Human Rights of Users and Survivors of Psychiatry<br />Tina Minkowitz<br />
Paradigm Shift<br />Old paradigm:<br />Took for granted the “need” for coercive measures<br />Human rights meant standardi...
Paradigm Shift 2<br />Old paradigm associated with “Principles for the Protection of Persons with Mental Illness and for t...
What Changed?<br />Non-discrimination as central principle<br />Social model of disability – change society and not the pe...
Concept of Legal Capacity<br />Old paradigm: <br />Capacity for rights vs. capacity to act<br />“Having” vs. exercising le...
Basis of New Paradigm<br />Equality<br />Human development requires agency<br />Social solidarity and interdependence<br /...
What about “Best Interest”?<br />PWD have equal rights as others to make decisions with risky or harmful consequences<br /...
Engagement<br />Harm reduction is more effective if non-coercive<br />Domestic violence – shelters, responsive law enforce...
Engagement 2<br />Old paradigm:<br />Medical diagnosis/labeling<br />“Evidence-based” treatment<br />Mechanistic approach ...
Engagement 3<br />How to do support or create mental health alternatives:<br />Peer support<br />Residential models<br />U...
Gender and Race Perspectives<br />Avoid stereotyping about social interactions and qualities<br />For example: women “are”...
Creating New Legal Frameworks<br />Abolish mental health and incapacity laws – stereotyping, discriminatory, violate CRPD<...
Remedies<br />Torture prevention framework – international and national<br />CAT articles 1 and 16 may prohibit forced psy...
Participation<br />User/survivor participation in implementing new paradigm essential<br />Expertise by experience, mutual...
Information<br />tminkowitz@earthlink.net<br />
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Presentation Castan Final

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

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Presentation Castan Final

  1. 1. Human Rights of Users and Survivors of Psychiatry<br />Tina Minkowitz<br />
  2. 2. Paradigm Shift<br />Old paradigm:<br />Took for granted the “need” for coercive measures<br />Human rights meant standardizing and subjecting to the rule of law<br />New paradigm:<br />Coercive measures are incompatible with equality and inherent dignity<br />Human rights means abolishing coercion and creating new types of support<br />
  3. 3. Paradigm Shift 2<br />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)<br />New paradigm associated with Convention on the Rights of Persons with Disabilities<br />CRPD supersedes MI Principles to the extent of conflict, e.g. on involuntary treatment<br />
  4. 4. What Changed?<br />Non-discrimination as central principle<br />Social model of disability – change society and not the person<br />Participation of users and survivors of psychiatry as part of international disability community<br />
  5. 5. Concept of Legal Capacity<br />Old paradigm: <br />Capacity for rights vs. capacity to act<br />“Having” vs. exercising legal capacity<br />Legal capacity vs. mental capacity/competence<br />New paradigm:<br />Legal capacity as right to make decisions and be held responsible for one’s acts<br />Universal; cannot be denied based on disability<br />Limitations in ability met with support<br />
  6. 6. Basis of New Paradigm<br />Equality<br />Human development requires agency<br />Social solidarity and interdependence<br />Abuses in guardianship and incapacity framework:<br />Civil and social death<br />Enforced powerlessness facilitates victimization<br />Acknowledgement of human imperfection<br />
  7. 7. What about “Best Interest”?<br />PWD have equal rights as others to make decisions with risky or harmful consequences<br />Forgoing medical treatment even if condition worsens or death results<br />Use of mind-altering drugs<br />Extreme sports<br />Sexual and relationship choices including unsafe sex and pain infliction, by mutual free and informed consent<br />
  8. 8. Engagement<br />Harm reduction is more effective if non-coercive<br />Domestic violence – shelters, responsive law enforcement, counseling<br />HIV/AIDS – anonymous testing, needle exchange<br />Drugs/alcohol – availability of rehab, learn by example, change social surroundings<br />Why is “mental health” different?<br />
  9. 9. Engagement 2<br />Old paradigm:<br />Medical diagnosis/labeling<br />“Evidence-based” treatment<br />Mechanistic approach to mind by treating the brain<br />New paradigm:<br />Human engagement – curiosity and interest<br />Judicious use of drugs when desired for particular results, feedback, low dose and shortest duration<br />
  10. 10. Engagement 3<br />How to do support or create mental health alternatives:<br />Peer support<br />Residential models<br />User-run respite/crisis hostel<br />Soteria<br />Counseling and psychotherapy successful for people labeled with schizophrenia<br />“Open Dialogues” approach – use with caution as it can be authoritarian<br />
  11. 11. Gender and Race Perspectives<br />Avoid stereotyping about social interactions and qualities<br />For example: women “are” or “should be” emotional and like to interact socially<br />Escaping gender and race stereotypes may be seen as risky by others<br />Intersecting discrimination – whose abilities and competencies are mistrusted?<br />
  12. 12. Creating New Legal Frameworks<br />Abolish mental health and incapacity laws – stereotyping, discriminatory, violate CRPD<br />Systematically reform all laws dealing with capacity or competence<br />Identify what is the risk protected against<br />Use disability-neutral alternative<br />Provide access to supported decision-making and prevent abuse of such support<br />
  13. 13. Remedies<br />Torture prevention framework – international and national<br />CAT articles 1 and 16 may prohibit forced psychiatric drugging and electroshock, psychiatric detention<br />Special Rapporteur on Torture Manfred Nowak, 2008 Interim Report to UNGA<br />
  14. 14. Participation<br />User/survivor participation in implementing new paradigm essential<br />Expertise by experience, mutual support, lifelong advocacy<br />CRPD requires close consultation (Article 4.3)<br />Human rights education for user/survivor communities<br />
  15. 15. Information<br />tminkowitz@earthlink.net<br />

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