Is involuntary treatment for mental illness allowed under CRPD?
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Read Article 14: 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for people with mental illness is not allowed, and any laws that contain provision for involuntary treatment must be repealed.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/GuidelinesA...
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?
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."
So either we have 2 tracks or we continue to fill jails with the mentally ill even though it is obviously an incorrect application of justice.
> What results is an environment where boundaries are blurred and children accused of crimes are made to believe that everyone in the courtroom is there to “help” them when, in reality, defense attorneys are the only parties obligated to advocate on their behalf.
- The Marshall Project, https://www.themarshallproject.org/2017/05/15/give-juveniles...
Just to name a few:
* conspiracy to commit a whole range of crimes, including murder
* threatening people with an actual weapon
* threatening people
BUT this would prevent mental health "professionals" from detaining light or "highly functional" cases of things like autism and forcing "treatment" (confinement, nothing more) on them. And let's not forget that they are very much not above forcing themselves with brutal violence, locks and forced medication onto perfectly healthy patients when given the chance [1].
Nor are they above causing mental health issues in order to create themselves easy patients. [2] Or just lying. [3] (note: this is one of the centres where psychiatry was developed)
Those easy but involuntary patients would be replaced, out of necessity, with people with actual mental disabilities, homeless, who need constant care, are addicted, destroy the place and/or are actually dangerous to the staff. In other words, almost exclusively patients that cannot be helped and/or are dangerous. This would destroy psychiatry.
Good riddance.
[1] https://en.wikipedia.org/wiki/Rosenhan_experiment [2] https://en.wikipedia.org/wiki/Controversies_about_psychiatry [3] https://www.thelocal.ch/20190701/locked-up-for-being-differe...
As a resident psychiatrist, I can tell you that most of the time I'm not conflicted about involuntarily admitting a patient, at my institution it happens rarely, almost all patients sign in voluntarily and can request to leave, in fact most of the time we deal with patients who actually want to get admitted and will feign symptoms to do so, forcing us to admit them. 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).
Every field has its history of controversies, that doesn't mean the field as a whole is inherently bad.
Psychiatry has gotten caught, repeatedly, at a 100% false positive rate. Think about it, from a mathematical point of view: anything significantly over 50% can only be the result of fraud. Or more specifically, declaring patients ill irrespective of the variable: the patient. Just being completely wrong will only ever get you to 50%, so let's say you might get to 55% on a particularly bad day, but anything higher is fraud.
This has not happened in just 1 experiment but has been repeated, and repeated, and repeated again. In the 19th, 20th and 21st century.
Furthermore actual diseases have systematically been removed from psychiatry. Everything from epilepsy, seizures, milk allergies in children (yes, really), multiple sclerosis, cancer (esp. brain tumors), various hormone imbalances, a number of parasitic infections and other "unexplained" diseases that may interfere with normal behavior (either directly, or for example by causing long-term pain. Or simply by having symptoms but being undiagnoseable (or merely undiagnosed). For example, in both cancer and multiple sclerosis patients may present with symptoms in some cases years before a test for the disease shows a positive result. In the case of cancer a test may in fact remain negative right up to the point the patient dies, diagnoses have been corrected through autopsies where it really wasn't the docter's fault. But the problem is, when referred to psychiatrists, these patients were generally diagnosed with mental illnesses, and treated, in quite a few cases right into the grave.
Psychiatrists had all sorts of very convincing theories (except not really if you read them) how they were going to fix these. Needless to say, none of them were ever verified experimentally, and quite a few have been caught at outright fraud. Even Freud himself is known to have knowingly contributed to help perpetrators of rape hide their crimes by convincing women they didn't happen, and using violence when that failed.
And when you read today's psychiatric theories, for example about EMDR, you know: give it 10 years, and we'll know it to be a fraud as well. Shapiro had plenty of chances, more than enough data, patients, and all the authority and places to publish she could possibly want to verify her treatment. She didn't. Not in over 2 decades. Give it 10 years, and we'll know: it's because she knows it, and herself, to be a fraud. Even if you believe that she wasn't sure, that would mean you concede that she experimented on patients for 2 decades. Any other medical practitioner would not just have been fired, they would have been convicted to decades of prison.
And let's take today's favorite diagnosis Autism/ADHD/Autism Spectrum Disorder. I'm going to have to violate Godwin's law on that one. It sounds absurd, but it's true: Hans Asperger invented that ... to "justify" the large scale killing of Polish and Jewish children in "Aktion T4". Let me just provide a link because I would readily understand you not believing me [1]. This guy is revered by today's psychiatrists, for the same reason Freud was. Not, of course, because he helped people, in fact he killed far more than Dr. Mengele, but because he enabled psychiatry to grow.
Even the more benign theories, like famously Taylorism, turned out to be ... a fraud. Quite simply a fraud. There is zero chance Taylor believed in his theories himself, as he paid people to lie about them.
Second, clear patterns of fraud keep coming forward over time. Famously "hysteria" and, of course, running away from a slave master ("drapetomania"), getting raped, being female in general, being gay (although choosing voluntarily for prostitution is still "being treated" with the patients incarcerated. Well, only for women of course). It turns out psychiatry was only used for social control in those (many) cases. The fight against psychiatrists was an important (and now de-emphasized) part of emancipation in both cases.
HIV actually manages to fall into both categories. God's punishment for being gay, with of course psychiatrists making sure some of that heavenly punishment is not just restricted to posthumous roasting.
Today is different ? Let me just say "VERY unlikely". If something was true for 200 years, and there haven't been any big changes ... why would anyone believe it has changed ?
