Involuntary mental health treatment ``torture'', says top human rights lawyer
10 Jun 09 @ 07:00am by Brigid O'Connell
Human rights lawyer Tina Minkowitz stayed in Eltham last week.
IF someone decides not to have chemotherapy in Victoria; that's their choice.
If they want to opt out of an organ transplant, or forego taking daily insulin injections; people have that right.
But if you have a mental illness in this state and you refuse treatment, you will most likely be treated against your will.
This emotional and ethically fraught debate of whether someone with a mental illness has the insight to rationally refuse treatment, is bread and butter for Tina Minkowitz.
As one the world's leading human rights lawyers in the area of mental health and disability, she tackled these issues during her visit to Melbourne last week - where she stayed in Eltham - as guest speaker at the Australian Federation of Disability Organisations' conference.
The New York resident, is also the co-chair of the World Network of Users and Survivors of Psychiatry; a movement that sees involuntary mental health treatment as paramount to torture.
And her visit is timely given that Victoria is undergoing the first comprehensive review for more than two decades of its Mental Health Act - the laws surrounding the involuntary treatment of the state's most unwell.
Harmful, not helpful
Ms Minkowitz, who played a key role in the drafting of the UN Convention on the Rights of Persons with Disabilities, said often the best intentions from medical professionals were often actually more traumatic than therapeutic.
"What does it mean to say somebody needs help? Because I don't think it helps to put somebody in a locked ward," she said.
"Often the person is put in handcuffs or in an ambulance, sometimes your clothes are taken away and you have to put on a hospital gown or a nightgown.
"And then you're put behind a locked door, you're almost certainly going to be forced to take drugs."
She said the key to making human rights the focus of the mental health system was to move away from psychiatric medication as core of the system. "I think that needs to be turned on its head.
"The central piece needs to be engaging with people on a human level, seeing if there are conflicts or issues with their family or community and have psychotherapy available among other alternatives."
Learning to listen
Coersive treatment, no matter what the intension, should never be allowed no matter what the situation Ms Minkowitz said.
``An example where harm reduction is never coercive is domestic violence.
``It might be really painful to hear the sounds of your friend or neighbourher getting beaten up by her abusive spouse, but it doesn't give me the right to get her out of there against her will and put her somewhere I think she'd be safer.
``That's something the women's movement addressed; you don't do that.
``How do you deal with a friend in that situation? You talk to her, you make opinions available to her, you let her know that it's not ok, you train the police so they can respond in a useful way.
``You don't see the person as the problem, to be done things to. You don't see her as incapable and I think in mental health the opposite is true.
``The assumption is because this person is going through this intensive, emotional, psychic state that they're incapable of making any decision about where they want to go or what kind of help they need, and that's just not true.''
Legislating consent
Ms Minkowitz's drive to lobby for improving the human rights for those with a mental illness, was ignited from what she heard during menal health review hearings in Brooklyn, New York.
``What I found was that in New York people have a right to refuse drugs unless they're deemed to lack the capacity to make a rational decision. So just the fact that you're an involuntary patient didn't mean they'll force drug you on an involuntary basis.
``When that came out people in the movement thought that's great. Of course I have the capacity to make a rational decision, we said. I know those drugs are poison, I know how bad they are, I'm making a very rational decision to refuse.
``But that's not how the courts were seeing it.
``That was the main thing that struck me when doing these observations; sometimes a psychiatrist would make a mere observation that these people lacked the capacity to refuse treatment. A lot of times they used the word ''paranoia'' to categories the person's refusal of treatment.
``The judge would say "order granted", meaning their psychiatrist could go ahead and force them to take it.
``We may have the fight in theory, but in reality it's useless to protect us because it's so easy for them to say if you've got a mental illness, of course you lack the capacity to make a decision.''
''New era''
But with the convention ratified, and activists like Ms Minkowitz now monitoring its implementation, she said the system was entering "a new era" in dealing with mental health issues from a human rights perspective.
``I think there was a previous point in which people were starting to understand that you had to apply some human rights principals to the mental health system, that it couldn't just go on unreined and unregulated, allowing doctors to do coercive treatments, allowing people to be locked up for long periods of time without any kind of oversight,'' she said.
``But it was still assumed that these coercive practices were legitimate, and that basically human rights meant you had to regulate them and limit the power to doctors, but not take it away entirely.
``Now - and it's associated with the Convention on the Rights of People with a Disability - what this convention comes out of is about 30 years of development from the survivors of psychiatry, that the primary demand of that movement has been to get rid of the coercion and seeing forced treatment as something violent, a form of assault or torture.
``People are seeing that there's the possibility of a new way to look at 'madness'.
"It's up to people in Australia to decide what they think is a useful strategy and lobbying for that to happen. Maybe implementing goals for reducing forced druggings, electro-convulsive therapy, and the use of seclusion and restraint might be an interesting way to go in this country."
fyi.
----- Original Message -----
From: David Webb
To: David Webb
Sent: Wednesday, June 10, 2009 7:12 AM
Subject: Tina Minkowitz in The Leader
Hi all,
Here's the link to the article on Tina in today's Diamond Valley Leader:
http://diamond-valley-leader.whereilive.com.au/news/story/top-human-rights-lawyer-wants-mental-health-system-turned-on-its-head/
Ya gotta love the headline ... speaks truth to power, eh ...
Cheers - David
PS Please circulate
________________End of message________________
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