David,
I have forwarded your response (below) re the medicalisation of psychsocial disability from another forum for the enlightenment of members of this list.
It seems to me that some here may feel it's safer to lock them away to protect society than to allow people not to choose treatment.
Your challenge to the Status Quo to show the scientific evidence that any of the major psychiatric disorders is a biological, medical illness of the brain and our unconcern at the lack of response is a great example of how deeply rooted our acceptance of the medical model is in psychosocial disability.
Regards,
Frank
----- Original Message -----
From: David Webb
Sent: Tuesday, November 16, 2010 6:15 PM
Subject: Re: VEOHRC: Conversation about the mental health bill - exposure draft
Hi Everyone,
First of all, I hope the little time we have on the agenda for this topic on Friday is not wasted arguing the validity of psychiatric diagnosis. The issue is a proposed new Mental Health Act that severely limits the rights of people with psychosocial disability. We had an excellent meeting at the Commission last week where we stayed focused on the rights issues in this new Draft Bill, which were the issues in my original message of this now rather long thread/conversation. With that said, my brief answers to your question, follow ...
On 15 November 2010 23:31, wrote:
David,
many congratulations on the launch of your new book and I hope I'll have the opportunity to read it.
Thanks, the launch was great.
What is your recommendation on how to respond to someone in a severe mental health crisis , such as suicidal behaviour or a pyschotic episode.
Big question, no single answer - other than to stop diagnosing them with a medical condition. If you're really interested, here's a few of references that will get you started.
A) Suicide
1) The Aeschi Group, who I regard as the only creative and critical in mainstream suicidology. Lots of info at:
http://www.aeschiconference.unibe.ch/ ... you need to click on the Klee painting to enter
2) The Maytree Sinctuary for the Suicidal (UK) - I've not visited but it looks great and I've good things about it from people I know in the UK
http://www.maytree.org.uk/
B) Psychosis - not part of my story, nor of my research, but there's some excellent books:
1) "Alternative Beyond Psychiatry", Peter Lehmann and Peter Stastny
http://www.peter-lehmann-publishing.com/
2) "Unshrinking Psychosis", (Melbourne's very own) John Watkins
http://www.michelleandersonpublishing.com/general_health.html
3) "Madness Explained" and "Doctoring the Mind", Richard Bentall
http://www.amazon.co.uk/Richard-P.-Bentall/e/B001HNK00O/ref=ntt_athr_dp_pel_1
Should they still be seen by a Crisis assessment and treatment team?
The CAT teams have such a bad name (it appears I'm one of very few people who had a good CATT experience) - you know the joke is that they're known on the street as the Can't Attend Today Teams. So, with another name, of course I think we need properly trained people who can respond to people in crisis - where and when it is needed - but not to call the cops to drag us off to the psych wards. There are examples elsewhere in the world, in particular I've heard really good things about the "Personal Ombudsman" scheme in Sweden, which is actually an exemplar of the supported decision-making model of the CRPD - rather than the substituted decision-making model of our CAT Teams. You can read about the POs in the Lehman and Stastny book above.
Should they be detained in some kind of safe place , but not a psychiatric facility?
I repeat - if suicidal people (and only suicidal people, no-one else) are to be detained then it MUST be to a safe place. For me this is a "Duh!" observation - except the exact opposite is the reality in Australia today. Our psych wards are inherently and intrinsically unsafe spaces. Maytree (above) is one possible example, or perhaps a model or prototype of what's needed.
How long should they stay and if they are not better after the acute episode, what length of "grace" period, before some kind of treatment intervention is made?
Have you not heard me? NO "treatment" intervention should be made EVER without full, free and informed consent. With consent, a person can take whatever medical treatments they want. So I don't know what your "grace period" refers to. Unless it's the case where if detention is to be allowed - and only for suicidality, not psychosis!!! - what is the maximum time that a person can be detained? Yes, an extremely important question as an essential safeguard and protection of our right to liberty. I don't know but I'd say a max of, say, one week. Yes, even if people like you and Patrick McGorry and Jeff Kennett (etc etc) judge them to be "not better after the acute episode", which is you medicalising it again.
If the person is not detained in a psychiatric facility, where else should they be detained and who would be responsible for their care?
Answered (partially) above ... i.e. as best we can at the moment because there's a lot of work to be done to develop genuine supported decision-making alternatives to the current status quo that relies on force ... i.e. a radical re-training of the mental health workforce, for instance, plus etc etc and etc ...
Is there a clear definition of psychosocial disability? Is it only a temporary impaiment, not a long term chronic illness?
Suzanne, please stop calling my disability "impairment" and "illness", which I find really offensive. No, there's not a clear definition of psychosocial disability. First, there's not a clear definition of disability, which the CRPD correctly says has an "evolving definition". There is the ICF from the WHO, which many people use as a definition (including the Aust government - sometimes). But many people with disabilities are not happy with the ICF, primarily because it still puts a medical "impairment" at the centre of the definition - many deaf or blind people, for instance, especially those who have been since birth, take offence at their deafness or blindness being called a (medical) impairment. And for us in psych, we too find it offensive and regard a psychiatric diagnosis as an imputed or alleged impairment (by the medicos), which should be placed in the ICF as a social factor that discriminates against people with psychosocial disabilities. The debate continues ... all around the world ...
I still disagree with you on the causes and treatments, but I'd like to know more about what are the alternatives if involuntary treatment is not used?
I think I asked you previously to stop talking about (medical) causes and treatments without putting some scientific evidence on the table to support what you are saying. In 2003, several MindFreedom members in the US went on a hunger strike with just one demand - for the American Psychiatric Association (APA) to put on the public record the scientific evidence that any of the major psychiatric disorders is a biological, medical illness of the brain. The APA failed spectacularly and we are all still waiting for this evidence. Meanwhile, in contrast, the scientific evidence that madness is NOT a medical illness is now overwhelming. So I ask you to please stop peddling unsubstantiated, unscientific medical propaganda that discriminates against people with psychosocial disability and cause so much harm and suffering. Put the evidence for your beliefs on the table, or be silent please. To read about the MindFreedom hunger strike, please visit:
http://www.mindfreedom.org/kb/act/2003/mf-hunger-strike
Finally, and this relates directly to the Draft Bill we'll be talking about on Friday (and the Human Rights Charter), I ask you to state your justification for involuntary treatment. With the Charter, I no longer have to argue for my right to refuse unwanted medical treatment, which is a right now explicitly protected by law in the Charter (Section 10). The Charter also makes it very clear (Section 7) that any limitation of this right is only permitted if it can be "demonstrably justified in a free and democratic society". So ... I don't have to justify my rights ... rather, people like you who wish to limit them are obliged BY LAW to justify these limitations, otherwise it's not permitted. The review of the Mental Health Act started over two years ago but we still have not had one word of justification for the rights that are being limited in this Draft Bill. So please, PLEASE, give me your reasons for supporting involuntary treatment. Let's have the debate, as the Charter insists. But the onus is on YOU to justify involuntary treatment, not me to defend my right to refuse it.
See you Friday - David
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