And psychiatry doesn't actually help patients. This is a somewhat problematic issue that keeps popping up. In empirical studies, it keeps coming forward that many psychiatric treatments don't work better than a placebo. A great number of treatments, that are nevertheless used, are known to be far worse than doing nothing at all. There isn't a single involuntary treatment that's empirically verified better than a placebo despite more than a hundred years of searching for one. Antidepressants are famous for their incredibly bad long-term effects, yet psychiatrists keep prescribing them. Before you say "pharmacological industry", THEY label their products as having a maximum indicated usage of weeks to months. Psychiatrists and even nurses however, give them to patients for years, with disastrous effects. For children Ritalin (and Valium before it) are known to have extreme negative effects on child development with anything but extreme short term use. Valium was in fact quite exceptional in that it's long term effects were relatively benign, but it was addictive and therefore a drug. But it gave much less serious long term problems, especially compared to prozac/fluoxetin/SSRIs, what they use now. The problem with Valium was also that it was abused on a large scale, and when push comes to shove, it's similar to keeping a kid drunk for years, even if liver failure is much less likely. But of course sedation leads to serious problems if it's used for any length of time. Again, any other medical practitioner giving patients medications beyond their indicated usage with known bad effects on the patient ... would lead to jail time.
It's time that the same becomes true for psychiatrists and social workers.
He, like a LOT of famous psychiatrists, certainly also including Hans Asperger, should be treated like dr. Mengele and excised from the profession, all their theories replaced in psychological texts, to be replaced with a warning. Like in medical texts that there were famous and incredibly horrible crimes committed by famous psychiatrists.
The only use Freud and Asperger should have for the profession is to illustrate the need for an ethical code of conduct and severe penalties for even mild violations of it. Because you just cannot imagine how horrible the lives of quite a few people got with "help" from these people.
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.
"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.
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.
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.
Personally, I choose to believe my clinician, an experienced psychiatrist, who said bluntly to me "You don't want that. ECT makes you stupid." Loss of cognitive abilities is something I (and many techies) can't afford to risk.
https://www.sciencedirect.com/science/article/pii/S106474811...
https://psychcentral.com/lib/research-findings-on-memory-and...
> "...We aimed to examine whether long-term effects of ECT on discrete memory systems could be detected in patients with B[ipolar]D[isorder]... Compared with healthy subjects, patients had verbal learning and memory deficits. Subjects who had received remote ECT had further impairment on a variety of learning and memory tests when compared with patients with no past ECT. This degree of impairment could not be accounted for by illness state at the time of assessment or by differential past illness burden between patient groups..."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911194/
I don't think there's sufficient evidence on the long-term effects yet and a high incentive for clinicians to reach for ECT as something that works when nothing else will.
It would probably be better both for your aims and those of the parent commentator if rather than defend your practices and instances where you do practice involuntary committal, if you specified the wide range of cases where the public believes involuntary committal would happen and it wouldn't actually.
And for all our peace of mind, please do keep an eye on whether that list starts to shrink. Acquaintances who want to change the subject aren't the only ones who want to enforce the overton window.
Moreover, there is no incentive for psychiatrists to be admitting people inappropriately. Psychiatrists are physicians and want to feel like they're actually doing something useful like everyone else. I have no interest in admitting a patient that doesn't have a treatable illness. There are plenty of patients with real illnesses to treat.
The concern I find more reasonable, having seen the role it plays in the old world, is that the mental healthcare community over here will seek to expand its opportunities to commit that kind of abuse. And why not? You seem fairly secure in your belief that none of your colleagues would actually abuse that power if you had it.
https://en.wikipedia.org/wiki/Gustl_Mollath
>the court deemed him a danger to the public and declared him insane based on expert diagnoses of paranoid personality disorder. Mollath's forensic incarceration for seven years and the surrounding legal judgments became the basis of a public controversy in Bavaria and the whole of Germany when at least some underlying elements of his supposedly fabricated paranoid story about money-laundering activities at a major bank turned out to be true after all.
There's indeed nothing dubious about ECT: it creates temporary behavior changes ... and permanent cognitive impairment. There is no real argument about this. If you're a psychiatrist, can you quickly remind me of "the first duty" ?
The problem is not even that it doesn't work. Like aversion therapy it works. In the same sense that a bullet to the head is very effective against back pain. You're causing a MUCH bigger problem than you're curing.
Here's the links with psychiatrists getting caught at large scale abuse, mostly for money, with sex a second reason, and it seems sometimes literally just for ego. From selling children to brothels and paedophiles to directly pimping out "patients" in the local prostitution scene. All done by psychiatrists, social workers, psychiatric nurses and "child protection":
https://www.france24.com/en/20190627-italy-arrests-18-allege...
https://nltimes.nl/2019/06/17/victim-sexual-abuse-youth-care...
https://sci-hub.tw/10.1257/aer.97.5.1583 It turns out NOT treating seriously kids with "serious" psychological problems has ... better outcomes than treating them.
https://en.wikipedia.org/wiki/Rotherham_child_sexual_exploit...
https://www.bbc.co.uk/news/resources/idt-sh/norways_hidden_s...
http://www.childpact.org/wp-content/uploads/2014/04/Reform_s...
It goes on and on and on. EVERYWHERE. US. Netherlands. Italy. Japan. China. Australia.
I mean how bad does it need to be before one can reasonably say "abolish the whole thing". At mimimum there need to be strong guarantees tying the hands of psychiatrists and social workers, and making sure the enforcement of patient rights reaches deep into every institution and all social work facilities.
I genuinely believe the vast majority want the best for their patients. In my experience, psychiatrists are far more conservative with treatment than primary care physicians are with mental health conditions (see overprescription of ritalin, antidepressants, and benzodiazepines).
The narrative that psychiatrists and other mental health practitioners are in some way nefarious further stigmatizes mental health sufferers and limits access to care.
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.
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.