Human Rights of Users and Survivors of Psychiatry

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Human Rights of Users and Survivors of Psychiatry

• Tina Minkowitz

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Paradigm Shift

• Old 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

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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

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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

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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 ones acts
• Universal cannot be denied based on disability
• Limitations in ability met with support

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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

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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

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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?

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Engagement 2

• Old 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

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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

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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?

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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

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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

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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

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Information

• tminkowitz_at_earthlink.net