www.wnusp.net
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Submission to the Subcommittee on Prevention of Torture for
Thematic Discussion on Mental Health and Places of Deprivation of
Liberty
22-23 February 2012
Contents
Part I: Application of Convention on the Rights of Persons with Disabilities
(CRPD) to Mental Health and Places of Deprivation of Liberty
I. CRPD as Authoritative Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
II. CRPD Framework Regarding Psychiatric and Social Care Institutions . . 2
III. CRPD Framework and People with Psychosocial Disabilities in Other
Detention Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part II: Recommendations for Subcommittee on Prevention of Torture in
relation to Mental Health and Places of Deprivation of Liberty
I. Visiting Institutions in General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
II. Visiting Prisons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
III. Visiting Psychiatric Institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
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IDA members are: Disabled Peoples' International, Down Syndrome International, Inclusion
International, International Federation of Hard of Hearing People, World Blind Union, World Federation of
the Deaf, World Federation of the DeafBlind, World Network of Users and Survivors of Psychiatry, Arab
Organization of Disabled People, European Disability Forum, Pacific Disability Forum and Red
Latinoamericana de Organizaciones no Gubernamentales de Personas con Discapacidad y sus familias
(RIADIS).
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Part I:
Application of Convention on the Rights of Persons with Disabilities (CRPD) to
Mental Health and Places of Deprivation of Liberty2
I. CRPD as Authoritative Guidance
The CRPD defines an updated understanding of the human rights of persons with
disabilities and offers guidance for the application of all treaty provisions without
discrimination. As noted by the Special Rapporteur on Torture, the CRPD is
authoritative guidance to the rights of persons with disabilities and supersedes
outdated non-binding instruments that contravene its provisions, particularly with
respect to the prohibition of involuntary treatment and involuntary confinement.3
II. CRPD Framework Regarding Psychiatric and Social Care Institutions
1. Detention Based on Disability is Unlawful Detention
CRPD Article 14 prohibits deprivation of liberty based on disability. There is no
doubt about this under the article itself and it is confirmed by the CRPD Committee’s
first two sets of Concluding Observations,4 which urged the abolition of laws
authorizing the deprivation of liberty of people with psychosocial and intellectual
disabilities.
Psychiatric institutionalization and hospitalization, whether for short or long
periods of time, is prohibited without the free and informed consent of the person
concerned.5
The Special Rapporteur on Torture noted that involuntary psychiatric
institutionalization and indefinite detention may amount to torture or illtreatment.6
Whether ordered by a judge or by one or more doctors, or decided by a family
member or by an appointed guardian, any psychiatric internment against the
person’s own will, for purposes of diagnosis, assessment, containment/control or
See also WNUSP/IDA document “OPCAT monitoring of psychiatric institutions and
related issues in other forms of detention: CRPD Framework,” available at
http://www.chrusp.org/home/Resources.
3 Report of Special Rapporteur on Torture 28 July 2008, A/63/175, paragraph 44.
4 Concluding Observations on Report of Tunisia, CRPD/C/TUN/CO/1, and
Concluding Observations on Report of Spain, CRPD/C/ESP/CO/1.
5 See also CRPD Articles 12, 17, 19 and 25.
6 A/63/175, paragraphs 64-65.
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treatment is contrary to Article 14, as it always relies on a premise of
discrimination.
From the standpoint of the CRPD, such internment is always a form of unlawful
detention, irrespective of whether domestic laws regulate it. Domestic laws that
contravene international human rights must give way.
Internment in social care homes is similarly contrary to Article 14 and a form of
unlawful detention.7
Other places of internment where people with psychosocial disabilities are
unlawfully confined based on their disability may include prayer houses/rooms,
“safe houses,” shrines, police stations, prisons8 and refugee camps.
To the extent that a system of services for people with disabilities is based on
institutionalization, states must shift their resources to inclusively designed
measures that allow people with disabilities to meet their needs in communities,
with choices equal to those of others (CRPD Article 19).
However, the right to liberty is not contingent on the state having made resources
available so that people can meet their basic needs. This is equally true for persons
with disabilities as it is for those without disabilities. Offering release to all persons
unlawfully deprived of their liberty is an immediate obligation.
