Human rights of users and survivors of psychiatry
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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

  • 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 one’s 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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  • 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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  • 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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  • 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