that people may at times need help to make decisions, which can include decisions related to treatment, and are legally entitled to whatever kinds of personal supports we might need for that purpose. Notably, it upholds the right to supported decision-making – as opposed to substitute decision-making, where someone else decides on our behalf. Supported decision-making means that, whatever the process, each of us  ultimately decides for ourselves. Anyone helping us decide must do so according to our wishes and preferences – even when we are in a state that is out of tune with or upsetting to others, including the person helping.

How Canada fails its citizens by ignoring the CRPD

It is a major problem that our government has made a “conditional reservation” to its acceptance of article 12 of the CRPD. This is the section on “legal capacity” – the right to make decisions that affect our lives, and especially those that affect our physical and mental integrity – which is fundamental to being legally recognized as a person. Canada’s reservation supports provincial and territorial mental health legislation in continuing to deny our legal capacity and to allow the discriminatory practice of substitute decision-making. It perpetuates the outmoded idea that, if  we refuse treatment, we are shown to “lack insight into our illness” and should therefore be forcibly treated “in our best interests.” As such, it violates the whole purpose and intent of the CRPD.

Adults have the right to say no to medical treatment. Yet Canadian law does not directly require the enforcement of international human rights treaty provisions in domestic legislation. Therefore, regardless of Canada’s “conditional reservation” to article 12, our country’s laws continue to allow clinicians to overrule the refusal of any person whom they have deemed legally “incapable” of making treatment decisions.

Canada’s obligations

Under the CRPD, Canada is obliged to eliminate all legislation and all practices that discriminate on the basis of disability. Mental health laws that authorize involuntary commitment and involuntary treatment are discriminatory because they target people with psychosocial disabilities for deprivation of liberty and for denial of control over our own bodies, minds and health, based on psychiatric opinion.

The practice of substitute decision-making is also discriminatory, in that it denies our right to legal capacity. In its 2017 Concluding Observations on Canada, the Committee on the Rights of Persons with Disabilities voices its concern about our country’s reservation to article 12, which allows the continued use of substitute decision-making. This reservation, the Committee points out, contradicts the object and purpose of the Convention and prevents Canada from fully implementing and addressing our human rights.

When will Canada act?

In light of the above, the Committee recommended in 2017, based on Canada’s report of that year, that all federal, provincial and territorial legislation be brought into line with the CRPD, and that governments should work on these issues in consultation with us, through our representative organizations. It pointed out that mental health legislation should respect our individual autonomy, and that we should be free to make choices about where and with whom we live and have access to affordable housing and to support services of our own choosing. It asked governments to set up strategies, with time frames, to close institutions and replace them with a comprehensive system of support for independent living, and to put in place legislation, plans and programs that facilitate our inclusion in our own communities and prevent our isolation and institutionalization.

Canada’s next report is due this year, and the Committee will surely question how well the government has implemented the Committee’s recommendations. In 2017, the Mad Canada Shadow Report Group was one of several non-governmental organizations that submitted parallel, or “shadow,” reports. Our report highlighted numerous human rights abuses throughout Canadian mental health practice. We recently conducted a nation-wide survey attempting to elicit the views of various relevant bodies, such as health and human-rights authorities. The lack of response was gravely disappointing.

Catalina Devandas Aguilar, the United Nations Special Rapporteur on the Rights of Persons with Disabilities, visited Canada in 2019 to meet with representatives of disabled persons’ organizations, including our group. In her End of Mission Statement, she specified that “[p]rovincial and territorial legislation across Canada provides for the involuntary hospitalization and treatment of persons with psychosocial disabilities, in contradiction to … the CRPD,” and added, “I urge the provincial and territorial governments to transform their mental health systems to ensure a rights-based approach and well-funded community-based responses, ensuring that all health care interventions are provided on the basis of free and informed consent.” Canada may think article 12 can be ignored, but other sections of the CRPD still impel legislators to stop psychiatric incarcerations and forced treatments.

We have no evidence whatsoever that any aspect of either the Committee’s 2017 recommendations or the Rapporteur’s 2019 urgings have even been discussed, much less followed, by legislators and policy planners. It is our hope that the current document will help them address and overcome this inaction.