2. Respect for Integrity of the Person – Conditions of Detention and the Freedom
from Nonconsensual Treatment
Beyond the fact of unlawful detention, conditions and treatment under detention
need to be examined for violations of human rights.
In this respect it should be noted that forced psychiatric interventions, such as
administration of electroshock or of mind-altering drugs including neuroleptics by
force or without the free and informed consent of the person concerned, are
contrary to the CRPD and may amount to torture and ill-treatment.9 WNUSP
maintains that such interventions are in fact torture.
According to the Special Rapporteur on Torture, such acts are not justifiable as
medical treatments, and furthermore may constitute torture or ill-treatment
In the case of Stanev v. Bulgaria, 36760/06 [2012] ECHR 46 (17 January 2012), the
European Court of Human Rights has acknowledged that involuntary placement in a
social care home constitutes a deprivation of liberty.
8 This refers to prisons being used as places of detention without a person having
been accused or lawfully convicted of a crime.
9 A/63/175 paragraphs 61-63.
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notwithstanding the “good intentions” of medical professionals.10 This needs to be
emphasized as it is contrary to earlier standards adopted by the European Court of
Human Rights and used by the European Committee to Prevent Torture in
monitoring psychiatric institutions. The doctrine of “therapeutic necessity” as
either a justification of forced medical interventions against persons with
disabilities, or as a yardstick by which to measure their treatment under detention,
is incompatible with the CRPD and requires a new approach that fully recognizes
the right to respect for physical and mental integrity of persons with disabilities on
an equal basis with others, such as we have proposed in our recommendations that
constitute the second part of this submission.
While we recognize that the intention of a “therapeutic” standard in detention
monitoring is to take account of the difference between punishment and healing, we
cannot accept that there is any role for detention or enforced treatment in a place of
healing. The injustice of unlawful and discriminatory detention makes it impossible
to monitor psychiatric institutions according to a therapeutic standard. We
therefore suggest monitoring for enjoyment of all human rights and freedoms
(economic, social, cultural, civil and political rights), to which people unlawfully
deprived of their liberty in psychiatric institutions are entitled equally as all other
human beings. The right to clean water, decent food, sanitary facilities, etc., to
respect for one’s dignity and privacy, to physical and mental integrity and to liberty
itself need to be fully upheld.
Restraint (both physical restraint and chemical restraint using psychotropic drugs)
and solitary confinement in a psychiatric institution, social care home, prayer camp
or other such institution, are incompatible with the CRPD and with basic human
rights and freedoms. It should be noted that the Special Rapporteur on Torture has
called for a complete ban on solitary confinement of people with mental disabilities
due to its harmful effects that exacerbate existing distress.11
3. Legal capacity
CRPD Article 12 guarantees to people with disabilities the equal enjoyment of legal
capacity in all aspects of life. To this end, substituted decision-making regimes must
be replaced by supported decision-making, which “respects the autonomy, will and
preferences of the person.”12
A/63/175 paragraphs 40, 47 and 49.
Report of the Special Rapporteur on Torture, A/66/268, paragraphs 68, 78, 81.
Note however that paragraph 78 of the report refers to outdated MI Principles; it
would be better practice to refer to CRPD for authoritative guidance.
12 CRPD Committee, Concluding Observations on the Report of Spain,
CRPD/C/ESP/CO/1, paragraph 34.
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The right to legal capacity ensures that people with psychosocial disabilities are
recognized as the decision-makers with respect to their own care and treatment,
housing, and in all other aspects of their lives, as a matter of international law
notwithstanding any domestic law to the contrary. Domestic laws that allow for
restriction of legal capacity or the right to make decisions of people with disabilities
need to be reformed accordingly.
III. CRPD Framework and People with Psychosocial Disabilities in Other
Detention Settings
1. Criminal responsibility
As individuals with full legal capacity, people with psychosocial disabilities can be
held responsible not only for obligations they create by contractual agreements, but
also for obligations imposed on all members of society, such as accountability for
wrongdoing through civil and criminal processes.
