Human Rights of Users and Survivors of Psychiatry Tina Minkowitz

Paradigm Shift Old paradigm: New paradigm: Took for granted the “need” for coercive measures Human rights meant standardizing and subjecting to the rule of law New paradigm: Coercive measures are incompatible with equality and inherent dignity Human rights means abolishing coercion and creating new types of support

Paradigm Shift 2 Old paradigm associated with “Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care” (non-binding UN declaration) New paradigm associated with Convention on the Rights of Persons with Disabilities CRPD supersedes MI Principles to the extent of conflict, e.g. on involuntary treatment

What Changed? Non-discrimination as central principle Social model of disability – change society and not the person Participation of users and survivors of psychiatry as part of international disability community

Concept of Legal Capacity Old paradigm: Capacity for rights vs. capacity to act “Having” vs. exercising legal capacity Legal capacity vs. mental capacity/competence New paradigm: Legal capacity as right to make decisions and be held responsible for one’s acts Universal; cannot be denied based on disability Limitations in ability met with support

Basis of New Paradigm Equality Human development requires agency Social solidarity and interdependence Abuses in guardianship and incapacity framework: Civil and social death Enforced powerlessness facilitates victimization Acknowledgement of human imperfection

What about “Best Interest”? PWD have equal rights as others to make decisions with risky or harmful consequences Forgoing medical treatment even if condition worsens or death results Use of mind-altering drugs Extreme sports Sexual and relationship choices including unsafe sex and pain infliction, by mutual free and informed consent

Engagement Harm reduction is more effective if non-coercive Domestic violence – shelters, responsive law enforcement, counseling HIV/AIDS – anonymous testing, needle exchange Drugs/alcohol – availability of rehab, learn by example, change social surroundings Why is “mental health” different?

Engagement 2 Old paradigm: New paradigm: Medical diagnosis/labeling “Evidence-based” treatment Mechanistic approach to mind by treating the brain New paradigm: Human engagement – curiosity and interest Judicious use of drugs when desired for particular results, feedback, low dose and shortest duration

Engagement 3 How to do support or create mental health alternatives: Peer support Residential models User-run respite/crisis hostel Soteria Counseling and psychotherapy successful for people labeled with schizophrenia “Open Dialogues” approach – use with caution as it can be authoritarian

Gender and Race Perspectives Avoid stereotyping about social interactions and qualities For example: women “are” or “should be” emotional and like to interact socially Escaping gender and race stereotypes may be seen as risky by others Intersecting discrimination – whose abilities and competencies are mistrusted?

Creating New Legal Frameworks Abolish mental health and incapacity laws – stereotyping, discriminatory, violate CRPD Systematically reform all laws dealing with capacity or competence Identify what is the risk protected against Use disability-neutral alternative Provide access to supported decision-making and prevent abuse of such support

Remedies Torture prevention framework – international and national CAT articles 1 and 16 may prohibit forced psychiatric drugging and electroshock, psychiatric detention Special Rapporteur on Torture Manfred Nowak, 2008 Interim Report to UNGA

Participation User/survivor participation in implementing new paradigm essential Expertise by experience, mutual support, lifelong advocacy CRPD requires close consultation (Article 4.3) Human rights education for user/survivor communities

Information tminkowitz@earthlink.net