AAfter years of work involving hundreds of people in dozens of countries, the World Health Organization (WHO) and the Office of the High Commissioner for Human Rights (OHCHR) of the United Nations have released their joint production , Mental Health, Human Rights and Legislation: Guidance and Practice (WHO / OHCHR, 2023, called the Guide. The launch event schedule is here , and the full video here ).
This outlines in considerable detail the current international legislative framework with which mental health acts in signatory nations must conform, and provides examples to demonstrate how each element of the law can be implemented and tested.
Currently, the foundation of international law is the Convention on the Rights of Persons with Disabilities (CRPD, 2006), to which Australia is a signatory. A full list can be seen in Box 9, p124, together with the four HRC resolutions and three special rapporteurs whose responsibilities cover the field of mental disorder. In one sentence, the CRPD states that no one shall suffer any form of discrimination, loss of liberty or violation of rights by virtue of a disability, including mental disorders. There is no room to break in it.
Chapter 1 of the Guide, “Rethinking Legislation on Mental Health”, defines mental health, locating its preconditions in the physical and social environment of the individual. In practice, however, this broad definition attracts little more than lip service. Worldwide, mental health receives about 2.1% of government health spending, the majority of which is spent on institutions and physical care: “… the biomedical model, which focuses mainly on diagnosis, medication and symptom reduction, prevails in all existing mental health systems. As a result, the social determinants that impact people’s mental health are often ignored…”Guide, p. 10).
In the introduction to the launch, the MC listed what he called three major mistakes that current national laws make regarding mental health: the emphasis on detention and involuntary treatment; the overreliance in the biomedical model; and the failure to involve people with mental disorders in the decision making of their management. They are “wrong” because each is explicitly prohibited by the CRPD or betrays a serious misunderstanding of the nature of mental disorder. Thus, as these characteristics more or less define modern psychiatric practice, it is clear that the international human rights community and institutional psychiatry are on a collision course.
S4. of the Introduction asks: “Why is the Guide important?” and looks at a number of reasons, reaching some quite blistering conclusions:
- “A fundamental change is needed in the field of mental health … There is an over-reliance on biomedical approaches to treatment options, care services and inpatients, and little attention given to the determinants social and community-based, person-centered interventions…”
- “Most mental health legislation fails to embrace a rights-based approach. Many people … are not treated equally before and under the law, and are often discriminated against … legislation can be paternalistic … (People) are generally considered incapable of making decisions … there is no adequate mechanism to prevent, detect or remedy these and other human rights violations” (i.e. standard mental hospital procedures they inevitably violate human rights).
- “The international human rights framework requires a transformation in the way mental health services are provided. All people should be able to exercise their right to give free and informed consent to accept or refuse treatment in the systems of mental health. Denial of legal capacity, coercive practices and institutionalization must end.”
- “Legislation can … promote a cultural change that promotes social transformation in the realm of mental health … away from a narrow emphasis on biomedical approaches towards a more holistic and inclusive understanding of mental health.. “
In other words, psychiatry got it all wrong. How wrong? With the benevolent aim of publicizing this important document, I sent an email to the editors of Australian and New Zealand Journal of Psychiatry to see if they accept a document on the Guidelines as a “Viewpoint”. According to their website, “Point of view articles are longer pieces (3000 words) that allow personal perspectives and opinions on issues relevant to psychiatry practice and research. They will offer new insights, demonstrate academic rigor and be of interest to the journal’s readers. Author: At the invitation of the Editor (who can be contacted with an article proposal). Forty-five minutes later, they returned their answer: No thanks. It’s okay, I don’t think you’re doing anything out of place. But back to the Guide.
Chapter 1 describes the state of mental health legislation and gives relevant international agreements relating to health and disability. It begins with the definition: “Mental health is a state of physical, mental, emotional and social well-being, determined by the interaction of the individual with society…” Already, Chapter 1 page 1, we see the sides that form for a cosmic brawl. Is mental disorder a genetic disorder of brain function, or is it not? You can’t have it both ways, even if, with their spurious biopsychosocial model and their eclectic psychiatry, they tried. U Guide continues:
Different ways of being, thinking, feeling, expressing and making sense of the world are part of human diversity: there is no “normal” or “right” way to be. A failure to understand and respect these differences can lead to isolation and discrimination (p. 9).
