1. Support in Crisis to Replace Forced Psychiatry
Tina Minkowitz
Center for the Human Rights of Users and Survivors of Psychiatry

2. Article 12 and forced psychiatry
Dual regime of substitute decision-making and arbitrary detention – forced psychiatry has a dual nature of paternalism and social control
Different from most other issues under Article 12
Needs multi-pronged comprehensive and integral approach under social model of CRPD to both name the problem and solve it
Cannot be deferred to health sector or to discourse of ‘human rights and mental health’

3. Why focus on ‘crisis situations’?
Those who disagree with us see crisis situations as ‘hard cases’ where CRPD paradigm (in their view) falls short
No debate about eliminating long-term institutionalization
Peruvian reform demonstrates feasibility of meeting political and technical challenges to substantial compliance with Article 12/GC1
However even that landmark achievement retained possibility of mental health detention on ‘emergency’ basis, regulations define as 72 hours
‘Danger to self and others’ trope still holds sway despite CRPD Committee’s Guidelines on Article 14 and repeated recommendations in country reviews

4. Demedicalization
First, we need to remove psychosocial crisis from the framework of medical emergency
Requires unlearning of carefully-constructed narrative of ‘chemical imbalances successfully treatable with drugs’ which cannot be supported with evidence and is not proper scientific hypothesis
To remain within that framework is a disservice to narratives of people with psychosocial disabilities who have much richer descriptions - see e.g. webinar series of RedEsfera Latinoamericana de Diversidad Psicosocial (in Spanish, hopefully English subtitles to come)
Implication: support to make decisions in psychosocial crisis does not equate to ‘support to decide about mental health treatment’ – rather we are looking at support to make the decisions that resolve the crisis itself

5. Crisis Crisis is by nature a dilemma – we don’t know what to do
Pressures from economic and social issues – housing and income are major stressors
Relationships with intimate partners, family, community, co-workers, activist comrades
Patterns of abuse, violence, discrimination, ongoing and past issues re- emerging
New life experiences and challenges
New perceptions and feelings
Each person’s self-care, construction of self and relation to world, inwardness and subjectivity

6. Support in crisis
Support can help us manage immediate sense of urgency and address actual urgent needs like shelter and food, while allowing ourselves to experience intense emotions and perceptions
This requires support for two phases of decision-making: discernment and decision (inward-looking and outward-looking) (Art 12)
and practical support to meet immediate needs – to remove the pressure of external crisis so that the process of decision-making can evolve (Art 19)
This is support for the person’s own process of decision-making that is manifesting in a way she experiences as a crisis
No imposition of any particular narrative or timeframe

7. Relations and conflict
In crisis situations there is often pre-existing conflict that gives rise to crisis
Also, one person’s crisis affects those around them
Can be several people experiencing crises of their own and needing support
CRPD rejects ‘danger to self and others’ and requires non-discrimination by police and justice systems with respect to any acts of violence or abuse, by or towards persons with disabilities
De-escalation of conflict and avoiding violence needs to be routine obligation of police
Mediation or communication assistance from someone who can be trusted by all parties to a conflict can also be also useful
Sensitivity to and acceptance of diverse manifestations of distress and crisis, which are not the focus of the interaction

8. How this replaces forced psychiatry
Rejects ‘incompetence’ and ‘danger’ narratives that are enshrined in regime of substitute decision-making and arbitrary detention
Rejects institutionalization even for short time
Safety is addressed from point of view of the person concerned – shelter, freedom from violence and abuse, comfort, choice of surroundings and interactions, choice about risk and vulnerability
Safety is also addressed interpersonally as impartiality, without assuming that person in crisis is the cause of conflict – we need for aggression against person in crisis to be taken seriously
Rejects medicalization of both personal distress and interpersonal conflict
Accepts diversity of transitory states and person’s ownership of her own evolving life and self-narrative

9. Questions? Comments? Presenter resources: tminkowitz@earthlink.net