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Presentation Castan Final

Presentation Castan Final



Castan Human Rights lecture delivered in Melbourne, Australia, June 3, 2009

Castan Human Rights lecture delivered in Melbourne, Australia, June 3, 2009



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    Presentation Castan Final Presentation Castan Final Presentation Transcript

    • 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:
      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
      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:
      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
      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