6 ms·

Is involuntary treatment for mental illness allowed under CRPD?

32 points by DanBC 7y ago

DanBC 7y ago
The Convention on the Rights of People with Disabilities (CRPD) is here: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/convention-on-the-rights-of-persons-with-disabilities-2.html https://www.un.org/development/desa/disabilities/convention-... Read Article 14: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-14-liberty-and-security-of-person.html https://www.un.org/development/desa/disabilities/convention-... Art14 says "Are not deprived of their liberty unlawfully or arbitrarily, and that any deprivation of liberty is in conformity with the law, and that the existence of a disability shall in no case justify a deprivation of liberty." The committee for the CRPD have said this means that involuntary treatment for people with mental illness is not allowed, and any laws that contain provision for involuntary treatment must be repealed. In England those would be the Mental Health Act and the Mental Capacity Act. The committee have also said that work arounds - detaining people not because they are mentally ill but because they pose a risk of danger to themselves or others - are also forbidden. Here's the thoughts of the committee: https://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesArticle14.doc https://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesA...
- deleted 7y ago
  [deleted]
- dmitrygr 7y ago
  > detaining people [...] because they pose a risk of danger to themselves or others - are also forbidden. What he actual fuck? If someone is out waving a knife around in the street because the voices in their head are telling them to, we very much DO need to detain them, for their safety and the safety of others. Who cares what any "committee" says about it?
  - notfashion 7y ago
    You could have read the document before spewing toxic FUD about the kind of things mentally ill people supposedly do. Here's the section that addresses your concern: "All persons, including those with disabilities, have a duty to do no harm. Legal systems based on the rule of law have criminal and other laws in place to deal with the breach of this obligation. Persons with disabilities are frequently denied equal protection under these laws by being diverted to a separate track of law, including through mental health laws. These laws and procedures commonly have a lower standard when it comes to human rights protection, particularly the right to due process and fair trial, and are incompatible with article 13 in conjunction with article 14 of the Convention."
    - agdpf 7y ago
      It's normal that mental health laws have a lower standard for "human rights" when mentally ill people often behave in unexpected, illogical, and dangerous ways. We have to accommodate for that, for the safety of humans.
      - notfashion 7y ago
        Here we go again with the FUD: "mentally ill people often behave in ... dangerous ways". This kind of claim is harmful to the mentally ill as a group, because it is just not true. The vast majority of mentally ill people are not dangerous. You seem to be arguing also that it is only the mentally ill who often behave in "unexpected, illogical and dangerous ways". The reality is that humans in general sometimes do that, whether or not they have a clinical mental health problem. The way your comment insinuates that the mentally ill are sub-human is repellent, but I suppose you might not even realize that you are doing that. You may think of yourself as a model of logical, predictable and safe behaviour. I'm so tired of engineers who deny that there is any irrational element in their makeup. It is a naive thing to claim and a lame kind of deluded bid for superiority. "Others might be irrational, but not me!" Spare us. That attitude is the curse of HN and YC.
        pkaye 7y ago
- jdietrich 7y ago
  The position of the committee given in the guidelines on Article 14 appears to be completely untenable and fundamentally conflicts with the Article 10 right to life. Unless I have profoundly misunderstood their arguments, their position is that someone with a mental illness or intellectual disability may not be deprived of liberty on the basis of that illness or disability (or risks following from that illness or disability), ever, under any circumstances. That interpretation would forbid the carer of someone with severe intellectual disabilities from stopping them if they tried to run into traffic. It would forbid a care home for people with severe dementia from preventing patients from wandering off, even if those patients are agitated, disoriented and non-verbal. It would forbid a paramedic from tackling someone who is distressed, delusional and trying to jump off a rooftop. There is a perfectly legitimate argument to be had about the legitimacy of institutionalisation - even brief, time-limited institutionalisation - but these guidelines make a nonsense of the CPRD. It seems to me to be self-evident that some people lack the mental capacity to act in their own self-interests at least some of the time and would, left to their own devices, be at serious risk of death. I do not understand how the right to life and the absolute right to liberty can be compatible.
williamscales 7y ago
The discussion in the article gets to an interesting point: while the CRPD takes an absolute position on the issue of involuntary confinement of mental patients, it also takes an absolute position on requiring the state to provide the right to independent living and the right to health to folks with mental illnesses. "if one of his (legal) tools as a psychiatrist is to be removed, there needs to be a corresponding commitment from society to do better by all its members. It is precisely this commitment that the CRPD demands through, for instance, the obligation it imposes upon states to secure the right to independent living for those with disabilities (Article 19) and the obligation that it imposes upon states to secure the right to health of those with disabilities (Article 25). If those obligations are carried through, and proper attention paid to the socio-economic factors underpinning mental ill-health, then it is not too much to suggest that the need for coercion will be dramatically reduced as the (perceived or actual) choice for clinicians such as Dr Gosney will not be between detention and watching a patient die." Interpreted this way, involuntary confinement should never be necessary because the state must have already provided something that would obviate it. I'm not sure what that something is, however.