CRPD Article 12 recognizes the legal capacity of persons with disabilities on an
equal basis with others "in all aspects of life," which includes criminal as well as civil
matters. The Office of the High Commissioner for Human Rights agrees that Article
12 requires abolition of the insanity defense, which should be replaced by disabilityneutral concepts such as the subjective element of a crime (mens rea).13
The principle of reasonable accommodation may require the non-enforcement of
criminal law against a person whose inability to follow the law is related to a
disability, unless enforcement is essential to the functioning of society (e.g. for
serious crimes of violence). This differs in crucial respects from an insanity defense,
as it is not a determination that criminal responsibility is inapplicable, nor is it a
categorical exoneration but rather a balance of justice. Restorative justice focusing
on repair of harm, acceptance of responsibility and building community may offer
good insights for creating systems of accountability amenable to inclusive design,
able to include people with disabilities on an equal basis with others rather than
relying on exceptions to any rule.
2. Equal guarantees and reasonable accommodation in investigation, trial, and
detention
The most relevant norms are enunciated in CRPD Article 14.2 on liberty and
security of the person, and Article 13 on access to justice, see also Article 2 for
OHCHR Thematic study on measures to enhance awareness and understanding of
the Convention on the Rights of Persons with Disabilities, A/HRC/10/48, paragraph
47.
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definition of reasonable accommodation and Article 5 on equality and nondiscrimination.
People with psychosocial disabilities are entitled to the same guarantees as others
when facing criminal investigations and accusations, including a trial to determine
guilt or innocence with due process. Compulsory or ill-informed diversion to the
mental health system is a violation of the right to a fair trial. Accommodations are
required to ensure equal access to justice, including accommodations for an
individual's unusual manner of communication, and affirmative effort to avoid the
impact of prejudice and stereotyping in accusations and determinations of guilt.
In pre-trial detention and when serving a jail or prison sentence, people with
psychosocial disabilities have a right to access all programs available to other
detainees (such as early release programs, work and education), to be provided
with reasonable accommodation when necessary to participate in such programs
and services, and to be treated with respect for their inherent dignity and without
discrimination of any kind. Disciplinary measures and proceedings that have a
disproportionate impact on people with psychosocial disabilities should be
questioned and reformed. A trauma-informed approach should be adopted
throughout the detention setting for men as well as women, to avoid an institutional
culture of cruelty and violence that reinforces past trauma and does a disservice to
the goal of re-integration. This is an example of inclusive design, since people with
psychosocial disabilities benefit along with everyone. Reasonable accommodation
may also require refraining from enforcement of rules when a prisoner’s inability to
comply with such rules is related to a disability and enforcement is not essential to
the functioning of the overall program.
People with psychosocial disabilities must also be treated "in conformity with the
objectives of" the CRPD in any detention setting. One significant implication of this
is a prohibition on any compulsory mental health treatment or compulsory
rehabilitation (Articles 17, 25 and 26). Services must be provided on the basis of
free and informed consent of the person concerned, and the prohibition of
compulsory interventions is no excuse for withholding of a desired service to any
individual.
Furthermore, Article 19 is relevant to the right of people with psychosocial
disabilities to not be placed involuntarily in a segregated part of the prison, to
receive desired support in general population, and to be eligible to participate in all
services available to other inmates in general population.
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Part II:
Recommendations for Subcommittee on Prevention of Torture in relation to
Mental Health and Places of Deprivation of Liberty
I: Visiting Institutions in General
When visiting a country, the SPT should inquire as to whether any places of
detention exist where people with psychosocial disabilities are deprived of their
liberty as a social and/or legal response to their disability. Such places may include
psychiatric institutions, social care homes, prayer houses/rooms, “safe houses,”
shrines, police stations, prisons14 and refugee camps. Monitoring of the detention
where people are detained on the basis of disability needs to address both the
unlawfulness of such detention under international human rights law, and the
conditions and treatment of detainees.
Unlawfulness under international human rights law may refer to one or both of the
following: there may be no basis in domestic law for the detention, thus violating
rule of law principles, and/or the detention may be on grounds that are prohibited
under international law. An example of the latter is found in ICCPR Article 11, which
prohibits imprisonment for failure to fulfill a contractual obligation. The CRPD
Article 14.1 obligation to ensure that deprivation of liberty shall in no case be
justified by a disability is another such prohibition. It is common for short- and
long-term detention (or institutionalization) in psychiatric institutions to be
regulated under domestic law, but such detention is nevertheless unlawful by
international human rights standards as a result of the CRPD.15
People with disabilities who are detained or imprisoned on grounds applicable to
the general population (such as being accused or convicted of a crime, immigration
status, etc.) are in a different situation in that the detention is not per se unlawful.
