Memorandum submitted by the European Network
of (ex) Users and Survivors of Psychiatry [ENUSP][13]
ENUSP welcomes the Joint Committee's review
of the UK's progress toward ratification and implementation of
the UN Convention on the Rights of Persons with Disabilities.
This paper seeks to clarify our priorities and
concerns in relation to the equal enjoyment of human rights for
our constituency remains at significant risk. Our aim, in the
remainder of this brief paper, is to outline our justification
for this claim.
1. We believe that the report of Manfred Nowak,
Special Rapporteur of the Human Rights Council on torture and
other cruel, inhuman or degrading treatment or punishment[14]
published in July 2008 is particularly relevant. Mr Nowak's Report
emphasises that human rights law and conventions have traditionally
failed to address special concerns of people with disabilities
or the subgroup with mental "disabilities" or mental
"illnesses".
2. Some instruments have addressed the specific
provisions needed to address the rights of groups likely to be
vulnerable to discrimination and abuse; for example, the 1993
Vienna Declaration[15],
affirmed that people with mental and physical disabilities are
entitled to the full protection of international human rights
instruments, and that governments must establish domestic legislation
rights and fundamental freedoms are universal and this unreservedly
include people with disabilities.
3. The United Nations Convention Against Torture
and Other Cruel, Inhuman, or Degrading Treatment or Punishment[16]
is an international human rights instrument intended to prevent
torture and other similar activities and, as the Nowak report,
referred to above, makes abundantly clear, is entirely relevant
to disabled people.
4. Article 3 of the European Convention on
Human Rights contends that: "No one shall be subject
to torture or to cruel, inhuman or degrading treatment or punishment".
ENUSP—in common with other regional organisations of (ex)
Users and Survivors of Psychiatry—contend that coercive
psychiatric interventions must be classified under this heading.
5. Manfred Nowak's report in July 08 to the UN
General Assembly includes these comments which apply to people
with mental health problems— in the UK as elsewhere in the
world.
Persons with disabilities are exposed to medical
experimentation and irreversible medical treatments without their
consent (eg sterilization, abortion, and interventions aiming
to correct or alleviate a disability, such as electroshock treatment
and mind-altering drugs including neuroleptics.
The Special Rapporteur is concerned that inmany
cases such practices, when perpetrated against persons with disabilities,
remain invisible or are being justified and are not recognized
as torture or other cruel, inhuman or degrading treatment or punishment.
The recent entry into force of the Convention on the Rights of
Persons with Disabilities provides a timely opportunity to review
the anti-torture framework in relation to persons with disabilities.
6. The Special Rapporteur notes that in relation
to persons with disabilities, the Convention on the Rights
of Persons with Disabilities complements other human rights
instruments on the prohibition of torture and ill-treatment. For
instance, Article 3 of the Convention proclaims the principle
of respect for the individual autonomy of persons with disabilities
and the freedom to make our own choices.
7. Further, Article 12 recognises our equal right
to enjoy legal capacity in all areas of life, such as deciding
where to live and whether to accept medical treatment. In addition,
Article 25 recognises that medical care of persons with disabilities
must be based on their free and informed consent. Thus the Special
Rapporteur notes that the acceptance of involuntary treatment
and involuntary confinement runs counter to the provisions of
the Convention of the Rights of Persons with Disabilities.
8. The experience of our constituency confirms
that, inside institutions—as well as in the context of forced
outpatient treatment—psychiatric medication, including neuroleptics
and other mind-altering drugs, may be administered to persons
with mental disabilities without their free and informed consent
or against their will under coercion, or as a form of punishment.
9. The administration in detention and psychiatric
institutions of drugs, including neuroleptics, that cause trembling,
shivering and contractions and make the subject apathetic and
dull his or her intelligence has been recognised as a form of
torture. The Special Rapporteur notes that forced and non-consensual
administration of psychiatric drugs, and in particular of neuroleptics,
for the treatment of a mental condition needs to be closely monitored.
Depending on the circumstances of the case, the suffering inflicted
and the effects upon the individuals health may constitute a form
of torture or ill-tratment.
10. Against a background of endemic reports of
indignities, neglect, violence and abuse perpetrated against persons
with disabilities, the recognition of these practices for what
they are: torture and ill-treatment, and the utilisation of the
international anti-torture framework, will afford avenues for
legal protection and redress.[17]
ENUSP requests the Joint Committee notes—and
affirms—that:
— Coercion is not medicine.
— Coercive psychiatric interventions
cannot be a legitimate medical practice.
— Treatment can be given not only without
consent, but against the will of the person concerned, in contrast
to all other medical "treatment".
— Some attempts have been made in recent
years to extend free and informed consent to the mental health
context. However, law and custom is still based on the days of
the asylum when patients had no power to refuse.
— People in psychological distress
and anguish seek healing and alleviation of pain. Many do find
psychiatric medications provide relief or a way to manage disabling
thoughts and feelings. However, psychiatric interventions with
these same medications against a person's will are not justified
as a medical practice.
— Forcible interventions should be
understood as a profound violation of the physical and mental
integrity of any person, performed for the purpose of changing
the individual's personality;
— Coercion necessarily involved both
injury and distress.
— We would question whether forced
treatment can correctly be construed as medical help, when it
appears to be no more than social control.
— Coercion in psychiatry changes the
role of the doctor, who is not free to focus on serving the expressed
needs of the patient, but has taken on a duty to third parties
[usually the State] to control the patient.
— Coercion in psychiatry is still widespread
and hundreds of thousands of European citizens are deprived of
their legal capacity so as to authorise medical treatment against
the will of the individual concerned.
— In almost all countries, the legal
assumption is that treatment is and unquestionable good, and that
people diagnosed must be compelled to accept it.
— In incorporating the European Convention
on Human Rights into British Law, the Human Rights Act perpetuates—rather
than challenges—the lesser regard for the autonomy of patients
with mental illness. (Szmukler & Holloway, 2000).
— Bindman et al [2003] (a group of
British psychiatrists) argue that despite the Act, patients' capacity
to make treatment decisions is still essentially ignored:
"When persons are admitted in a general
hospital for any other problems—stroke, cancer, broken hip,
x rays, tests—these persons wouldn't dream of allowing the
doctors, nurses, or nursing aides to lock them up, shock them,
tie them up or drug them, and the staff wouldn't do it to them.
Those patients are treated with compassion, caring, respect, and
dignity, and persons who have serious emotional/mental problems
need to be treated the same."
— It is social attitudes, not lack
of treatment, that have been shown over and again to be the main
barrier to social inclusion for many people diagnosed and treated
as mentally ill.
— It is our clear understanding that
States that ratify or accede to the UN Convention on Rights for
People with Disabilities necessarily undertake to enact laws and
other measures to improve disability rights and to repeal legislation
and change customs and practices that discriminate against disabled
people.
— The underlying foundation of the
Convention is, self evidently, the principle that welfare and
charity should be replaced by the equal enjoyment of rights and
freedoms.
24 October 2008
13 www.enusp.org Back
14
UN General Assembly 28.08.08, 63rd Session, Item 67(a) Back
15
World Conference on Human Rights Back
16
http://www.unhchr.ch/html/menu3/b/h_cat39.htm Back
17
Subject, of course, to the UK's ratification of the Optional Protocol
to the UN Convention on the Rights of Persons with Disabilities. Back
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