Torture and ill-treatment in psychiatry Tina Minkowitz

Welcome “absolute ban” Absolute ban on nonconsensual psychosurgery, electroshock, mind-altering drugs including neuroleptics, restraint and solitary confinement long- and short-term Replace forced treatment and commitment with services that meet expressed needs, respect autonomy, alternatives to medical model CRPD as authoritative guidance Treatment that violates CRPD cannot be justified as medical necessity Revise contrary legal provisions

Concerns Contradiction with CRPD in paragraph 69, impacts on recommendations “Necessity to protect the person or others” is a red herring and masks the discriminatory and violent character of detention based on “mental illness” or “unsoundness of mind” Lack of clarity re legal capacity and informed consent in paragraphs 27 and 66, CRPD does away with “incapacity”

Civil commitment/detention CRPD prohibits all forced and coercive interventions in mental health services, including civil commitment/detention Mandate formerly recognized that psychiatric detention was within the scope of acts causing severe pain and suffering Mandate in current report unqualifiedly rejects detention of drug users

“Danger to self or others” Standard created to justify psychiatric detention – Part of MI Principles, overruled by CRPD Labeling any person as dangerous is character assassination, unjustifiable and arbitrary Psychiatric profiling and other profiling

How do we respond to suicide and violence? Non-discriminatory standards, larger social conversation – not about “mental health” Preventive detention too serious an infringement on human rights, causes suffering and violence, not a solution Intervening to stop an act of violence or suicide is not the same as detention Safe spaces to explore suicidal feelings or intent – detention is not a safe space

Recommendations Uphold CRPD standards requiring the repeal of civil commitment and incapacity/ substituted decision-making Publicize and implement absolute ban on nonconsensual psychiatric interventions, and obligation to replace forced treatment and commitment by services that respect autonomy Raise awareness about psychiatric profiling and its relationship to civil commitment, explore safety, mutuality and autonomy