Human Rights
International Human Rights Lawyer Tina Minkowitz challenges Mental Health System
IF someone decides not to have chemotherapy in Victoria; thatโs their choice.
If they want to opt out of an organ transplant, or forego taking daily insulin injections; people have that right.
But if you have a mental illness in this state and you refuse treatment, you will most likely be treated against your will.
This emotional and ethically fraught debate of whether someone with a mental illness has the insight to rationally refuse treatment is bread and butter for Tina Minkowitz.
Ms Minkowitz, one of the worldโs leading human rights lawyers in the areas of mental health and disability, tackled these issues as guest speaker at the Australian Federation of Disability Organisationsโ conference in Melbourne last week.
The New York resident is also co-chair of the World Network of Users and Survivors of Psychiatry, a movement that sees involuntary mental health treatment as paramount to torture.
And her visit, in which she stayed in Eltham, was timely given Victoria is undergoing the first comprehensive review for more than two decades of its Mental Health Act - the laws surrounding the involuntary treatment of the stateโs most unwell.
Harmful, not helpful
Ms Minkowitz, who played a key role in the drafting of the UN Convention on the Rights of Persons with Disabilities, said often the best intentions from medical professionals were often actually more traumatic than therapeutic.
โWhat does it mean to say somebody needs help? Because I donโt think it helps to put somebody in a locked ward,โ she said.
โOften the person is put in handcuffs or in an ambulance, sometimes your clothes are taken away and you have to put on a hospital gown or a nightgown.
โAnd then youโre put behind a locked door, youโre almost certainly going to be forced to take drugs.โ
She said the key to making human rights the focus of the mental health system was to move away from psychiatric medication as core of the system. โI think that needs to be turned on its head.
โThe central piece needs to be engaging with people on a human level, seeing if there are conflicts or issues with their family or community and have psychotherapy available among other alternatives.โ
Learning to listen
Coersive treatment, no matter what the intension, should never be allowed no matter what the situation Ms Minkowitz said.
โAn example where harm reduction is never coercive is domestic violence.
โIt might be really painful to hear the sounds of your friend or neighbourher getting beaten up by her abusive spouse, but it doesnโt give me the right to get her out of there against her will and put her somewhere I think sheโd be safer.
โThatโs something the womenโs movement addressed; you donโt do that.
How do you deal with a friend in that situation? You talk to her, you make opinions available to her, you let her know that itโs not ok, you train the police so they can respond in a useful way.
You donโt see the person as the problem, to be done things to. You donโt see her as incapable and I think in mental health the opposite is true.
The assumption is because this person is going through this intensive, emotional, psychic state that theyโre incapable of making any decision about where they want to go or what kind of help they need, and thatโs just not true.โโ
Legislating consent
Ms Minkowitzโs drive to lobby for improving the human rights for those with a mental illness, was ignited from what she heard during menal health review hearings in Brooklyn, New York.
What I found was that in New York people have a right to refuse drugs unless theyโre deemed to lack the capacity to make a rational decision. So just the fact that youโre an involuntary patient didnโt mean theyโll force drug you on an involuntary basis.
When that came out people in the movement thought thatโs great. Of course I have the capacity to make a rational decision, we said. I know those drugs are poison, I know how bad they are, Iโm making a very rational decision to refuse.
But thatโs not how the courts were seeing it.
That was the main thing that struck me when doing these observations; sometimes a psychiatrist would make a mere observation that these people lacked the capacity to refuse treatment. A lot of times they used the word โโparanoiaโโ to categories the personโs refusal of treatment.
The judge would say โorder grantedโ, meaning their psychiatrist could go ahead and force them to take it.
We may have the fight in theory, but in reality itโs useless to protect us because itโs so easy for them to say if youโve got a mental illness, of course you lack the capacity to make a decision.โโ
New era
But with the convention ratified, and activists like Ms Minkowitz now monitoring its implementation, she said the system was entering โa new eraโ in dealing with mental health issues from a human rights perspective.
I think there was a previous point in which people were starting to understand that you had to apply some human rights principals to the mental health system, that it couldnโt just go on unreined and unregulated, allowing doctors to do coercive treatments, allowing people to be locked up for long periods of time without any kind of oversight,โโ she said.
โBut it was still assumed that these coercive practices were legitimate, and that basically human rights meant you had to regulate them and limit the power to doctors, but not take it away entirely.
โNow - and itโs associated with the Convention on the Rights of People with a Disability - what this convention comes out of is about 30 years of development from the survivors of psychiatry, that the primary demand of that movement has been to get rid of the coercion and seeing forced treatment as something violent, a form of assault or torture.
โPeople are seeing that thereโs the possibility of a new way to look at โmadnessโ.
โItโs up to people in Australia to decide what they think is a useful strategy and lobbying for that to happen. Maybe implementing goals for reducing forced druggings, electro-convulsive therapy, and the use of seclusion and restraint might be an interesting way to go in this country.โ
By: Brigid O'Connell
When: 7/2/2014