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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.

27 COMMENTS

  1. Irit,
    you amaze me. You are undertaking such a monu-mental task/tasks.
    Please forward this hopefully to our PM, although I am not certain he understands or for that matter
    has any power over dehumanization.

    Psychiatry is above the law, and no one wants to tackle that huge issue. Which begs the question, why not?
    Why has psychiatry and all medicine become it’s own little legal system?
    Obviously the tax payers want their moneys worth and see all the “mental” gone.

    Honestly I’m not sure why we have to beg for human rights. At that point, anything is possible.

    As was demonstrated in the US. They refuse to pay attention until we fight back.
    And that fighting back only results in a particular case being dealt with, it will not have a systemic change, following. And it really was about much more than colour, the problem really is abuse of power and leaving control freaks at the helm who have no desire to create better societies.

    Our prime ministers and leaders should be thoroughly disgusted. The underpinnings of beliefs are that people MUST “deserve” this. (it’s not “treatment, it’s abuse)

    Thank you for doing all this work. I am in Canada.

    • “the problem really is abuse of power and leaving control freaks at the helm who have no desire to create better societies.” Despite hypocritically claiming that creating better societies is their goal. I agree, this is the real problem, including the bad systems that these bad actors have funded, like the psychiatric system.

      Thanks for all you’ve done, and are doing, Irit. If I recall correctly, the US has yet to adopt the CRPD at all, which does need to happen. I couldn’t agree more, however, that all people should have the right “to be free from psychiatry and other pseudoscientific means of social control.”

      Especially now that at least some know the primary actual societal function of both the psychologists and psychiatrists, and all the DSM “bible” billing “mental health” workers, is covering up child abuse and rape, and this is by DSM design.

      https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
      https://www.madinamerica.com/2016/04/heal-for-life/
      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      And now some also know US citizens are living in a “pedophile empire,” implying, of course, that the wrong people had taken over the United States long ago.

      https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
      https://www.foxnews.com/us/human-trafficking-in-america-among-worst-in-world-report

      Absolutely we need a real return to the rule of law. And the, primarily child abuse covering up, criminals of the pseudoscientific medical industries need to be taken down, as the criminals that they actually are.

    • Yes Gerard, we are almost all treated equally as in psychiatry truly rules us and is RAMPANT even in the ER.

      I asked a few doctors lately (in my clever fashion) how the field of doctors is doing and they gave me the thumbs down and stick out their tongue.

      It’s cool too since they pass the plate at collection time and then pay our doctors, and psychiatrist, plus their lawyers, plus the colleges.
      Mind you, they think they are not being paid enough, so the good ones go to the US.

      Lawsuits are unheard of here, due to the fact no lawyer wants to and our taxes are used up paying for the doctors lawyers so most of us have no funds.

      Plus ALL our med records are seen by whoever wants to. Even shared with non medical people if they want to and I HAVE PROOF, since it’s in one of my emails. LOL.

  2. This issue is made more difficult for me by the re-framing of certain concepts like “disability.” I ran into a similar problem recently when I attended some online discussions about race. The discussants seemed to be saying that they wanted to reject all traditional meanings of the word “race” yet still use the word. Similarly here, it seems there is an attempt to reject our normal concepts of “disability” while still using the term.
    From the viewpoint of someone who is “not disabled,” there is an inherent problem with “help” in that it may be rejected even though, from our moral or ethical viewpoint, help should be given. Would you not help a person who had fallen while crossing the street to get up and continue to the other side, no matter their protests about how they would “rather do it myself?”
    Of course, what we are running into more often is a system that doesn’t really know how to help, yet for some reason feels compelled to do so, clashing with a public that knows the help offered is false, yet stands the constant risk of being forced to accept that false help, with the refusal taken as proof that they need it. This idea on the part of the helper might be workable if the help were not false. Most health care workers would probably leave their jobs if it were clear to them that they were not really helping. So they are bombarded with propaganda to convince them that they are.
    Thus, to me, finding “interventions” (I hate that term!) that really do help is part of the battle here, particularly at the ground level where workers meet “patients.”
    When it becomes this difficult, though, to get the higher-level persons who fund or control the “helping” institutions to change the practices of those institutions, it raises questions for me such as, 1) are they really in control? and 2) do they really care?
    In a political setting you always have considerations of expediency and economics. Even though people in government and politics are trained in universities and can converse in a very intellectual way, this doesn’t mean that they actually share the interests, concerns, or even understandings, of others who came up through that same system. Did they get into politics to serve – or be served? One always has to wonder. And the political environment does not usually favor putting humanitarian concerns ahead of other ones.
    My impression is that the people who care will have to make the changes they want through their own personal efforts. Though our political systems give lip service to the issue of Human Rights, there seems to be an abiding sense that they cannot really afford to implement such rights. It’s almost as if going down that road would take them in a direction they really don’t want to go. If that’s true, then we are essentially on our own regarding such issues. The next question becomes: Can the intellectuals who support humanitarian reforms step away from their books and keyboards and classrooms long enough to actually lend a hand that’s going to make a difference, or does the real responsibility for action devolve to the victims of institutional inhumanity? I’d like to think we can help, but I know from personal experience how uncomfortable that can be.

