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Post by Admin on May 26, 2020 15:43:17 GMT
Reform Mental Health Human rights for all. Non-discriminatory legislation. Non-coercive healthcare.wecareaboutmh.wixsite.com/mysiteOur values
We believe that everyone is born with certain inalieanable rights, known as human rights. These human rights cannot be withdrawn from anyone, by anyone.However, in the West, the State has decided to withdraw these fundamental rights from people suffering from mental health problems. Once a medical professional, usually a psychiatrist decides that someone suffers from a mental health problem or lacks capacity, that person loses their findamental rights. They lose their right of autonomy, their right to freedom, their right to privacy and to a family life. They may be forcibly given medical treatment which is of no therapeutic benefit. These acts breach the European Convention on Human Rights 1998, which is supposed to be integrated into UK legislation. And yet, these acts are permitted by the Mental Health Act 1983, last reformed in 2007. We believe that people with mental ill-health possess human rights just as much as anyone else. We believe that modern medicine has departed from its traditional maxim of 'Do no harm' and needs to be reformed. We believe that our values are consistent with all major political persuasions although our own movement is largely apolitical. Except that we reserve the right to campaign against political policies that result in gross inequality such as the Tory austerity programme. Our objectives
Our primary objective is to enhance the status of people with mental health conditions.To achieve this objective, we campaign for the following causes: Make all UK legislation fully compliant with the European Convention on Human Rights 1998 Reform then abolish the Mental Health Act (MHA) So far as possible, eliminate all forms of coercion from mental healthcare Stop clinical drug trials which do not conform to the provisions of the Helskinki Declaration [Rest in Link]
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Post by Admin on Jul 14, 2020 19:29:00 GMT
Domestic Abuse Bill risks sending disabled people “back to the days of the Victorian asylums”Posted by June Knight 14th July 2020 3 min read welfareweekly.com/domestic-abuse-bill-risks-sending-disabled-people-back-to-the-days-of-the-victorian-asylums/Domestic Abuse Bill risks sending disabled people “back to the days of the Victorian asylums” Disability Rights UK has written to the Rt Hon Robert Buckland QC, the Lord Chancellor, and Secretary of State for Justice, the Rt Hon Priti Patel MP about its grave concerns about provision for disabled people in the Domestic Abuse Bill. The ‘carers’ defence’ legitimises coercive control against disabled people, and undermines disabled peoples’ ability to live independent lives. Fazilet Hadi said: “As things stand, this Bill would allow carers such as partners and family members to take away the autonomy of disabled people, and to abuse them by going against their will. There is clear scope at the moment for abusers to present themselves as wolves in carers’ clothing and force feed or drug disabled people, and then walk free under the terms of this Bill. “We have fought for decades for the lives of disabled people to have the same parity of self-determination and independence as non-disabled people. This Bill risks sending us back to the days of the Victorian asylums, where the medical model of disability saw millions of people have what was best decided for them – often to their irreparable harm.” Letter to Ministers Dear Lord Chancellor and Secretary of State for Justice, Unequal Treatment of Disabled People in the Domestic Abuse Bill Disability Rights UK is extremely concerned about the unequal treatment of disabled people in the Domestic Abuse Bill. The right to live free from domestic abuse should be absolute and apply to all, yet the Bill limits this right in respect of disabled people. We believe any limitation to be wholly unfair and unjust and contrary to our human rights. The so called “carer’s defence”, which legitimises coercive control against disabled people, devalues our lives and undermines our autonomy, control and choices. The Domestic Abuse Bill should give us the same legal protection from coercive control, as available to others in society. There should be absolutely no defence to exerting coercive control. At the Committee Stage of the Bill, the government maintained that a “carer’s defence” to coercive control was needed. Examples given to support this assertion were, a carer needing to force medication or a carer needing to imprison someone, in the person’s best interests. The government felt that these instances should not be treated as coercive control. In our view, the examples given may well be coercive control. Indeed, in the briefing on the Bill, prepared by Stay Safe East, an organisation with many years of supporting disabled women experiencing domestic abuse, it is explained that perpetrators exploit the impairments and circumstances of disabled women, by putting unnecessary and abusive restrictions on their lives. Disability Rights UK would ask the government to remove the “carer’s defence” from the Domestic Abuse Bill and to make it clear that disabled people enjoy the same absolute legal protection from coercive control, as the rest of the population. Disabled people need to know that we are protected from all forms of domestic abuse and perpetrators need to know that the domestic abuse of disabled people is unlawful. We would welcome an urgent meeting with you to discuss this issue. Yours Sincerely, Kamran Mallick, CEO Disability Rights UK
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Post by Admin on Jul 20, 2020 18:52:17 GMT
Petition Abolish the Mental Health Act and legislate for new forms of support The Mental Health Act is one of the few areas of law where individuals can be detained against their will despite having committed no crime, and given medical treatment without their consent. This appears inconsistent with both the Equality Act and Human Rights Act. petition.parliament.uk/petitions/317620
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Post by Admin on Nov 5, 2020 22:03:35 GMT
A recent article published in the Journal of Mental Health explores the language used to discuss mental health issues in parliamentary debates around the UK’s 2007 Mental Health Act. Psychologists in the UK analyzed these debates using a discourse analysis methodology, highlighting how members of parliament frame or “construct” individuals in the mental healthcare system. These constructions, such as “expert” and “patient,” serve to reinforce existing narratives around, for example, the “risk to public safety” posed by the “mentally ill.” “Mental distress has not always been described as a disorder or illness. It has been constructed differently throughout the ages, being regarded variously as a visitation or punishment from the gods, demonic possession, ‘madness,’ or ‘lunacy’ or requiring rational inquiry. It was only in 1774 that British legislation on mental disorder first mentioned doctors when the Madhouse Act allowed doctors to visit asylums,” write UK psychologists Tom Kent, Anne Cook, and Ian Marsh. How the UK Mental Health Act Uses Psychiatric Discourse to Justify Rights RestrictionsA study of the UK’s 2007 Mental Health Act finds that the debate was framed in terms of experts and “patients” in need of professional intervention. www.madinamerica.com/2020/11/uk-mental-health-act-uses-psychiatric-discourse-justify-rights-restrictions/“The expert and the patient”: a discourse analysis of the house of commons’ debates regarding the 2007 Mental Health ActTom Kent ,Anne Cooke &Ian Marsh Received 23 Feb 2020, Accepted 28 Jul 2020, Published online: 15 Sep 2020 www.tandfonline.com/doi/full/10.1080/09638237.2020.1818706Abstract Background The Mental Health Act 1983 was amended in 2007. This legislation appears to be predicated on the assumption that an entity of “mental disorder” exists and that people who are designated mentally disordered require medical treatment, administered by force if necessary. Aims To explore the ways in which mental disorder is constructed and the possible practical effects of these constructions in the House of Commons’ debates regarding the Mental Health Act 2007. Method Verbatim transcripts from the House of Commons debates on the Mental Health Act were studied through a discourse analysis. Results Two primary discursive constructions were identified: “The Expert” and “The Patient.” Conclusion Mental disorder and associated roles, such as “The Expert,” were constructed through particular selective rhetoric, which taken together, made particular psychiatric