Monitoring of such detention would address itself to the conditions and treatment of
detainees with disabilities and the guarantee of all rights on an equal basis together
with the principle of reasonable accommodation and humane treatment in
accordance with the objectives and principles of the CRPD (as provided in CRPD
Article 14.2).
This refers to prisons being used as places of detention without a person having
been accused or lawfully convicted of a crime.
15 See Committee on the Rights of Persons with Disabilities Concluding Observations
on the Reports of Tunisia (CRPD/C/TUN/CO/1) and Spain (CRPD/C/ESP/CO/1);
Report of the Special Rapporteur on Torture and other cruel, inhuman or degrading
treatment or punishment, U.N. Doc. A/63/175 paragraphs 44, 64-65; Office of the
High Commissioner for Human Rights Thematic study on enhancing awareness and
understanding of the Convention on the Rights of Persons with Disabilities, U.N. Doc.
A/HRC/10/48, paragraphs 48-49.
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Monitoring the conditions and treatment of persons with psychosocial disabilities in
unlawful detention cannot be done with reference to therapeutic or clinical
standards of good practice, since it is an oxymoron to define therapeutic standards
for a practice that violates human rights. Furthermore, monitors need to be
sensitive to ways in which confusion about purpose (healing vs. control) can distort
the perceptions of all involved in such a situation.
On the whole, medical standards of practice should not be imported into human
rights monitoring as an approach to the humane treatment of prisoners with
disabilities (under ICCPR Article 10 and CRPD Article 14.2), as the CRPD has
rejected a medical model of disability in favor of a social model based on nondiscrimination and human rights. The rejection of the medical model needs to be
underscored in relation to psychosocial disability; persons with psychosocial
disabilities are entirely mainstreamed in the CRPD with no separate standards.
CRPD Article 19 can serve as a useful paradigm for access to housing, supports and
services in general population within a detention setting by persons with
disabilities, including those with psychosocial disabilities.
It should be noted that the Standard Minimum Rules on the Treatment of Prisoners,
which have at times been used to monitor conditions of detention in prisons, is
deficient and outdated with respect to the rights of prisoners with psychosocial
disabilities, and with respect to the principle of free and informed consent in
medical care generally.16 We caution that Rules 82 and 83, and Rule 33(b), among
others, cannot serve as a guide to the treatment of prisoners with psychosocial
disabilities according to CRPD Article 14.2 or ICCPR Article 10. The Standard
Minimum Rules are currently under review and it is hoped that a revised version
will emerge that is fully consistent with human rights law that has developed since
the adoption of the SMR in 1955. Until such time, the SMR must be both
supplemented and substituted by relevant treaty law in case of inconsistencies.
We have outlined preliminary sets of recommendations and concerns applicable to
prisons and psychiatric institutions in particular.17 For other types of detention
adaptations should be made according to whether the detention is lawful or
unlawful, and to address particular circumstances.
See WNUSP Intervention at the Inter Governmental Expert Meeting on the
Standard Minimum Rules (Vienna, 31 January – 2 February 2012) and IDA Position
Paper on CRPD and Other Instruments, both available at
http://www.chrusp.org/home/Resources.
17 The sets of recommendations dealing with prisons and with psychiatric
institutions were developed separately. Due to time constraints we have not
attempted to unify them stylistically.
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II: Visiting Prisons
I. The Subcommittee on Prevention of Torture needs to be given access to all
environments within the prison and to be able to interview prisoners in private
without prison staff present.
Prison Environment/Location(s)/Facility
. General Population
. Solitary Confinement/Special Housing Unit (SHU)
. Psychiatric Hospital in the prison
. Psychiatric Ward (Section) of the Prison
II. Questions to be asked when interviewing prisoners:
A. Regarding placement in a segregated prison environment such as Solitary
Confinement, psychiatric hospital in the prison, psychiatric ward of the prison:
1) How long have you been in the above?
2) Why does the prison administration say you are currently in the above?
3) How was the decision made to place you in the above?
