1. Human Rights of Users and Survivors of Psychiatry
Tina Minkowitz

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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?

9. 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

10. 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

11. 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?

12. 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

13. 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

14. 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

15. Information