practices and the need for legislation, such as compulsory detention, seem normal, and necessary. Introduction The Mental Health Act 1983 is a unique piece of legislation in England and Wales, as it can remove an individual's freedom, principally through detention without trial and the administration of medication without consent. This Act was amended in 2007, but the amendments have been described as “draconian” (Rose, 2008) and criticised for over-emphasising public safety at the expense of service quality and human rights (Pilgrim, 2007). Vassilev and Pilgrim (2007) have suggested that the Act is not about protecting patients from themselves or others – it is about the government wanting to minimise the perceived risks of mental disorder. Other literature examining policies in mental health came to comparable conclusions about risk concerns. Harper (2008) undertook a scholarly analysis of proposals to reform the mental health legislation and had identified constructions of risk and danger within them. Similarly, Moon (2000) explored the mental health policy of the time and stressed the significance of discourses of protection, safety, risk, and dangerousness in the positioning of confinement as a respectable and strategic response. The original legislation and amendments seem to be based on the assumption that a concrete entity called “mental disorder” exists and if a person diagnosed with a mental disorder is deemed a risk (to themselves or others) should be detained and treated by doctors. One way this assumption has been contested is on the understanding of mental disorder as a discursive construction, that it is a creation and product of language and historical, cultural and social circumstances rather than an objective medical fact. For definition, discursive construction can be understood to be a group of statements that produce social meaning and practices (Laclau, 1980; Parker, 1992). In this study, we employed a Foucauldian-informed approach based on the work of Parker (1992). This allows researchers to critically engage with (Burr, 2003) and explore the broader context of the language used to construct mental disorder and related psychiatric and psychological practices. Parker’s (1992) approach to discourse and its analysis focusses on coherent meanings and connotations, or the attempts at such, within language and how these interact. He asks what types of person, termed subject positions, talk about these meanings. Most important is his understanding of key Foucauldian concerns on identifying discourse as being historically located, the reinforcement of institutions, the ideological effects that sanction oppression and the reproduction of power relations. Foucault’s (1965) ideas have been inextricably linked to mental distress following his seminal analysis of madness through time that presented mental illness as a construction rather than a natural fact. He suggested that the modern notion of mental illness is maintained through psychiatric practices – that “mad” persons/subjects are created by discursive practices centred on notions of “madness” and “reason.” Foucault conceivably recognised that historical analyses could often provide convincing critiques for taken-for-granted knowledge and practices. Mental distress has not always been described as a disorder or illness. It has been constructed differently throughout the ages, being regarded variously as a visitation or punishment from the gods, demonic possession, “madness,” or “lunacy,” or requiring rational inquiry (Porter, 2002). It was only in 1774 that British legislation on mental disorder first mentioned doctors when the Madhouse Act allowed doctors to visit asylums (Cromby et al., 2013). Hacking (1986) suggested that categorisations and different diagnoses have been created in relation to the different power-knowledge configurations that have emerged, for example, he claimed that the clinical phenomenon of the multiple personality was invented in 1875. Similarly, Davidson (as cited in Hacking, 1986), expanding on Foucault's (1978) argument regarding sexuality, proposed that the concept of a “pervert” did not exist before the nineteenth century, but that the ideas of perversion as a disease and the pervert as a diseased person were created from a new functional understanding of disease. Beyond arguments about the existence of mental disorder, it is important to review its characterisation, and two discourses seem dominant in the literature. The first discourse is 'violence, risk, dangerousness, and criminality’ (the characters and actions of the “Mentally Ill”). People with mental disorder are often discursively constructed as being violent, risky, dangerous, or criminal particularly in newspaper accounts (e.g. Allen & Nairn, 1997; Bilić & Georgaca, 2007; Coverdale et al., 2002; Hazelton, 1997; Nairn, 1999; Nairn et al., 2001; Nairn & Coverdale, 2005; Olstead, 2002). In these studies, reporting of violence perpetrated by people with mental health problems were seen as newsworthy and appealed to sensationalism. Bilić and Georgaca (2007) and Olstead (2002) both identified in media text the conflation of the mentally ill with other stigmatised and “deviant” groups, such as drug addicts and HIV-positive patients. Furthermore, Bilić and Georgaca (2007) conceived the portrayal of people with mental illness as devoid of individual and social characteristics, which the authors see as a unified and less humanising category that can also have stigmatising implications. The second discourse is medical. This discourse classifies mental illness as a medical disorder, with psychiatrists as experts in its interpretation and management (Bilić & Georgaca, 2007). Various discursive strategies have been identified by the researchers to serve to construct mental illness as a medical matter. Rowe et al. (2003) noted that depression is compared with physical diseases like diabetes and was mentioned in the same sentences. Physical health associations acted rhetorically as an explanation rather than only as a description. Rowe et al. (2003) noted a lack of precision when scientific and medical terminology was used – a rhetorical device called “studied use of vagueness” (Edwards & Potter, 1992). Bilić and Georgaca (2007) also highlighted the use of vagueness in the application of scientific terminologies, such as “ions” and “cells,” which can make it unclear to the reader the exact detail underpinning a biological explanation for mental illness. The authors argued that this serves to deepen the difference between the psychiatrist and the reader constructing the former as an authority and an expert. Psychiatrists have featured in many of the texts studied, giving their professional opinions in matters of mental illness. Johnstone and Frith (2005), Nairn (1999), and Bilić and Georgaca (2007) all noted the use of category entitlement (Edwards & Potter, 1992) of doctors who are expected to have certain kinds of knowledge due to their position. Bilić and Georgaca (2007) noticed that in the reports from Serbian newspapers, psychiatrists had their professional titles reported and institutional position stated, whereas service users were less precisely described and quotations from them were used to support the psychiatrists’ opinion. The literature reviewed has focussed on media and government texts in examining mental disorder. However, there are many texts that could be of interest in examining the issues of mental disorder and society. Parliamentary debate transcripts have been used in other research areas to examine assumptions and discursive strategies in discussions about law reform, for example, homosexuality (Baker, 2004), European Refugee Crisis (Kirkwood, 2017) and human fertilisation (Kettell, 2010). These studies provided insightful analyses of the impact of language on the course of the debates. House of Commons' debates on the Mental Health Act could be seen as an essential way in which speech constructed a particular version of mental distress and helped to shape legal powers. The language used at this time point has created the future realities of professionals, service-users and families alike. Of course, over time, all discursive constructions are likely to change, including mental disorder. However, the Hansard transcripts on the Mental Health Act debates will always be of importance as a socio-historical document relating to the construction of mental disorder. In the context of the debate about the construct of mental disorder and associated practices, the current study aimed to critically examine the House of Commons debates with respect to the Mental Health Act 2007. The aim was to explore the ways in which mental disorder is constructed within the debates and the possible practical effects of these constructions.