4) Was there a hearing process or the ability to appeal the decision to place you in
the above?
5) Was there paper work regarding the decision to place you in the above?
B. Regarding conditions:
1) Do you have a "cell mate"?
2) Are you allowed to interact with other prisoners? (Where, when, and how?)
3) Are you permitted to partake in prison programs, work, etc?
4) How often are you allowed visitors?
5) Are you strip-searched? When?
6) Is your cell or area searched? When and how often?
7) Are "spit hoods", head coverings, table or chair restraints or similar devices used?
8) Are you required to wear restraints, including leg irons?
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9) How many hours of recreation time do you get? (Describe the area you have, is it
outside, what equipment do you have access to?)
10) How often are you allowed to shower?
11) Are hygiene supplies accessible?
12) How many meals do you receive daily? (Describe your meals and where you eat
them)?
14) Mail incoming and outgoing? (How many letters are you allowed to mail per
day?)
15) What items of personal property are you allowed or not allowed?
16) Do you have access to your attorney? (Describe the setting you meet with
attorney)
17) Do you have access to phone calls? (How often and where?)
18) Were you diagnosed/labeled with a psychiatric diagnosis prior to your current
incarceration?
19) Were you diagnosed/labeled with a psychiatric diagnosis during your
incarceration?
20) Have you been forced/coerced to take psychiatric medications/shock/ and
"treatments"?
21) What type of "mental health care" do you have access to?
22) Is this mental health care provided according to your free and informed
consent?
23) Were you provided with written explanations of the
grievance/appeal/complaint procedures?
24) What is your over all experience/opinion of the grievance procedures?
25) Do you have regular access to the library and/or law library? (Describe
conditions)
26) Do you have health concerns which you would like care for?
27) Have you asked to have care for these health concerns? How has the facility
responded?
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III: Visiting Psychiatric Institutions
I. Questions for systemic actors (directors of institutions, ministry or department in
charge of mental health, justice ministry, public defenders or similar lawyers who
represent people in psychiatric institutions, organizations of users and survivors of
psychiatry, national human rights institution, independent monitors of institutions,
etc.):
1. Is involuntary treatment used?
Involuntary status, involuntary admission, admission by a guardian or family
member, coerced voluntary admission, forced/coerced medication, forced/coerced
electroshock, forced/coerced psychosurgery, "emergency" medication against the
person's will, restraints, isolation cell/solitary confinement, outpatient
commitment/community treatment orders, forced/coerced sterilization,
forced/coerced abortion, forced/coerced contraception.
Provide statistics on these involuntary measures.
Provide data and statistics on deaths, adverse effects of treatment, incidents
of violence or abuse, complaints, other events on which information is kept.
2. Are they aware that these measures are contrary to international human rights
law?
3. Are psychiatric staff required to participate in involuntary measures? Is it
possible for a doctor, nurse, other worker to ensure his/her clients that no
involuntary measures will ever be used?
4. How does domestic law address involuntary measures in psychiatry?
- Mental health law
- Capacity to consent
- Civil code
- Health care law
- Administrative regulations
5. What part of government is responsible for repealing the legal authorization for
involuntary measures? How can this responsibility be engaged, and how can civil
society participate?
6. Do any courts or tribunals have the power to hear people's requests to be
released from psychiatric confinement and other complaints of human rights
violations in psychiatry, including torture and ill-treatment?
7. Are these courts or tribunals aware of the changes to international human rights
law as a result of the CRPD (either as binding law in a State Party, or as authoritative
guidance to the interpretation of customary law and treaties in force for that state)?
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8. How can courts and tribunals learn about the CRPD standards, including the
Committee's jurisprudence and the guidance from the Special Rapporteur on
Torture, if they are not yet aware of them?
9. What is the status of international human rights law in the domestic courts and
tribunals, when it conflicts with domestic law? How can courts and tribunals best
give effect to the CRPD standards in their jurisdiction?
II. Questions that may be asked of individuals in a psychiatric institution, unit or
ward:
1. Do you want to be here?
2. Do you have anyplace to go if you were to be released? Would you be in danger
(from your family, community, etc.) if you were to be released?