- deleted 7y ago
  [deleted]
soup10 7y ago
Psychiatrists and their colleagues have been lobbying for increased discretion to detain people in spartan psych wards and administer drugs and other dubiously ethical procedures like ECT and lobotomies without consent or through coercion since the dawn of the profession. That is how they are taught and that is the culture they work in.
- outlace 7y ago
  Resident psychiatrist here. That is simply not true. [See similar comment below]. I'm a resident psychiatrist, almost all patients we admit at my institution sign in voluntarily. The times we involuntarily admit patients are when they are so symptomatic that they would very likely die without treatment (e.g. they refuse to eat because they think their food is poisoned). Psychiatrists have no interest in detaining people, quite the opposite. Most of the time I'm dealing with patients who are feigning symptoms e.g. pretending to be suicidal to get admitted because they're homeless, and so we have to admit them lest we get sued, despite the fact there is good evidence many times an admission would be counter-productive. You have people who will sue psychiatrists if they don't admit someone and that person ends up killing themselves, and you have people who think psychiatrists are wantonly admitting too many people. Also there's nothing dubiously ethical about ECT. It's one of the safest procedures in psychiatrist and the most effective. Many many patients consent to do ECT voluntarily.
  - soup10 7y ago
    Ah yes, nothing dubiously ethical about strapping a patient to a gurney, administering tranquilizers(to reduce convulsions) and indiscriminately shocking the brain with high voltages. Everyone that volunteers for ECT is coached into it, nobody would naturally come to the conclusion that it's a good idea.
    - outlace 7y ago
      That's just wrong. I have seen many patients request ECT (many of them are well-educated) because they've tried everything else and are medication resistant. It's only significant side effects are temporary memory issues. ECT should be used more not less, it is way safer and more effective than many medications psych or not. Patient's are typically brought into a surgical suite, put to sleep and given paralytics as if they were having a surgery. The brain is shocked for like 10 seconds, the patient is asleep and paralyzed, no convulsions happen, no discomfort to the patient. The anesthetics wear off in a couple minutes, the patient wakes up and is able to go home, just as if it were some minor outpatient surgery.
olliej 7y ago
I recognize there is a history of over application of medication for mental health "defects" - I mean for HN crowd the involuntary "treatment" of Turing for the "mental illness" of being gay. But at the other end of the spectrum you have paranoid schizophrenia who for obvious reasons don't trust doctors. The CRPD seems to take the view that treating, even temporarily, is illegal and so you couldn't treat the patient to get them lucid enough to consent. Imagine a case where someone has been unable to get there meds (through some disaster or whatever), and so relapses and becomes paranoid and won't allow treatment. Even if when not relapsed they do want to take the medication. The CRPD appears to say that the patient can never be treated so any relapse must in effect be permanent and their life is functionally over. It also prohibits incarceration: so you're only option is the American system of waiting for someone with mental illness to commit a crime and then putting them in jail - they CRPD apparently explicitly prohibits putting them in a mental health facility. It is hard to see how that interpretation is possibly good for anyone - the patient, the patient's family, victims of any crimes that they commit, etc. You could extend the argument to say someone with diminished mental capacity should not be able to claim that in their defense because by definition that would be discriminatory. It's also hard to see how an untreated patient could possibly provide a meaningful defence of themselves if put on trial. Again, the rationale for the CRPD is sensible: it's trying to prevent things like how LGBT people have been "treated" by physicians, or things like the holocaust which also targeted people with mental health issues. But the apparent extremism seems hugely problematic.
- morpheuskafka 7y ago
  It's worth noting that committing a crime doesn't necessarily equal harm having occurred to people yet. For example, brandishing a knife is grounds for immediate arrest, before someone is stabbed. Communication across state lines to plan many types of offenses is illegal, and grounds for arrest before the actual offense occurs.
- candiodari 7y ago
  You mean to say that it was an important component of both the emancipation movement, the anti-racism movement AND and the LGBTQ movement to ... ban psychiatry out of the lives of these people. Psychiatry has a history of being abused for social control, mostly by psychiatrists. Freud defended rapists, often by using physical violence and long term incarceration against their victims. Hans Asperger mass-executed children at "Am Spiegelgrund". His signature is on the paperwork for locking children into a ward for execution. Jo Erik Brøyn, Norways "top child psychiatrist" (chairman of the council that decides to place children) ... was convicted last year to 22 years for child porn. He had placed 2 children ripped from their parents ... into his own care. It is not a temporary thing. Psychiatry served to violently abuse children when it was originally created. In fact you can make a decent argument that's WHY it was created. And last year VERY important psychiatrists were convicted for doing ... the same ... also to tens of thousands of children, just in Norway alone.