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Post by Admin on Jan 13, 2021 16:17:05 GMT
Press release Landmark reform of mental health laws Major reform of Mental Health Act will empower individuals to have more control over their treatment and deliver on a key manifesto commitment.Published 13 January 2021 From: Department of Health and Social Care www.gov.uk/government/news/landmark-reform-of-mental-health-lawsMajor reform of Mental Health Act will empower individuals to have more control over their treatment and deliver on a key manifesto commitment. Reforms will deliver parity between mental and physical health services and put patients’ views at the centre of their care. Plan will tackle mental health inequalities including disproportionate detention of people from black, Asian and minority ethnic (BAME) communities, the use of the act to detain people with learning disabilities and autism, and improve care for patients within the criminal justice system. People with mental health issues who are detained under the Mental Health Act will benefit from landmark reforms which provide more control over their care and treatment, the government has announced today. A package of reforms has been set out in a wide-ranging new Reforming the Mental Health Act white paper, which builds on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018. At the heart of the proposed reforms to the Mental Health Act is greater choice and autonomy for patients in a mental health crisis, ensuring the act’s powers are used in the least restrictive way, that patients receive the care they need to help them recover and all patients are viewed and treated as individuals. These reforms aim to tackle the racial disparities in mental health services, better meet the needs of people with learning disabilities and autism and ensure appropriate care for people with serious mental illness within the criminal justice system. Health and Social Care Secretary Matt Hancock said: I want to ensure our health service works for all, yet the Mental Health Act is now 40 years old. We need to bring mental health laws into the 21st century. Reforming the mental health Act is one of our central manifesto commitments, so the law helps get the best possible care to everyone who needs it. These reforms will rightly see people not just as patients, but as individuals, with rights, preferences, and expertise, who are able to rely on a system which supports them and only intervenes proportionately, and which has their health and wellbeing as its centre. This is a significant moment in how we support those with serious mental health issues, which will give people more autonomy over their care and will tackle disparities for all who access services, in particular for people from minority ethnic backgrounds. The government will consult on a number of proposed changes, including: introducing statutory ‘advance choice documents’ to enable people to express their wishes and preferences on their care when they are well, before the need arises for them to go into hospital implementing the right for an individual to choose a nominated person who is best placed to look after their interests under the act if they aren’t able to do so themselves expanding the role of independent mental health advocates to offer a greater level of support and representation to every patient detained under the act piloting culturally appropriate advocates so patients from all ethnic backgrounds can be better supported to voice their individual needs ensuring mental illness is the reason for detention under the act, and that neither autism nor a learning disability are grounds for detention for treatment of themselves improving access to community-based mental health support, including crisis care, to prevent avoidable detentions under the act – this is already underway backed by £2.3 billion a year as part of the NHS Long Term Plan The white paper sets out the path towards the government’s commitment to introduce the first new Mental Health Bill for 30 years, and end the stigma of mental illness once and for all. Minister for Mental Health and Suicide Prevention Nadine Dorries said: I am committed to improving people’s experience under the Mental Health Act, and most importantly to making sure their care and treatment works for them. We know people are too often disempowered and excluded from decisions, which is where the act, and our ability to successfully support people often fails. Informed by Sir Simon’s recommendations, we will transform the act to put patients at the centre of decisions about their own care. Decisive action will be taken to help tackle the disproportionate number of people from black, Asian and minority ethnic communities detained under the Mental Health Act. Black people are over 4 times more likely to be detained under the act and over 10 times more likely to be subject to a community treatment order. A national organisational competency framework for NHS mental health trusts will be introduced, referred as the ‘Patient and Carers Race Equality Framework’ (PCREF). The PCREF will be a practical tool which enables mental health trusts to understand what steps it needs to take to improve black, Asian and minority ethnic communities’ mental health outcomes. Improved culturally appropriate advocacy services will be piloted where needed, so people from BAME backgrounds can be better supported by people who understand their needs. The reforms will also change the way people with a learning disability and autistic people are treated in law by recognising a mental health inpatient setting is often not the best place to meet their specific needs. The proposal sets out that neither learning disability nor autism should be considered a mental disorder for which someone can be detained for treatment under section 3 of the act. Instead, people with a learning disability or autistic people could only be detained for treatment if a co-occurring mental health condition is identified by clinicians. Significant investment in community support has led to a 29% reduction since 2015 in the number of people with a learning disability and autistic people in a mental health inpatient setting. The government has established the £62 million Community Discharge Grant to make further progress on discharging people with learning disabilities and autism from inpatient care. The proposed changes in the legislation will help to further reduce reliance on inpatient care. The white paper also takes steps to ensure parity between mental health and physical health services. The government is already investing over £400 million to eradicate dormitories in mental health facilities as part of its response to Sir Simon’s recommendations and its commitment to level up access to mental health services and rebuild better than before, so people admitted to hospital can receive care in a modern and genuinely therapeutic environment. High impact changes are already under way – including vital capital spend on the mental health estate, and work to pilot and develop the Patient and Carer Race Equality Framework. For changes which require legislation, consultations will continue until early spring 2021 to listen to the concerns people have, and a draft Mental Health Bill will be shared next year. The benefits of reform will also be felt by people with serious mental illness within the criminal justice system. A 28-day time limit is being proposed to speed up the transfer of prisoners to hospital, ending unnecessary delays and ensuring they get the right treatment at the right time. Lord Chancellor and Justice Secretary Robert Buckland said: Prisons should be places where offenders are punished and rehabilitated, not a holding pen for people whose primary issue is their mental health. Keeping people safe must be at the heart of everything this government does, and the reforms announced today will allow us to do this while ensuring offenders still get the treatment their conditions require. The government also commits to ending the outdated practice of using prisons as ‘places of safety’ for defendants with acute mental illness. Instead, judges will work with medical professionals to ensure defendants can always be taken directly to a healthcare setting from court. Victims of all mentally disordered offenders will now have the option of being assigned a dedicated victim liaison officer to keep them informed of key developments in the offender’s case, including when the patient is discharged. Claire Murdoch, Mental Health Director for NHS England, said: The proposed reforms are a welcome step towards ensuring that people with mental health needs, a learning disability or autism, remain at the centre of decisions about their care, and that longstanding inequalities in experience and outcomes are addressed. The NHS is delivering a package of important measures set out in our NHS Long Term Plan to transform mental health, learning disability and autism services, which will ensure everyone can access the right treatment for their needs, when they need it most, which will improve lives and help to implement the Mental Health Act reforms effectively. Additional quotes Professor