3. Do you feel safe here or have you ever felt frightened?
4. Do you have access to clean drinking water when you want it?
5. Do you have access to private bathing and toilet facilities?
6. Have you been given drugs/medication? If so, which one(s)? Dosage? How does
it make you feel? Any additional drugs for side effects?
7. If you have taken drugs/medication, what were you told about the medication?
8. Have you ever been forcibly injected?
9. Have you ever taken a drug/medication not because you wanted to, but because
you felt threatened or intimidated to comply?
10. Have you ever been assaulted by staff or other inmates/patients? Describe the
circumstances.
11. Have you ever been placed in seclusion/ solitary confinement/ isolation cell?
How long? Please describe.
12. Have you ever been physically restrained (tied to a bed, straitjacketed, placed in
a cage bed, etc.)? Please describe.
13. Have you ever been given electroshock (ECT)? Were you awake/conscious or
unconscious? How many shocks? Please describe how it made you feel, any
reactions you had to the experience.
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14. If you were given electroshock, was this your choice or were you forced or
coerced?
15. What were you told about the electroshock? Were you told this before or after it
was done?
16. Have you ever been raped or sexually assaulted/ abused/ exploited, by staff or
by other inmates/patients?
17. Have you been strip-searched or made to be naked in front of others?
18. What were the circumstances of your coming here? Did you come by choice?
Were you brought by others? (Family? Police?)
19. Do you want services or support of any kind? What do you need?
20. Would you consider yourself a trauma survivor? Would you like to discuss the
circumstances behind this?
21. Do you have any concerns about your physical health that need attention?
22. Have you witnessed or experienced anything in here that troubles you?
23. Have you been punished or seen anyone else punished in any way? Please
describe.
24. Do you know if the staff here keeps records about you? Have you ever seen the
records? Are you able to change them if they are inaccurate?
25. How has your gender, race, culture, religion, sexual orientation, disability (other
than psychosocial disability) impacted on the ways you have been treated?
III. Recommendations for conduct of visits:
1. Ensure visitors adhere to CRPD standards when asking questions and making
observations.
2. Use visits to educate people inside institutions as well as staff and systemic actors
about CRPD standards.
3. Gain access to records and statistics, as well as making direct observations and
doing interviews.
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4. Proactively address the problem of psychiatric institutions refusing access to the
premises, interviews with individuals, and records, on grounds of confidentiality.
Confidentiality is a right of the person and not of the institution.
5. Treat information provided by people inside institutions (inmates/patients) as
credible.
6. Observe and take action regarding intimidation, threats and reprisals.
7. Insist on private interviews with inmates/patients.
8. Visits should be unannounced and should include nighttime.
9. Organizations and agencies in a position to do so should conduct “mystery
shopper” investigations: people who can present themselves to an intake center or
emergency room and ask for treatment, who will observe and report on their
experience.
10. Be aware of the complexities and power relations of the institutional psychiatric
environment and how this can shape communication and perceptions. Study
writings from the mad movement, disability studies from mad perspective, survivor
research, and sociological study of psychiatry (such as Erving Goffman's Asylums) to
prepare for visits.
11. Give inmates accurate information about who visitors are: their power, mandate,
purpose, personal relationship to psychiatry (as user or survivor, mental health
professional, family member, etc.), profession, and any other relevant information.
12. Treat inmates respectfully as valuable witnesses and as people who deserve to
have redress for the human rights violations committed against them.
13. Recruit users and survivors of psychiatry/ people with psychosocial disabilities
who are knowledgeable about the CRPD standards and have experience in peer
support and advocacy, from diverse countries and backgrounds, to participate in
visits. They should eventually make up a majority of such teams that visit
psychiatric institutions and programs.
14. Be aware of the discomfort that monitoring according to the CRPD standards
may create for psychiatrists and other mental health professionals who are
members of the SPT or related visiting teams. Such discomfort should be addressed
by providing information and learning opportunities.
15. Consider carefully the composition of visiting teams and whether it is advisable
for psychiatrists and other mental health professionals to participate, particularly in
interviews with inmates. This may confuse inmates as to the role of the visitor and
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may also be both counterproductive to getting valuable information and
traumatizing for the inmate.
16. Develop a roster of experts who can advise on law reform from user/survivor
perspective.