  3. Thanks for this blog and all your ongoing great work Irit. As for getting legislation in line with the CRPD, it’s high time Canada (and the U.S. and other countries) not just ‘talk the talk’ but ‘walk the walk’. There is much unrest and much at stake these days and giving lip service to human rights can no longer be acceptable.

    Also great statement you made (in the comment section) Irit bears repeating:

    “From what I see many people who get into politics do so to exert power over others, though I imagine most or all are lying to themselves about that, as shrinks and their minions (and a great many police officers, etc.) must surely be doing as well. Humanitarian concerns are only important when they don’t challenge the status quo.”

    • Rosalee:

      I would offer a different frame of reference. First, the brain’s operation is an extraordinary political expression as the will to live focus fires off across many gaps. Hence, one is already in the fray.

      I would encourage you and others to pick an office, file for that office, and experience a period by which you attempt to offer up what you are about, I did this in Louisville, partially in response to the civil rights abuse I would receive from the Mayor, who was schooled in Law from the University of Indiana.

      I thought more about my simple platform and type of service I might offer to my community. The experience was unusual and I would not take any money for my campaign; hence I self financed. I would also be encouraged to quit the race by the NAMI member or others with wealth. But to start quitting was not in the cards. I strive to finish what I start. And so the vote at the end showed a better cpv (cost per vote). I averaged .25/vote, the Mayor spent 3.00/vote.
      So, if one is wanting to see the content of a person’s character emerge, and then across this protest, I would encourage those who wish to change the system to file for offices.

      Flood the ballots, with participants.

      The filing fees may not be much, and once on the form, either aligned with prevailing major parties or independents, there is a way, the systems must work. And to travel during that window, the circuit to engage the best you can, is a way of giving voice. The content of a person’s character will emerge.

      And a voice, of a human who can relate to all the citizenry seems to be a rarer ability when the law firms in Washington are pouring money into campaign races or wealthier people contribute to both sides to cover their interests. I have not made revenues and in fact from being involved with civil rights advocacy would be dismissed.

      In the more estranged manner, the security man for the Mayor would be 1) keeping me from entering the Mayor’s disability committee on which I was a member, and 2) would be chasing me down the street, screaming at me to “go away”, the city doesn’t want to have anything to do with me and so forth”. Equally, the banks in town would be telling me “the government takes care of the handicapped”. The problem has been trying to be settled enough to experience the joy of earning a living, when the believe systems as we discover on these pages shows a nightmare of tragic experiences as well as beautiful expressions of love and commitment to social justice. The essence is to not give up. One last comment to this post, is a fond memory I have of my teacher at Waterloo, Harry Coblentz who looked more like Karl Marx. When I would talk about training programs, he would stop me, and then in his modest, English toned voice, convey to me, that one trains a monkey, but educates a human being. Thus to go back to the UN references about labor, how many times do you see the references to training programs. The context sets in motion a sort of experience that does not welcome questions, which corrupted systems really seem to be having a problem with. Hope this helps….

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