Sir Simon Wessley: Since the introduction of the Mental Health Act back in 1959 attitudes towards mental illness have changed dramatically. It was time for our legislation to catch up, so two years ago I presented my recommendations to modernise the Mental Health Act, so that it works better for those it protects. Today the government is taking the next steps to making these changes a reality The Mental Health Act white paper proposes changes which address amongst others rising rates of detention under the act, the disproportionate number of BAME individuals detained, and allows the patient voice to be heard better than in the past. I welcome today’s announcement and look forward to working closely with the government and all the parties during the consultation. Dr Adrian James, President of the Royal College of Psychiatrists, said: The Royal College of Psychiatrists welcomes the publication of the white paper. This is a great opportunity to modernise mental health law and improve safeguards and support for people in a mental health crisis. The reform of the Mental Health Act will help ensure that patients are heard, their choices respected and that they are supported to get better in the least restrictive way. We will consult with our members on how the changes will work on the ground and look forward to engaging positively with the consultation over the coming months. This includes exploration of the resources necessary to implement the proposed changes. Mark Winstanley, CEO of Rethink Mental Illness, says: The publication of the white paper to reform the Mental Health Act is a hugely significant milestone in a long struggle for change. Many people will take for granted their right to have choice and control over the medical treatment they receive. But thousands of people every year who are severely affected by mental illness and who are detained under the act lose those rights and temporarily their liberty. The proposals set out in the white paper, all informed by the Independent Review of the Mental Health Act, give real hope for a more person-centred and principled Mental Health Act which better reflects how a modern society thinks about mental illness. Sarah Hughes, Chief Executive at the Centre for Mental Health, said: The need to modernise the Mental Health Act could not be clearer. Every year, the number of people who are sectioned grows. While we know this can save lives, the use of coercion can also cause lasting trauma and distress. And we have known for too long that black people are subjected to much higher levels of coercion at every stage of the system. It is time for this to change. We need to redress the power imbalance between people subject to the act and the state and to make the system fairer for all. We hope that today will bring us a step closer to mental health legislation that respects and protects people’s rights and dignity, that reduces inequality and that turns the tide on the growing use of coercion. Sophie Corlett, Director of External Relations at Mind, said: We are pleased the government has accepted the majority of the recommendations made in the Independent Review in their long-awaited Mental Health Act white paper. At the moment, thousands of people are still subjected to poor, sometimes appalling, treatment, and many will live with the consequences far into the future. Change on the ground cannot come soon enough. It is important those who have been detained under the Mental Health Act, as well as their loved ones, feed into the consultation, helping shape the reforms. Given black people are 4 times more likely to be sectioned than white people, it’s crucial the government hears from people from different black, Asian and minority ethnic groups. We want to see steps taken to identify, address and tackle underlying and systemic racism that results in disproportionate detentions and use of force. Background information Four principles, developed by the review and in partnership with people with lived experience, will guide and shape the approach to reforming legislation, policy and practice. These are: Choice and autonomy – ensuring service users’ views and choices are respected Least restriction – ensuring the act’s powers are used in the least restrictive way Therapeutic benefit – ensuring patients are supported to get better, so they can be discharged from the act The person as an individual – ensuring patients are viewed and treated as rounded individuals Open consultation Reforming the Mental Health ActPublished 13 January 2021 From: Department of Health and Social Care www.gov.uk/government/consultations/reforming-the-mental-health-act
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Post by Admin on Jan 14, 2021 14:33:45 GMT
The Mental Health Act White Paper: a big step towards change13/01/2021 www.rethink.org/news-and-stories/blogs/2021/01/the-mental-act-white-paper-a-big-step-towards-change/The government has published the Mental Health Act white paper, setting out their plans to reform the act. Our Social Policy Manager, Will Johnstone, highlights the key areas that the white paper sets out to change and how it impacts people living with severe mental illness. For Rethink Mental Illness, the Mental Health Act white paper isn’t just the culmination of several years of campaigning, research, and working with our friends across the mental health sector. It’s also the beginning of a transition towards meaningful change in the care and treatment of people living with severe mental illness who are detained under the act. There are many potential changes to the act that we support, but here are three that we are most looking forward to: Guiding Principles The government plan to write guiding principles into the Mental Health Act. These will provide a guide for professionals involved in caring for someone detained under the act and help service users to know what they should expect from their treatment. The principles are as follows: • Choice and autonomy: people should be supported to express what they want and be heard; patients should understand their rights and their relationships should be respected. • Beneficial purpose: care and treatment should be delivered with a view to ending the need for coercion. • Treating patients as individuals: detention should respect the individual circumstances of the detained person, and consider their protected characteristics. • Least restriction: compulsory powers should be used in the least restrictive and least invasive way possible. Racial inequalities We also hope that the third principle – treating patients as individuals – will have a positive impact on the experiences of people from Black African and Black Caribbean backgrounds who are statistically more likely to be detained under the act than their white peers. The ‘treating patients as individuals’ principle is intended to reform parts of the law which have a negative impact on the rates of detention and experience of people from diverse backgrounds – including changes to reduce the high rates of Community Treatment Orders and to prefer less restrictive alternatives to detention under the act. Practical measures, such as pilots for culturally sensitive independent advocacy services, and the Patient and Carer Racial Equality Framework (an initiative which aims to make mental health providers better at measuring and improving the impact their policies have on service users from diverse backgrounds) are meaningful steps towards a Mental Health Act which does not unfairly discriminate against service users who are black or from other ethnic minorities. These changes are long overdue. Family and carer involvement The white paper recognises the vital role that carers, families, and friends play in supporting someone who’s detained under the act. We’re really pleased that recommendations we called for in previous reports on replacing the Nearest Relative system have been accepted by the government, and that the method of selection for the new Nominated Person will be through patient choice. This means that the powers and responsibilities for the Nominated Person will carry real weight and have meaning. Carers and loved ones play such a vital role in the recovery of people detained under the act that these changes are crucial in ensuring their role is legally recognised and enhanced. What’s next? There’s a great deal to look forward to, but it’s worth noting that the white paper’s publication is the continuation of a process, not the end of it. The government are setting out their views on what should change, but we still need to make sure that these changes become law. If you share our excitement, you can sign up to become a campaigner to help us continue our work on the act. If you have experience of the act, the government are looking to hear your views on their plans in a consultation. This white paper has been a long time coming, and it’s cause for celebration. But we still have a long way to before we get a Mental Health Act which we can all be proud of. We look forward to working with the government, people detained under the act, their carers and loved ones, and our campaigners and supporters, to see it delivered in the near future.
