Psychosocial Disability and the Asia Pacific
David Webb
World Network of Users and Survivors of Psychiatry (WNUSP)
A Disability Rights Tribunal for the Asia Pacific
Australian Federation of Disability Organizations & Tokyo Advocacy Law Office
Melbourne, Australia
13 August 2010
World Network of Users and Survivors of Psychiatry
Mental Health Laws in the Asia Pacific


unlike Australia, many Asia Pacific countries do not have
specific mental health laws
these countries are asking whether they should
introduce MH laws to protect the rights of people who
experience psychosocial disability
• e.g. at the CBR Congress in Bangkok last year


but MH laws such as we have in Australia do not protect
the rights of people with psychosocial disability
rather, they take away our rights
World Network of Users and Survivors of Psychiatry
Mental Health Laws in the Asia Pacific
For instance, in Victoria:

5,000+ people on CTOs in Victoria (population 5 million)
• equates to 128,000 people in Japan

every week over 100 involuntary patients are given ECT
NB – the WHO Mental Health Division says:

ECT without consent should be prohibited – no exceptions

same as direct/unmodified ECT (with or without consent)
• does not occur in Australia but does in several Asia Pacific
countries, such as Thailand
World Network of Users and Survivors of Psychiatry
CTOs around the world
There are striking variations in rate of use across jurisdictions and this
leads to criticism that their use is arbitrary and poorly linked to clinical
need. Broadly speaking, rates are low in Canada, high in Australasia
and mixed in the USA ... ‘Outpatient commitment’, in the USA, varies
enormously from less than two per 100 000 in New York, to 22 in North
Carolina ... to 26 in Nebraska, and even higher in Washington DC. In
Australasia, rates vary from 55 per 100 000 for Victoria, 44 for New
Zealand, 43 for Queensland, 37 for New South Wales, down to 10 in
Western Australia.
Editorial in 'Psychological Medicine' (2009), Vol 39, pp 1583-1586
World Network of Users and Survivors of Psychiatry
WHO and ECT
Although significant controversy surrounds electroconvulsive therapy
(ECT) and some people believe it should be abolished, it has been
and continues to be used in many countries for certain mental
disorders. If ECT is used, it should only be administered after
obtaining informed consent.
WHO Resource Book on Mental Health, Human Rights and
Legislation (2005, page 64)
http://whqlibdoc.who.int/publications/2005/924156282X.pdf
World Network of Users and Survivors of Psychiatry
Mental Health Laws in the Asia Pacific
The full implementation of the CRPD will protect the rights of
people with psychosocial disabilities



including the right to supported decision-making, if
needed, as required under the CRPD
and the right to the supports we need to achieve our other
CRPD rights
specific mental health laws are not needed except
(perhaps) for positive discrimination
• e.g. affirmative action legislation
World Network of Users and Survivors of Psychiatry
Medical Colonisation of Psychosocial Disability



in many western countries, the excessive medicalisation
of all aspects of life (not just MH) is causing great
concern (sometimes called disease-mongering)
medicalisation of MH in Australia (and the west in
general) is now virtually complete and causing great
harm, not just to individuals but to society as a whole
this has occurred despite any good scientific evidence
that psychosocial disability is a medical “mental illness”
• in stark contrast to the very good evidence that the medical
interventions offered are (a) not very effective and (b) often very
harmful
World Network of Users and Survivors of Psychiatry
Medical Colonisation of Psychosocial Disability


unscientific medical prejudices are the primary excuse
used to impose medical interventions on people with
psychosocial disability without their consent
in partnership with society’s prejudices that people with
psychosocial disability are dangerous (also not supported by
any scientific evidence)

we now have good evidence that the medicalisation of
psychosocial disability is actually disabling people
• i.e. creating/causing long-term disability
• see “Anatomy of an Epidemic”, Robert Whitaker
• also the “Americanization of Mental Illness”
http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?_r=1&emc=eta1
World Network of Users and Survivors of Psychiatry
Medical Colonisation of Psychosocial Disability
The western, medical model of “mental illness” is being
aggressively promoted in the developing world

WHO etc but also some major Australian organisations:
• Asia Australia Mental Health
o Melbourne Uni, St Vincents Mental Health, Nossal Institute)
• Mental Health First Aid International
o born in Melbourne, now exported to Hong King, Singapore,
Japan, Cambodia and Thailand
• beyondblue – China
• Nossal (again), in partnership with Basic Needs
World Network of Users and Survivors of Psychiatry
Medical Colonisation of Psychosocial Disability




this is the developed west once again colonising the
developing east, this time with the very western, very
medical model of psychosocial disability
with it comes widespread psychiatric labelling of
psychosocial distress, with all its stigma and
discrimination, and widespread (expensive) drugging of
many people
also widespread human rights violations – incarceration,
forced treatment etc – on the basis of this model
a Disability Rights Tribunal could help resist this
colonisation
World Network of Users and Survivors of Psychiatry
Social Model of Disability, the CRPD and
Mental Health Human Rights

mental health systems need to be based on the social
model of disability
• recognise the social determinants that contribute to disability
• and the disabling consequences of the medical model

must include full implementation of the CRPD, especially
• supported decision-making model now mandated by the CRPD
• the right to the supports needed to achieve other CRPD rights

and also, of course, the CRPD’s full protection of the
human rights of people with psychosocial disability on
an equal basis with others in society
World Network of Users and Survivors of Psychiatry
Conclusions:
Reconciliation, an Apology, and a Tribunal
Dr Janet Wallcraft is a pioneering psychiatric survivor
academic in the UK who has called for a public apology for
the wrongs done to us in the name of psychiatric treatment.



as the first, essential step towards reconciliation
must also include reparations and compensation for past
wrongs before we can move forward in genuine
partnership
Janet uses South Africa’s post-apartheid Truth and
Reconciliation Commission as one example of the kind of
process that is required
World Network of Users and Survivors of Psychiatry
Conclusions:
Reconciliation, an Apology, and a Tribunal
A familiar scenario to us in Australia – the Stolen Generation

gross human rights violations occurred against Indigenous
Australians, causing great harm and suffering
• by a privileged elite in partnership with a prejudiced majority
• on the basis of nothing more than the arrogant assumption that it
was “for their own good”

the same arrogant assumption that psychiatric force is “for
their own good” lies at the heart of Australia’s mental
health system and the current medical colonisation of
psychosocial disability throughout the world
World Network of Users and Survivors of Psychiatry
Conclusions:
Reconciliation, an Apology, and a Tribunal

the perpetrators of psychiatric human rights abuses are
usually well-intentioned
• same as the perpetrators of the Stolen Generation


but as the UN Special Rapporteur on Torture has said,
good intentions are no excuse for human rights abuses
Janet Wallcraft concluded her talk in Manchester with:
I suggest that the apology should be negotiated
internationally – through our representatives at EC
and UN level.
World Network of Users and Survivors of Psychiatry
Conclusions:
Reconciliation, an Apology, and a Tribunal
A Disability Rights Tribunal in the Asia Pacific could play an
important role in the region to achieve what Janet and many
other people with psychosocial disabilities all over the world
are calling for – and have been for many years.



an end to psychiatric force
protection of the rights of people with psychosocial
disabilities
reconciliation and genuine partnerships to move forward
Nothing About Us Without Us
World Network of Users and Survivors of Psychiatry