This is a direct challenge to psychiatry’s insatiable drive to medicalize the slightest deviation from “normal,” for example, the relentless drive to diagnose ADHD. Then they take up the problem of coercion and the loss of freedom of choice, which are part of the fabric of psychiatry: “… mental health laws continue to assume the underlying correctness of coercive practices, which are considered as ‘is a legitimate form of ‘patient’ management ‘…’ (p. 12). Solitary confinement, restraint and cuddling are mentioned, particularly in relation to minority and marginalized sub-communities who ‘… they are often denied the few protections that mental health legislation can provide.” Box 2, p. 15, states “The case against coercion.”
Box 3, p. 19, lists “CRPD provisions for a rights-based approach to mental health”, including legal capacity, liberty and security of the person, free and informed consent, independent living, inclusion in the community and access to justice. Manifestly, these rights, established by treaty, are routinely violated by psychiatry. In fact, current psychiatric practice is the polar opposite of these principles.
All these sins are placed before the plinth of what they call the “biomedical model”, which, for years, I have said does not exist. It is defined in the Glossary, p. xiii:
The biomedical model of mental health is based on the concept of mental health conditions caused by neurobiological factors. As a result, care often focuses on diagnosis, medication and reduction of symptoms, rather than considering the full range of social and environmental factors (and) cannot address the causes of distress and trauma.
Despite its central role as the source of all bad things in psychiatry, there is only one reference to this fabulous entity, to a document by Brett Deacon from 2013. Soon, I found my copy and found it again in case I missed something: No, I was right. There is nothing in that document that says such a model actually exists. It remains the case that no psychiatrist, or neuroscientist, or philosopher, or psychologist, has ever written anything that could be a reduced model of mental disorder. Of course, there are many people who believe that all mental disorder is a biological disease of the brain (see Deacon’s paper above and mine here for lists of quotes) but believing is not the same as proving. They may believe, but, if the philosopher Daniel Stoljar is right (and he usually is), lose his breath: there will never be a physical account of mental disorder.
In the shadow place “biomedical model”, the Guide proposes a human-centered, rights-based, community-based and accountable psychiatry. The other two chapters are a detailed detailed exposition of how mental health acts should be drafted and tested for compliance with the CRPD and the other eight relevant treaties to achieve this broad goal.
This impressive publication inevitably leads to two conclusions:
- Psychiatry systematically breaks practically every internationally sanctioned human rights law and treaty, without scientific mandate; and
- Apart from psychiatrists, the world is moving away from the idea that, when it comes to the mentally disturbed, the forms and standards of management of a hundred years ago are good.
This is the dilemma: according to the preeminent bodies of health and rights in the world, psychiatry has to change. How many? This is: “The denial of legal capacity, coercive practices and institutionalization must end.” So far, no one has told the psychiatrists and, as my little exchange with the editors showed, they are not particularly interested. However, knowing the psychiatrists, they will fight tooth and nail to resist the change, and so the irresistible force meets the immovable object.
The goal of psychiatry, as we know all too well, is to medicalize anything they can get their pudgy hands on. Anyone who doesn’t like this is obviously “anti-psychiatry” (not to mention dangerous, prejudiced, extremist and a tool of the scientologists). While the UN bodies will do the right thing, consulting widely and slowly building their case, we know that at the slightest hint of a threat, the psychiatry/drug company axis will run to their friends in government to drop a very large hammer. on beginners.
There is no doubt that mainstream psychiatry in the world will have a collective shape when they see what the non-psychiatrists have planned for them. There is also no doubt that moving to the model of practice provided for in the Guide it will require an upsetting change in psychiatry. To begin with, any national training program would have to be rewritten in its entirety, but the greatest resistance comes from the attitudes and belief systems of the establishment. Change of this nature will take years and years to implement. In fact, many of the old equipment could not be adjusted and had to be left at the old people’s home.
But we can be sure of one thing: given his record, institutional psychiatry will not give in with good grace. I mean, look at newspaper editors: they don’t even want to know that WHO or OHCHR exist. They do not understand that the Guide, as issued recently, is a gun pointed at the collective head of psychiatry. It is not an encouraging start.
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