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Post by Admin on Jan 16, 2021 17:32:25 GMT
Rights concerns over major Mental Health Act reformsBy John Pring on 14th January 2021 Category: Human Rights www.disabilitynewsservice.com/rights-concerns-over-major-mental-health-act-reforms/User-led grassroots groups have raised serious concerns about the government’s new mental health white paper, particularly its failure to offer the full human rights set out in the UN disability convention. The white paper, published yesterday (Wednesday), aims to deliver “major reform” of the Mental Health Act (MHA), providing service-users with more control over their care and treatment, and ensure the act’s powers “are used in the least restrictive way”. Ministers also said that it would address the disproportionate detention of people from black, Asian and minority ethnic communities, and the use of the act to detain people with learning difficulties and autistic people, as well as improving the treatment of people with mental health issues within the criminal justice system. Among proposed changes are the introduction of new “advance choice documents”, which would allow people to express their wishes for their care when they are well, before they need to go into hospital. Another proposal is to allow individuals to choose a “nominated person” who is best placed to look after their interests under the act if they cannot do so themselves. Initial coverage of the white paper in the mainstream media – before it had been published, and based on the government’s press release – was overwhelmingly positive. But the Reforming the Mental Health Act white paper – which is now out for consultation until 21 April, and will eventually be followed by a new mental health bill – builds on recommendations made by Sir Simon Wessely’s independent review of the Mental Health Act in 2018. That review was criticised for falling “significantly short” of recommending full human rights for people in mental distress. Although disabled activists have not yet had time to analyse the white paper in depth, they are already raising similar concerns, while also welcoming aspects of the reforms. Dorothy Gould, co-founder of the new user-led, rights-based organisation Liberation*, said: “It is undoubtedly true that the MHA white paper is extensive and looks at a large number of much-needed improvements to the current act. “However, these improvements fall well short of the government’s claim that it is bringing the law ‘into the 21st century’. “It is also intensely worrying that Matt Hancock regards the Wessely review, on which the white paper is based, as ‘one of the finest pieces of work on the treatment of mental health that has been done anywhere in the world’. “It is devastating that, so far from drawing adequately on promising international developments elsewhere and the full human rights set out in the UN Convention on the Rights of Persons with Disabilities, the white paper repeats many major flaws in the Wessely review.” She said the white paper “retains a dominant medical model focus”, and added: “It aims to reduce, but not bring to an end, the fundamental breach of human rights represented by involuntary detention in psychiatric hospitals and forced treatment. “It has an inadequate focus on the full range of multiple discrimination that exists. We want so much more than this.” The grassroots, user-led mental health group Recovery in the Bin (RITB) was also critical in its initial response to the white paper. An RITB spokesperson said: “We welcome proposed changes in the MHA white paper such as a nominated person and increased right to advocacy, but it falls short of a social justice approach and as with the existing act, in the absence of funding and the continuing hostile environment of the DWP [Department for Work and Pensions] and wider systemic racism, the act is irrelevant to the actual conditions people have to endure.” POhWER, the UK’s largest advocacy charity, which was founded by disabled people in 1996 and has a majority of disabled people on its board, welcomed “some progress” in reforming the act, “particularly where it strengthens relationships, empowers individuals, further upholds human rights and builds dignity for people supported by public services or in government-run institutions”. But Helen Moulinos, its chief executive, said there were “still many concerns” about the proposed changes. Among its concerns are the need for better investigations and regulatory oversight for non-natural deaths in mental health settings; more work on discrimination in how the act is applied, such as the disproportionate use of the act’s powers of detention on black people; more clarity on funding for advocacy; more safeguards for patients being treated informally with their consent; and more thought given to the needs of people with learning difficulties and autistic people. Health and social care secretary Matt Hancock said: “I want to ensure our health service works for all, yet the Mental Health Act is now 40 years old. “We need to bring mental health laws into the 21st century. “These reforms will rightly see people not just as patients, but as individuals, with rights, preferences, and expertise, who are able to rely on a system which supports them and only intervenes proportionately, and which has their health and wellbeing as its centre. “This is a significant moment in how we support those with serious mental health issues, which will give people more autonomy over their care and will tackle disparities for all who access services, in particular for people from minority ethnic backgrounds.” *Liberation can be contacted via email at: Liberationrights@gmail.com
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Post by Admin on Jan 19, 2021 11:44:34 GMT
Mental Health Act Review Summary of Recommendationswww.nsun.org.uk/news/mental-health-act-review-summary-of-recommendationsHere is a summary of the main recommendations of the Independent Review of the Mental Health Act, our views on the recommendations and some of our work during the process. It has been important to have a review of the Mental Health Act 1983. We would also want to acknowledge that a considerable number of suggested improvements have been put forward in the report, including recommendations that: There should be four new principles, now enshrined in the Mental Health Act itself and at the heart of all action taken: ‘Choice and autonomy, least restriction, therapeutic benefit and the person as an individual’ People should be detained only if there is ‘substantial’ risk of harm to themselves/others and it is thought that effective treatment cannot be provided without detention. The current risk aversion culture should also be tackled More accessible and responsive mental health crisis services and community-based mental health services should be available to pre-empt detention and there should be increased scope for people to be admitted to hospital informally Advocacy should be more widely available. People should also be able to choose a ‘nominated person’ for themselves, in place of being allocated a ‘nearest relative’ Detained patients’ wishes about treatment should carry considerably more weight, in particular if they are clinically assessed as ‘capable’. ‘Advance choice documents’ such as advance directives should have a greatly increased standing There should be statutory care and treatment plans Ward environments and conditions should be improved significantly Community treatment orders should continue for the time being, but with tightened criteria. More should be done about inequalities for people from black, Asian and other minority ethnic (BAME) communities, children and young people, people in the criminal justice system and people with a learning difficulty/disability and/or autism Complaints systems should be improved and there should be increased access to tribunals. However, many user-led groups and individuals have expressed disappointment about the scope of the Review report. The recommendations fall far short of giving people with mental health diagnoses full human rights as set out in the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), still leave them without the same rights that other people have. For example, people will continue not to have the right to refuse detention, even if they are clinically assessed as having capacity, and, whilst they will have increased treatment choices, these can still be overruled. Thus ‘autonomy’ for mental health patients will not mean autonomy in the usually accepted sense of the word. There is a continuing reliance on capacity assessments, problematic though these have proved to be. In addition, there has been a failure to draw actively on the type of supported decision-making recommended under the UNCRPD to enable decisions by people who are clinically assessed as lacking capacity. The recommendation that the Mental Capacity Act should be used for people who are assessed as lacking capacity and not thought to be objecting to hospital admittance is a point of concern; The current Mental Capacity (Amendment) Bill appears to enshrine decreased, not increased rights. Whilst the report makes considerable mention of service user and carer involvement in the Review - and there clearly has been consultation and involvement - we are also aware that significant numbers of service users and carers have not been involve and/or have been given limited information or scope to express their views. It is far from evident that the Review recommendations adequately address concerns raised by people from marginalised communities, racialised groups, people with learning difficulties/disabilities and/or autism, children and young people and people in the criminal justice system. In addition, there is a very concerning lack of focus on people who face other forms of additional discrimination, related, for example, to gender/gender identity, sexual orientation, socio-economic status, other disability issues, older age, Deaf people, or people living with dementia. The report also fails to include recommendations about the need for a significant increase in user-led services, non-clinical options and culturally appropriate alternatives. Further reading on our concerns about and involvement in the review process are below. NSUN has further concerns about the Mental Health Act Review Help us lobby the Mental Health Act Review NSUN's key points about the interim report for the Mental Health Act review NSUN members to get involved in the Mental Health Act Review Survivor researchers influencing Mental Health Act Review Mental Health Act Review: lobby your MP NSUN unable to endorse the final Mental Health Act survey report Queen's Speech promises to reform mental health legislation Dorothy Gould, NSUN Lead on Mental Health Act Review Active links in Link
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Post by Admin on Jan 25, 2021 13:53:27 GMT