32 points by DanBC 7y ago

The Convention on the Rights of People with Disabilities (CRPD) is here: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/convention-on-the-rights-of-persons-with-disabilities-2.html https://www.un.org/development/desa/disabilities/convention-... Read Article 14: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-14-liberty-and-security-of-person.html https://www.un.org/development/desa/disabilities/convention-... Art14 says "Are not deprived of their liberty unlawfully or arbitrarily, and that any deprivation of liberty is in conformity with the law, and that the existence of a disability shall in no case justify a deprivation of liberty." The committee for the CRPD have said this means that involuntary treatment for people with mental illness is not allowed, and any laws that contain provision for involuntary treatment must be repealed. In England those would be the Mental Health Act and the Mental Capacity Act. The committee have also said that work arounds - detaining people not because they are mentally ill but because they pose a risk of danger to themselves or others - are also forbidden. Here's the thoughts of the committee: https://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesArticle14.doc https://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesA...

deleted 7y ago
[deleted]
dmitrygr 7y ago
> detaining people [...] because they pose a risk of danger to themselves or others - are also forbidden. What he actual fuck? If someone is out waving a knife around in the street because the voices in their head are telling them to, we very much DO need to detain them, for their safety and the safety of others. Who cares what any "committee" says about it?
- notfashion 7y ago
  You could have read the document before spewing toxic FUD about the kind of things mentally ill people supposedly do. Here's the section that addresses your concern: "All persons, including those with disabilities, have a duty to do no harm. Legal systems based on the rule of law have criminal and other laws in place to deal with the breach of this obligation. Persons with disabilities are frequently denied equal protection under these laws by being diverted to a separate track of law, including through mental health laws. These laws and procedures commonly have a lower standard when it comes to human rights protection, particularly the right to due process and fair trial, and are incompatible with article 13 in conjunction with article 14 of the Convention."
  - agdpf 7y ago
    It's normal that mental health laws have a lower standard for "human rights" when mentally ill people often behave in unexpected, illogical, and dangerous ways. We have to accommodate for that, for the safety of humans.
    - notfashion 7y ago
      Here we go again with the FUD: "mentally ill people often behave in ... dangerous ways". This kind of claim is harmful to the mentally ill as a group, because it is just not true. The vast majority of mentally ill people are not dangerous. You seem to be arguing also that it is only the mentally ill who often behave in "unexpected, illogical and dangerous ways". The reality is that humans in general sometimes do that, whether or not they have a clinical mental health problem. The way your comment insinuates that the mentally ill are sub-human is repellent, but I suppose you might not even realize that you are doing that. You may think of yourself as a model of logical, predictable and safe behaviour. I'm so tired of engineers who deny that there is any irrational element in their makeup. It is a naive thing to claim and a lame kind of deluded bid for superiority. "Others might be irrational, but not me!" Spare us. That attitude is the curse of HN and YC.
      - pkaye 7y ago
jdietrich 7y ago
The position of the committee given in the guidelines on Article 14 appears to be completely untenable and fundamentally conflicts with the Article 10 right to life. Unless I have profoundly misunderstood their arguments, their position is that someone with a mental illness or intellectual disability may not be deprived of liberty on the basis of that illness or disability (or risks following from that illness or disability), ever, under any circumstances. That interpretation would forbid the carer of someone with severe intellectual disabilities from stopping them if they tried to run into traffic. It would forbid a care home for people with severe dementia from preventing patients from wandering off, even if those patients are agitated, disoriented and non-verbal. It would forbid a paramedic from tackling someone who is distressed, delusional and trying to jump off a rooftop. There is a perfectly legitimate argument to be had about the legitimacy of institutionalisation - even brief, time-limited institutionalisation - but these guidelines make a nonsense of the CPRD. It seems to me to be self-evident that some people lack the mental capacity to act in their own self-interests at least some of the time and would, left to their own devices, be at serious risk of death. I do not understand how the right to life and the absolute right to liberty can be compatible.

williamscales 7y ago

The discussion in the article gets to an interesting point: while the CRPD takes an absolute position on the issue of involuntary confinement of mental patients, it also takes an absolute position on requiring the state to provide the right to independent living and the right to health to folks with mental illnesses. "if one of his (legal) tools as a psychiatrist is to be removed, there needs to be a corresponding commitment from society to do better by all its members. It is precisely this commitment that the CRPD demands through, for instance, the obligation it imposes upon states to secure the right to independent living for those with disabilities (Article 19) and the obligation that it imposes upon states to secure the right to health of those with disabilities (Article 25). If those obligations are carried through, and proper attention paid to the socio-economic factors underpinning mental ill-health, then it is not too much to suggest that the need for coercion will be dramatically reduced as the (perceived or actual) choice for clinicians such as Dr Gosney will not be between detention and watching a patient die." Interpreted this way, involuntary confinement should never be necessary because the state must have already provided something that would obviate it. I'm not sure what that something is, however.

