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Human Rights of Users and Survivors of Psychiatry Tina Minkowitz 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:

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paradigm shift
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
paradigm shift 2
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
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
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
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
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
  • 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
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
engagement 3
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
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
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
  • 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
  • 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