Mental Health Act overhaul will not tackle racial disparities without societal change, experts warnGovernment’s commitment on racial inequality welcome, but risks blindness to impact of racism on mental health outcomes, amid concerns that lack of community provision will blunt efforts to cut detentions under the act by Charlotte Carter on January 20, 2021 in Adults, Children www.communitycare.co.uk/2021/01/20/mental-health-act-overhaul-will-tackle-racial-disparities-without-societal-change-experts-warn/Proposals to reform the Mental Health Act to tackle racial disparity and lower rates of detention and community treatment orders among Black Asian and Minority Ethnic (BAME) groups will be futile without systemic, societal change, experts have warned. The long-awaited Mental Health Act (MHA) White Paper, published last week, pledged “decisive action” would be taken to cut disproportionate use of the act among certain groups. Black people are over four times more likely than white people to be detained under the act and over 10 times more likely to be subject to a community treatment order (CTO) – under which people are discharged from detention but placed under conditions on their lives and treatment. Part of this would be achieved by tightening conditions for people to be detained or subject to a CTO, while the paper also sets out plans to subject mental health trusts to a patient and carer race equality framework (PCREF) designed to improve their response to Black and ethnic minority communities and improve access to culturally appropriate advocacy. Scope for change limited without addressing ‘racist society’ But Hári Sewell, a social worker by background, former mental health trust director and now a consultant in mental health and equalities, said he was sceptical about the scope for change “while Black people are still living in a racist society”. “Think of the response to an impoverished community drinking contaminated water because there is no clean water supply, if you improve your treatments and service structures, the experience of crisis may be less problematic but the number of cases coming through will not significantly reduce,” he said. Furthermore, Sewell said the underlying principles of mental health meant that the focus on looking for signs and symptoms of an illness could lead to “inattentional blindness to the role of racism in people’s presentations”, exacerbated because many forms of racism were invisible to many in the profession. “Racism is thought of as racist attacks, poo through the letter-box-type racism rather than the weathering that occurs from living with constant stereotyping and negative images of self and othering, often under the guise of benevolent racism,” said Sewell, who is director of HS Consultancy. Race equality ‘left to the charity sector’ Professor Kamaldeep Bhui, director of Synergi Collaborative Centre, which studies ethnic inequalities in mental health, echoed Sewell’s concerns, and said that while the government’s commitment to tackling racial inequality was welcome, more work was needed to “really unpack, expose and remove drivers of race equality in care systems”. “[This] means tackling racism more generally and the legacy of heritage and life course adversity, all the pathways that lead to a detention decision not only the decision to detain alone,” said Bhui, a professor of psychiatry at Oxford University While examples of good practice existed, Bhui said these had been under-resourced and disbanded, “leaving race equality to the charity sector and on an ad-hoc basis”. While there was an opportunity to embed it in the NHS, this needed “a total revolution in training”. ‘Discrimination will change form’ with CTO targets The government proposes to reform CTOs so that they can only be used where there is a strong justification, they are reviewed more frequently and by more professionals, are time-limited (to two years unless the person has relapsed or deteriorated), and that people subject to them really need them to receive a genuine therapeutic benefit. Sewell warned that, while this would likely reduce numbers on CTOs and the proportion of Black and ethnic minority people placed on them, though perhaps only slightly in the latter case, “it is also more likely than not that the discrimination [will change form] will show up elsewhere”. “In future, if CTO data ‘improves’ we are likely to see higher proportions of detentions for people from BAME backgrounds and longer lengths of stay,” he added. Lack of alternatives to CTOs and detention Meanwhile, Bhui said that raising the threshold for people to be detained or placed on CTOs could only work if there were community-based alternatives; however, these were severely lacking due to service cuts over many years. “Proposing a change in threshold for detention (as a progressive response) to apply only in the face of more serious or significant risk of harm to self or others, and that there is benefit to the patient for recovery, assumes existing decisions are made with significant scope for alternatives. “At the moment there are few alternatives such as crisis houses, community supports, and a range of different levels of supported care, many community services have been reduced in size and capacity and focus on those with the most severe illnesses, and less is preventive at earlier stages of the pathways,” Bhui said. He urged the government to publish specific examples on applying the proposed and current thresholds for detention, adding: “Legislation alone will not lead to reduced detention, but a total systems culture change is needed with more investment in care systems and more opportunity for people to choose alternatives to support recovery, as long as people understand the risks and agree to them.” Reforms ‘subject to funding’ Steve Chamberlain, chair of the AMHP leads network, echoed Bhui’s concerns about the availability of community alternatives to detention and said “the most telling” paragraph in the White Paper was one which said its proposals would be “subject to future funding decisions”. “To provide more effective community support, better crisis responses and alternatives to admission, and also improve conditions for psychiatric inpatients, there needs to be more resources available and changing the law is not going to solve many of the issues which have developed and become more severe during the past ten years of austerity,” Chamberlain said. Bhui also questioned the evidence base for the patient and carer race equality framework (PCREF), which is currently being piloted in some mental health trusts. “As far as I’m aware the evidence that PCREF will work to reduce race disparity is lacking,” he added. “At the moment this title compels Trusts and organisations (along with an OCF) to measure, review, and implement processes to change the disparities. Again, this lacks any empirical evaluation or clear logic model, although the shift to an organisational and structural framework is important and welcome.” AMHP role expansion must be ‘adequately resourced’ The White Paper proposals would involve an increased workload for approved mental health professionals (AMHPs), particularly through more involvement in renewals of CTOs, and also moots a new role for AMHPs in managing transfers of people from prisons or immigration removal centres to hospitals. The impact assessment on the White Paper states that, by 2023-24, the full-time equivalent AMHP workforce would need to grow by 7% above current projections to take on their proposed responsibilities – and this excludes the suggested prison transfer role. AMHPs are already due to take on a new role later this year, assessing people receiving mental health crisis services who are in debt so they can gain access to a freeze on their debt repayments and any enforcement action for the duration of their treatment plus a month. Chamberlain said it was widely acknowledged that the AMHP workforce was considerably stretched across much of the country, with a 4% fall in numbers from 2018-19. In November 2019, the Department of Health and Social Care and other organisations issued an AMHP workforce plan to improve recruitment, retention and development, including by tackling salary disparities, workloads and stress, and developing national education and service standards for the role. Chamberlain said that, while these were welcome, any expansion of the role would need to be adequately resourced. “The White Paper helpfully states that adequate resources are needed in order to deliver some of these developments and their success will, without doubt, be dependent on those resources.”
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Post by Admin on Feb 1, 2021 16:15:49 GMT
Guidance Independent Human Rights Act ReviewThe Review will consider how the Human Rights Act is working in practice and whether any change is needed. www.gov.uk/guidance/independent-human-rights-act-reviewAbout the Independent Human Rights Act Review Her Majesty’s Government is committed to upholding the UK’s stature on human rights; the UK contribution to human rights law is immense and founded in the common law tradition. We will continue to champion human rights both at home and abroad. The Human Rights Act (HRA) has been in force for 20 years, it is timely to undertake a review into its operation. The UK’s constitutional framework has always evolved incrementally over time, and it will continue evolving. We need to make sure that our human rights framework, as with the rest of our legal framework, develops and is refined to ensure it continues to meet the needs of the society it serves. We are committed to remaining a signatory to the European Convention on Human Rights. The government is establishing an independent review to examine the framework of the HRA, how it is operating in practice and whether any change is required. Specifically, the review will look at two key themes, which are outlined in the Terms of Reference (ToR) as follows: the relationship between domestic courts and the European Court of Human Rights (ECtHR) the impact of the HRA on the relationship between the judiciary, the executive and the legislature The review will consider the approach taken by domestic courts to jurisprudence of the ECtHR, including how the duty to “take into account” jurisprudence has developed. It will consider whether the HRA strikes the correct balance between the roles of the courts, the Government and Parliament. Moreover, it will consider whether the current approach risks domestic courts being unduly drawn into questions of policy. The panel will then consider whether and if so, what reforms might be justified. As part of its work the review will also examine the circumstances in which the HRA applies to acts of public authorities taking place outside the territory of the UK, with consideration of the implications of the current position, and whether there is a case for change. The review is limited to consideration of the Human Rights Act, which is a protected enactment under the devolution settlements. The review will not consider the scope of the substantive rights scheduled to the Human Rights Act. Call for Evidence The Review has now launched a public Call for Evidence (PDF, 295KB, 12 pages), details on how to submit a response can be found in the linked document. The Call for Evidence closes on the 3 March 2021. Publication of submissions on this website does not imply the views contained therein are endorsed by the Independent Human Rights Act Review. The Independent Human Rights Act Review Panel reserves the right not to publish submissions on this website.It may decide not to publish submissions where it concludes their publication is likely to be abusive, defamatory, likely to incite the commission of an offence or otherwise potentially unlawful.