17. Develop a roster of experts to advise on transformation of the mental health
system in ways that meet the requirements of the CRPD framework, for example:
- Trauma-informed care/support
- Survivor-defined recovery
- Working with hearing voices and other extreme states
- Working with self-injury
- Working with suicidality
- Family group conferencing
- Personal Ombudsperson
- Intentional Peer Support
- Soteria
- Yoga, trance, and other traditional mental healing practices
- User/survivor-run crisis and respite centers
- Peer advocacy/support
- Harm reduction approach to psychiatric drugs
18. In making recommendations, emphasize that any involuntary retention in
psychiatric institutions or units, any forced or coerced treatment, any restraint or
solitary confinement, violates human rights, notwithstanding domestic law. The
rights to liberty, legal capacity, and freedom from torture and ill treatment are not
subject to progressive realization. Those who wish to leave must be allowed to do
so, and institutional staff and authorities must inform people of this right. Staff must
immediately cease and desist from using restraints, solitary confinement and forced
or coerced medication, electroshock and psychosurgery, and must inform inmates of
their right to be free from such treatment. Domestic law that conflicts with these
duties must be nullified or repealed.
19. People leaving a psychiatric institution must be provided with basic necessities
of life and support to begin or resume a life in the community. This should be
treated like a situation of humanitarian emergency. Mental health services and
supports should be made available separately to those who desire them, and not
interwoven with social services and economic assistance.
20. Further recommendations should address the obligation to immediately begin to
transform mental health care and services, and to make an open-ended inquiry
about needs, in collaboration with organizations of people with psychosocial
disabilities, so as to develop appropriate programs beyond the mental health
system.
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21. Monitors should visit courts and tribunals both to gain information and to
provide information about the CRPD standards. Recommendations should be made
to these actors as well, regarding their obligations under international law to
exercise their authority to release individuals from deprivation of liberty in
psychiatric institutions/units, to refuse to authorize forced or coerced interventions
(medication, electroshock, etc.), and to reject applications for guardianship or any
other measures that fail to respect the person's autonomy, will and preferences.
22. Recommendations should be made as well to NGOs and communities, to assist in
creating a culture of relationships and acceptance of mental/emotional diversity
without fear. In all measures, people with psychosocial disabilities and their
organizations must be centrally involved with a leadership role and due respect for
their expertise.
17
The World Network of Users and Survivors of Psychiatry is a democratic
organization of users and survivors of psychiatry that represents this constituency
at the global level. In our Statutes, "users and survivors of psychiatry" are selfdefined as people who have experienced madness and/or mental health problems,
or who have used or survived mental health services.
WNUSP had its beginnings in 1991 and became a full-fledged organization
with a democratic global structure on adopting its statutes in 2001. Currently we
have members in over 50 countries, spanning every region of the world.
WNUSP is a member of the International Disability Alliance (IDA), and is
represented on the Panel of Experts of the UN Special Rapporteur on Disability.
WNUSP was involved in the work on the Convention on the Rights of Persons with
Disabilities (CRPD) since the inter-regional expert meeting convened by the Mexican
government before the 1st session of the Ad Hoc Committee (the UN forum in which
the CRPD was negotiated), and has been active and successful in achieving our aims
for the Convention, especially with regard to legal capacity, liberty, integrity and
free and informed consent, as well as principles of autonomy, human diversity and
equality reflected not only in article 3 but throughout the Convention. WNUSP
brought over 20 users and survivors of psychiatry to the UN, from every region of
the world, in addition to representatives of other user/survivor organizations that
worked closely with us, such as Mind Freedom International and People Who.
WNUSP was among the organizations that created the International
Disability Caucus, and served on its steering committee; it is also currently on the
steering committee of the IDA CRPD Forum. WNUSP was also one of the
organizations represented in the 2004 working group that produced the first official
draft text of the CRPD, and was represented as one of two civil society speakers at
the adoption of the CRPD by the General Assembly.
Since the adoption of the CRPD, WNUSP has produced an Implementation Manual
from a user/survivor perspective (available on our website), and continues to work
with the rest of the international disability community, especially through the Legal
Capacity Task Force, a working group of the IDA CRPD Forum.
WNUSP has Special Consultative Status with the Economic and Social
Council of the United Nations (ECOSOC).
Please see our website www.wnusp.net for more information.