deleted 7y ago
[deleted]

soup10 7y ago

Psychiatrists and their colleagues have been lobbying for increased discretion to detain people in spartan psych wards and administer drugs and other dubiously ethical procedures like ECT and lobotomies without consent or through coercion since the dawn of the profession. That is how they are taught and that is the culture they work in.

outlace 7y ago
Resident psychiatrist here. That is simply not true. [See similar comment below]. I'm a resident psychiatrist, almost all patients we admit at my institution sign in voluntarily. The times we involuntarily admit patients are when they are so symptomatic that they would very likely die without treatment (e.g. they refuse to eat because they think their food is poisoned). Psychiatrists have no interest in detaining people, quite the opposite. Most of the time I'm dealing with patients who are feigning symptoms e.g. pretending to be suicidal to get admitted because they're homeless, and so we have to admit them lest we get sued, despite the fact there is good evidence many times an admission would be counter-productive. You have people who will sue psychiatrists if they don't admit someone and that person ends up killing themselves, and you have people who think psychiatrists are wantonly admitting too many people. Also there's nothing dubiously ethical about ECT. It's one of the safest procedures in psychiatrist and the most effective. Many many patients consent to do ECT voluntarily.
- soup10 7y ago
  Ah yes, nothing dubiously ethical about strapping a patient to a gurney, administering tranquilizers(to reduce convulsions) and indiscriminately shocking the brain with high voltages. Everyone that volunteers for ECT is coached into it, nobody would naturally come to the conclusion that it's a good idea.
  - outlace 7y ago
    That's just wrong. I have seen many patients request ECT (many of them are well-educated) because they've tried everything else and are medication resistant. It's only significant side effects are temporary memory issues. ECT should be used more not less, it is way safer and more effective than many medications psych or not. Patient's are typically brought into a surgical suite, put to sleep and given paralytics as if they were having a surgery. The brain is shocked for like 10 seconds, the patient is asleep and paralyzed, no convulsions happen, no discomfort to the patient. The anesthetics wear off in a couple minutes, the patient wakes up and is able to go home, just as if it were some minor outpatient surgery.

olliej 7y ago

I recognize there is a history of over application of medication for mental health "defects" - I mean for HN crowd the involuntary "treatment" of Turing for the "mental illness" of being gay. But at the other end of the spectrum you have paranoid schizophrenia who for obvious reasons don't trust doctors. The CRPD seems to take the view that treating, even temporarily, is illegal and so you couldn't treat the patient to get them lucid enough to consent. Imagine a case where someone has been unable to get there meds (through some disaster or whatever), and so relapses and becomes paranoid and won't allow treatment. Even if when not relapsed they do want to take the medication. The CRPD appears to say that the patient can never be treated so any relapse must in effect be permanent and their life is functionally over. It also prohibits incarceration: so you're only option is the American system of waiting for someone with mental illness to commit a crime and then putting them in jail - they CRPD apparently explicitly prohibits putting them in a mental health facility. It is hard to see how that interpretation is possibly good for anyone - the patient, the patient's family, victims of any crimes that they commit, etc. You could extend the argument to say someone with diminished mental capacity should not be able to claim that in their defense because by definition that would be discriminatory. It's also hard to see how an untreated patient could possibly provide a meaningful defence of themselves if put on trial. Again, the rationale for the CRPD is sensible: it's trying to prevent things like how LGBT people have been "treated" by physicians, or things like the holocaust which also targeted people with mental health issues. But the apparent extremism seems hugely problematic.

morpheuskafka 7y ago
It's worth noting that committing a crime doesn't necessarily equal harm having occurred to people yet. For example, brandishing a knife is grounds for immediate arrest, before someone is stabbed. Communication across state lines to plan many types of offenses is illegal, and grounds for arrest before the actual offense occurs.
candiodari 7y ago
You mean to say that it was an important component of both the emancipation movement, the anti-racism movement AND and the LGBTQ movement to ... ban psychiatry out of the lives of these people. Psychiatry has a history of being abused for social control, mostly by psychiatrists. Freud defended rapists, often by using physical violence and long term incarceration against their victims. Hans Asperger mass-executed children at "Am Spiegelgrund". His signature is on the paperwork for locking children into a ward for execution. Jo Erik Brøyn, Norways "top child psychiatrist" (chairman of the council that decides to place children) ... was convicted last year to 22 years for child porn. He had placed 2 children ripped from their parents ... into his own care. It is not a temporary thing. Psychiatry served to violently abuse children when it was originally created. In fact you can make a decent argument that's WHY it was created. And last year VERY important psychiatrists were convicted for doing ... the same ... also to tens of thousands of children, just in Norway alone.