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Post by Admin on Feb 2, 2021 20:15:58 GMT
CRPD Consultation on Deinstitutionalization: A Reparations ApproachBy Tina Minkowitz, Esq.February 2, 2021 www.madinamerica.com/2021/02/crpd-reparations-approach/The Committee on the Rights of Persons with Disabilities has announced a series of regional consultations on deinstitutionalization, starting with one for Central Asia and Eastern Europe on February 25 and a second for Central and South America on March 1. The other regions will follow. You can read all the details in an information note here. This is an important opportunity for survivors of psychiatric oppression (if you are still alive and struggling as a current victim, I consider you a survivor, along with those who have gotten out) and our allies to make sure we are heard. Victim’s perspective or system’s perspective? Too often ‘deinstitutionalization’ has meant community-based mental health services, instead of freedom and acceptance, instead of recognition that we return from hell as survivors, that ‘survivor’ isn’t a euphemism. Deinstitutionalization initiatives tend to take a service-provider point of view, seeking to rearrange their own territory in response to criticism of severe and egregious abuses. We need instead to start from the perspective of victimized persons, acknowledging that the human rights violations go wide and deep, that they are systemic and cannot be rooted out unless we unseat the ‘service providers’ who have as a class been the perpetrators of these violations from directing repair. Similar to the approach of feminists who insist on the personhood of female human beings – autonomous, not the negation of males or their perspectives but something entirely different – we need to start as victims of psychiatric oppression, looking at our reality – as individuals as collectively in our countries, localities, communities – and naming both the violations and what we want as remedies. Of course our movement has been doing this since its beginnings, and we now have the excellent resource from our early days as a liberation movement, the archives of Madness Network News. (I urge everyone to read them, and mad artists to respond to the call for submissions for a new issue, as MNN as starting up again with the blessings of its original editors.) In the US we have the Principles of the 10th International Conference on Human Rights and Against Psychiatric Oppression as a reference; globally there are also the WNUSP Human Rights Position Paper, the WNUSP Kampala Declaration, the PANUSP (now PANPPD) Cape Town Declaration, the TCI-Asia Pacific Bali Declaration, and the Lima Declaration of the Redesfera Latinoamericana de Diversidad Psicosocial. We have the Convention on the Rights of Persons with Disabilities itself and the UN materials interpreting and applying that Convention, which have been developed with substantial input from the survivor (and mad, and persons with psychosocial disabilities) community. If you read my blog regularly you will be familiar with these resources, and with my writings on the topic; you can find links on the CHRUSP website. You will have your own experience and history as part of this movement, and the burning issues in your life and community to bring to the CRPD Committee’s consultation. Think big (but be concise… 520 word limit) The CRPD Committee is open to the totality of experiences that can be considered as forms of institutionalization, including ‘placement in… all mental health settings’ and ‘criminal forensic detention’, as indicated in the Information Note on the consultation, question (d): ‘What measures need to be adopted to end all forms of institutionalization in legislation and practice, including placement in small or large group homes or family-like settings, special schools, colonies for persons affected by leprosy, all mental health settings, religious or faith healing settings, criminal forensic detention, or any other places where persons with disabilities are deprived of their liberty?’ Question (e) also opens up a wide avenue for addressing the totality of discrimination against us and the barriers to ‘freely enjoying [the] right to live independently,’ as we experience them: ‘What measures need to be adopted to address the situation of specific groups, such as children with disabilities, young persons with disabilities, older persons with disabilities, persons requiring high levels of support, women with disabilities, persons with intellectual disabilities, persons with psychosocial disabilities or any group that is at a high risk of institutionalization, reinstitutionalization, isolation, and coercion? What needs to be done to eliminate discrimination against these groups in legislation and in practice, and to allow them to freely enjoy their right to live independently?’ The consultation addresses short-term as well as long-term support needs (including ‘crisis support’) and includes arbitrary detention, which can be short- or long-term, as one of the relevant human rights violations. The Information Note cites the Committee’s Guidelines on Article 14 (liberty and security of the person) along with its General Comment on Article 19 (living independently and being included in the community) as the norms that ground their work on deinstitutionalization, and asks question (f) on disability-related support and (g) on remedies and redress: ‘What kinds of disability-related support is required for the specific group you are part of, to meet long-term, periodic, and transitory requirements, including crisis support?’ ‘What kinds of remedies and redress should be available for persons with disabilities who have been institutionalized, and/or subjected to any form of arbitrary detention, forms of torture, other inhuman or degrading treatment or other coercive and harmful practices in connection with institutionalization?’ All of this opens the door to putting forward a comprehensive, holistic, survivor human rights agenda, including to discuss your view of what crisis support should be and whether it is a mental health service or something else. (Here is my short take on that question, one version of it in any case, and I am in process of finalizing a longer piece on crisis support based on CRPD Articles 12 and 19 – decision-making support and support to continue living independently and being included in the community.) One more important reference for thinking about deinstitutionalization from a survivor perspective is in the UN Basic Principles and Guidelines on Remedies and Procedures on the Right of Anyone Deprived of Their Liberty to Bring Proceedings Before a Court. Principle 20 and Guideline 20 address the absolute prohibition of detention based on actual or perceived psychosocial disability and other disability-related issues related to the right to liberty. Paragraph 107 (d) and (e) set out a possible approach to judicial remedies for individual and system-wide release from detention and forced treatment in mental health settings, which is victim-centered and responded to survivor input: ‘(d) Individuals who are currently detained in a psychiatric hospital or similar institution and/or subjected to forced treatment, or who may be so detained or forcibly treated in the future, must be informed about ways in which they may effectively and promptly secure their release, including injunctive relief; ‘(e) Injunctive relief should consist in an order requiring the facility to release the person immediately and/or to cease immediately any forced treatment and any systemic measures, such as those requiring mental health facilities to unlock their doors and to inform persons of their right to leave, and establishing a public authority to provide for access to housing, means of subsistence and other forms of economic and social support in order to facilitate de-institutionalization and the right to live independently and be included in the community. Such assistance programmes should not be centred on the provision of mental health services or treatment, but free or affordable community-based services, including alternatives that are free from medical diagnosis and interventions. Access to medications and assistance in withdrawing from medications should be made available for those who so decide.’ The standard developed by the Working Group on Arbitrary Detention is also referenced in the CRPD Guidelines on Article 14, which forms part of the normative background for the current consultation on deinstitutionalization. If you agree with it or think it can be adapted to your country or locality, you might mention that in your submission. Reparations as a framework for deinstitutionalization Some survivors, notably Hege Orefellen as well as myself (including in one of my blog posts here), have called for reparations as the way to comprehensively provide individual and collective remedies to survivors. ‘Reparations’ means the obligation of states (countries, governments) under international law to remedy serious human rights violations. This obligation has varied sources and was elaborated on in a set of Basic Principles and Guidelines adopted by the United Nations General Assembly in 2005. Our approach is grounded in international law and in the absolute prohibition of forced psychiatry; we address demands to the state and do not seek reconciliation between survivors and psychiatrists, unlike some initiatives that have been put forward in the past for a truth and reconciliation commission. In Hege’s intervention on this topic, she summarizes the different types of reparation measures – satisfaction, guarantees of non-repetition, restitution, ‘rehabilitation’ and compensation – and how they are relevant to survivors of psychiatry. That is a valuable reference that is concise and clear, for anyone wanting an orientation to focus their own advocacy. I have promoted the framework of reparations as an avenue for comprehensive change in law and policy to dismantle psychiatric oppression – a framework to look at all that is wrong, all that has violated our human rights as a matter of deliberate discrimination as well as cruel indifference (which I think mirror one another and always go together). From a reparations standpoint, we start out with the premise that forced psychiatry, all the commitment laws (inpatient and outpatient), guardianship and incapacity laws, categorical insanity defense, all the legislated inferiority and exclusion in areas from child custody to voting rights to employment and licensing (did you know that in Korea there are a huge number of professions and occupations from which psychiatrized people are excluded?) – that all these laws, all the ways that seemingly neutral discrimination hides discrimination or has a discriminatory effect, all the ways that laws said to benefit us channel us into subjugation (e.g. disability pensions that aren’t enough to afford housing so you have to live with abusive family or in de facto institutional ‘mental health’ housing programs) – all these and any other discriminatory policies and practices, violate our human rights. They are not merely a matter of bad practice or outdated approaches that have to be changed. A reparations framework says that people leaving institutions are owed something by the state because the state put them there or enabled the private actors who put them there. It reminds us that trauma, brain damage, poverty, dis-ablement and de-skilling, ways we survive unremitting violence and abuse (that don’t always look pretty or feel good), moral injury from what we have to do to ourselves for that survival – all this and more is harm done to us by the oppression and not a sign of ‘mental illness’ or ‘psychosocial disability’ for which services are required. Everyone – *everyone* – coming out of a psychiatric institution is traumatized; some of us also need and want support services related to madness, distress, unusual perceptions or beliefs; some of us want to receive those kinds of services from the mental health system (and some of those also question the mental health system and would rather find something better, or come to question it after hearing new ideas in the survivor movement). States shy away from reparations, though UN human rights mechanisms call for them in many contexts. To states, reparations mean primarily money – compensation, and formal acceptance of responsibility for having violated international law, which hurts their reputation and opens them to a whole set of demands they would rather not address. The victims of military sexual slavery by Japan in the Asia-Pacific War/World War II, known as ‘comfort women’, still have not won formal acknowledgement or compensation based on assumption of responsibility, though a Korean court has recently ruled that it is owed to them. I would like to see reparations as a way to shape the discussion of what ‘deinstitutionalization’ means, if ‘deinstitutionalization’ is of interest globally as a focus for the disability movement and UN human rights mechanisms. Compensation is an obligation in itself, but is also a way to think about economic assistance due to people leaving institutions – those who leave because they’ve been held against their will (arbitrary detention, arbitrary because all mental health detention is discriminatory and therefore arbitrary) and they exercise the right to leave, and also those who remain in institutions because they haven’t proactively exercised the right to leave but can be approached in a process of systemic elimination of institutions, to support them to express their needs and wishes for how they want to live. Some survivors have reframed ‘disability pensions’ for themselves as compensation for the trauma and disablement caused by institutionalization; that’s a fair point. Policies on eligibility for disability pensions should be reviewed to ensure that no one is required to demonstrate their abject inability or use psychiatric services, or other mental health services, as a formal or informal component of an evaluation if the disability claimed is trauma, mental health condition, psychosocial disability. That is one example of how a reparations framework can be applied to deinstitutionalization. We can do this explicitly, invoking that framework and the obligations imposed on states, which the CRPD Committee has invited us to do (it is mentioned in the Guidelines on Article 14 also). Although we can also do it implicitly, thinking out for ourselves, what does restitution mean for us? What does satisfaction mean? etc. – the consultation represents an opportunity to make the linkage explicit as a part of states’ obligations under the CRPD in particular. The CRPD Committee’s Information Note refers to reparations as due to individuals, but there are collective dimensions, particularly satisfaction and guarantees of non-repetition. The interplay between individual and collective is addressed implicitly in the paragraphs from the Working Group on Arbitrary Detention quoted above. Individuals need to be released from being held involuntarily in a mental health setting, and they need to be guaranteed that it will not happen to them again. This guarantee could be given to the particular individual through a court judgment or settlement, but in fact it is a systemic, usually de jure human rights violation (one that the law itself has enshrined in practice), and the solution has to be systemic, so that every individual gets the benefit of it and isn’t forced to go to court to seek redress personally, which is out of reach practically for most people (for economic reasons, because of scarcity of willing and competent lawyers, because it’s a huge effort to bring a case pro se, etc.). I would therefore argue that the collective dimension of reparations is required in order to comply with the CRPD with respect to each individual whose rights are violated. The laws have to be repealed or otherwise nullified, and each person has to be released (restored to their liberty, having their legal capacity restored); economic and social assistance to re-establish themselves in the community can also be understood as restitution – if their former dwelling is no longer available (e.g. they were evicted or it was an abusive situation), they need a replacement that is of a decent standard. This needs to be made available proactively to each individual, without requiring them to make individual applications to a court – i.e. redress and remedies cannot be subordinated to the concept of ‘access to justice’ in the procedural sense. Collective measures require input from the collective as a whole, so that all victims of institutionalization have the opportunity to contribute their vision. This is congruent with the obligation under Article 4.3 to closely consult and actively involve persons with disabilities, including children with disabilities, through their representative organizations, in all matters relating to them including implementation of the Convention (see General Comment No. 7 for further elaboration). A reparations approach starts from the premise that institutionalization, arbitrary detention and forced treatment (including coerced voluntaries, anything other than *free* and *informed* consent *by the person concerned*) are human rights violations and that the population to be consulted on remedies are those who have been victimized. This might help to shift the discussion away from ‘human rights in mental health’ approaches to policy-setting that start from the contrary premise that mental health services need to be transformed, i.e. that the services are necessary and held as a constant. In a human rights reparations framework, the victims’ needs as they articulate them should be held as the constant, giving space to diverse points of view about the role or non-role of mental health services. I hope that this approach may resonate with some of you reading, and that you will put all your passion and intelligence into a submission to the CRPD Committee that helps to create the collective vision that they are seeking, to inform a set of guidelines on deinstitutionalization that will be relevant to survivors of psychiatric oppression. *** Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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Post by Admin on Feb 18, 2021 22:56:30 GMT
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Post by Admin on Feb 19, 2021 10:47:06 GMT
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Post by Admin on Mar 18, 2021 12:56:09 GMT
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Post by Admin on Apr 26, 2021 14:04:54 GMT
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