aAfter work involving hundreds of people in dozens of countries, the World Health Organization (WHO) and the Office of the United Nations High Commissioner for Human Rights (OHCHR) released their joint production, Mental health, human rights and the law. guidance and practice (WHO/OHCHR, 2023, cited as Guidance. The agenda for the launch event is here and the full video is here).
This outlines in considerable detail the current international legal framework to which mental health acts in signatory countries must comply, and provides examples to show how each element of the law can be applied and tested.
Currently, the basis of international law is the Convention on the Rights of Persons with Disabilities (CRPD, 2006), to which Australia is a signatory. The full list is presented in box 9, page 124, together with the four UN resolutions and the three special rapporteurs whose responsibilities cover the field of mental disorders. In one sentence, the CRPD states that no person shall be subjected to any form of discrimination, loss of freedoms or violation of rights on account of a disability, including mental disorders. There is no flexibility in this.
1st chapter of Guidance, “Mental Health Legislation Review,” defines mental health by locating its antecedents in an individual’s physical and social environment. In practice, however, this broad definition pays more than lip service. Globally, mental health accounts for about 2.1% of public health spending, most of which is spent on institutions and physical care; systems. As a result, the social determinants that influence people’s mental health are often overlooked…” (Guidancepage 10).
In presenting the launch, MC listed three main mistakes that current national mental health laws make: overreliance on the biomedical model; and failure to involve people with mental disorders in their management decisions. They are “mistakes” because each is expressly prohibited by the CRPD or indicates a serious misunderstanding of the nature of mental disorder. Thus, since these features more or less define contemporary psychiatric practice, it is clear that the international human rights community and institutional psychiatry are on a collision course.
S4. In the introduction he asks: “Why Guidance important? and observes a number of reasons, arriving at rather noisy conclusions;
- “A fundamental shift in mental health is required… There is an over-reliance on treatment options, inpatient services and biomedical approaches to care, and little attention to social determinants and community-based, person-centred interventions…”.
- “Most mental health legislation does not take 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 usually considered incapable of making decisions … there are no adequate mechanisms to prevent, discover or remove these and other human rights. violations” (ie standard psychiatric hospital procedures inevitably violate human rights).
- “The international human rights framework requires a transformation of the way mental health services are delivered. All persons should be able to exercise their right to give free and informed consent to accept or refuse treatment in mental health systems. Denial of legal capacity, coercive practices and institutionalization must end.”
- “Legislation can … promote a cultural shift that fosters social transformation in mental health … away from a narrow emphasis on biomedical approaches to a more holistic and inclusive understanding of mental health…”.
In other words, psychiatry has misunderstood everything. How wrong is it? With the entirely benevolent intention of publicizing this important paper, I emailed the editors Australian and New Zealand Journal of Psychiatry to see if they would accept the guidelines document as a ‘Viewpoint’. According to their website, “Opinion Articles are longer pieces (3,000 words) that allow for personal views and opinions on issues related to psychiatric practice and research. They will offer new insights, demonstrate academic rigor, and engage the journal’s readers. Reputation. At the invitation of the editor (who can be contacted with an article proposal).” Forty-five minutes later, their answer came. No thanks: That’s good, you don’t believe you’re doing anything wrong. But back to Guidance.
Chapter 1 describes the state of mental health legislation and provides relevant international treaties relating to health and disability. It begins with a 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 forming in the cosmic fray; Is mental disorder a genetic brain disorder or not? You can’t have it both ways, although they tried with their bogus biopsychological model and eclectic psychiatry. It Guidance continues.
Different ways of being, thinking, feeling, expressing and making sense of the world are part of human diversity; there is no such thing as a “normal” or “correct” way. 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,” such as the relentless drive to diagnose ADHD. They then discuss coercion and the loss of freedom of choice that are part of the fabric of psychiatry; management…” (p. 12). It mentions solitary confinement, restraints and shackles, particularly against minorities and marginalized sub-communities, who are “…often denied the few protections afforded by mental health legislation”. Box 2, p. 15 defines “Case Against Compulsion”.
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. Clearly, these treaty rights are routinely violated by psychiatry. In fact, current psychiatric practice is the polar opposite of these principles.
All of these sins are placed before a “biomedical model” that I have been saying for years does not exist. It is defined in the Dictionary, 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 symptom reduction rather than considering the full range of social and environmental factors (and) may not address the root causes of distress and trauma.
Despite its central role as the source of all evil in psychiatry, there is only one reference to this mythical entity, a 2013 article by Brett Deacon. I quickly found my copy and double-checked it in case I missed anything; No, I was right. There is nothing in that paper to say that such a model actually exists. The fact remains that no psychiatrist, neurologist, or philosopher or psychologist has ever written anything consistent with a reductionist model of mental disorder. Of course, there are plenty of people who believe that all mental disorders are a biological disease of the brain (see Deacon’s paper above and mine here for a list of citations), but believing is not the same as proving. They may believe it, but if the philosopher Daniel Stollard is right (and he usually is), they are wasting their breath; there will never be a physical history of mental disorder.
Instead of a shadowy “biomedical model”. Guidance offers person-centered, rights-based, community-based, and accountable psychiatry. The other two chapters are a carefully detailed description of how mental health acts should be written and tested for compliance with the CRPD and the other eight relevant treaties to achieve this far-reaching goal.
This impressive publication inevitably leads to two conclusions.
- Psychiatry routinely, systematically violates every internationally recognized human rights law and treaty, with absolutely no scientific warrant. and:
- Apart from psychiatrists, the world is moving away from the idea that when dealing with mentally disturbed people, the management styles and standards of a hundred years ago are very good.
This is the dilemma. According to the world’s top health and human rights bodies, psychiatry needs to change. How much? That much. “Denial of legal capacity, coercive practices and institutionalization must end.” So far, no one has told the psychiatrists, and as my little interaction with the editors has shown, they’re not particularly interested. However, knowing psychopaths, they will fight tooth and nail to resist change, and so the irresistible force meets the immovable object.
The goal of psychiatry, as we well know, is to medicalize everything they can get their hands on. Anyone who doesn’t like it is clearly “anti-psychiatry” (not to mention dangerous, biased, extremist and a tool of scientists). While the UN bodies will do the right thing by consulting widely and slowly building their case, we know that at the slightest hint of a threat the psychiatry/pharmaceutical axis will start screeching to their friends in government to drop the very big hammer. on the beginnings.
There is no doubt that mainstream psychiatry around the world will have a collective fit when they see what non-psychiatrists have planned for them. There is also no doubt that by switching to the model of practice, which is intended for s.t Guidance a dramatic change in psychiatry will be required. For starters, every national training program needs to be completely rewritten, but the biggest resistance will come from the attitudes and beliefs of the establishment. A change of this nature will take years and years to implement in practice. In fact, many of the senior staff would not be able to adapt and would have to be relegated to an old people’s home.
But we can be sure of one thing. Institutional psychiatry, given its credentials, will not yield to good graces. I mean, look at the magazine editors. they don’t even want to know the existence of WHO or OHCHR. They don’t realize that GuidanceAs recently published, a gun is pointed at the collective head of psychiatry. It’s not an encouraging start.
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