lørdag 26. november 2016

Innspill til Helse- og omsorgsdepartementet vedr strategi om psykisk helse

 
Mail sendt til Helse-og omsorgsdepartementet:
 
"Hei,
 
Jeg viser til invitasjonen fra Helse-og omsorgsdepartementet til å gi innspill til strategi om psykisk helse http://www.sfj.no/ato/esa62/document/invitasjon-til-aa-gi-innspill-til-en-strategi-om-psykisk-helse-og-til-moete.16115330d16115330.daf8c71821.pdf
 
Dette er undertegnedes innspill. Jeg skriver altså ikke på vegne av en bestemt organisasjon. (...).

Med vennlig hilsen
Anne Grethe Teien"



Innspill til Helse- og omsorgsdepartementet vedr strategi om psykisk helse



1)   Hva kjennetegner et psykisk helsevennlig samfunn?

a) I et psykisk helsevennlig samfunn er det rom og aksept for annerledeshet.

b) I et psykisk helsevennlig samfunn er arbeidslivet (og andre arenaer) bra på å tilrettelegge mht. behov som ikke nødvendigvis er synlige og åpenbare. En forstår f.eks. at åpne landskap ikke funker for enhver, en forstår at noen er mer støysensitive enn andre og mer sårbare for sosialt stress, og legger til rette så godt det lar seg gjøre for slike faktorer.

c) I et psykisk helsevennlig samfunn er det god beskyttelse mot mobbing, seksuelle overgrep, vold, overgrep i helsevesenet etc.

d) I et psykisk helsevennlig samfunn er psykisk helsevernloven fjernet og myndighetene har fremsagt en offisiell unnskyldning for den diskriminering og de grove menneskerettsbrudd som tidligere var legitimert gjennom dette lovverket. Det har i denne sammenheng også vært viktig for myndighetene å offentlig anerkjenne de traumer, re-traumatiseringer og andre skader dette har forvoldt hos utsatte som egentlig trengte hjelp, da dette tidligere i stor grad ble møtt med et bortvendt blikk, omdefineringer og bagatellisering. En har nå startet et stort reparasjonsarbeid i tråd med kravene fra torturkonvensjonen (1).

e) Når en i et psykisk helsevennlig samfunn får behov for psykisk helsehjelp, er denne hjelpen ikke noe som påtvinges, og den er basert på personens egne preferanser og behov. Myndighetene har gått helt bort fra ideen om diagnosestyrte pakkeforløp, da de erkjente at dette ikke var veien å gå. De valgte i stedet å utvikle et meget mangfoldig og kreativt psykisk helsevern, med et stort spekter av hjelpetilbud, der det er like greit å få hjelp av kontakt med dyr som å gå i samtaleterapi; like greit å velge medisinfri behandling som medisiner; like greit å ha nytte av et malekurs som av psykoedukasjon; like greit å ønske involvering av familien som å ikke ønske det; like greit å trenge langtids psykodynamisk terapi som et superkjapt CBT-opplegg; like greit å ville snakke med en filosof som en psykolog osv. Myndighetene fant også ut at et slikt mangfoldig psykisk helsevern, der hjelpen ikke styres av diagnose og der den ikke er begrenset til visse terapeutiske metoder, på lang sikt var langt bedre samfunnsøkonomi.


2)  Hvordan sikrer vi økt brukerinnflytelse i utformingen av tjenester både på individnivå og på systemnivå?

a) Få mennesker fra den såkalte brukersiden inn alle steder der beslutninger som angår dem tas, også i departementene. «Ingenting om oss uten oss». Artikkel 4. 3 av CRPD sier følgende: “In the development and implementation of legislation and policies to implement the present Convention, and in other decision-making processes concerning issues relating to persons with disabilities, States Parties shall closely consult with and actively involve persons with disabilities, including children with disabilities, through their representative organizations.” Så en slik systemisk, aktiv involvering av personer med psykososiale funksjonsnedsettelser på arenaer der beslutninger om dem tas, uavhengig av hvor høyt oppe i systemet arenaen måtte befinne seg (som f.eks. Utenriksdepartementet), er med andre ord et krav fra konvensjonen.  

b) Utarbeid på systemnivå tilgang til CRPD-baserte støtteordninger, slik at retten til rettslig handleevne og til å ta egne valg hva angår hjelp og behandling ivaretas til enhver tid, også i krisesituasjoner.

c) Gå bort fra å fortelle folk som sliter hvordan de har det, hva de trenger, hva de bør gjøre og hvordan de bør tenke om seg selv, virkeligheten og sin egen situasjon (om de da ikke spesifikt ønsker det selv). Dette krever sensitivitet og gehør i møte med den enkelte.


3)  Hvordan kan vi redusere tvangsbruken?

Tvangsbruken reduseres ved at Norge tar konsekvens av sine internasjonale forpliktelser og fjerner tolkningserklæringene til FN-konvensjonen for rettighetene til personer med funksjonsnedsettelser – CRPD (2, 3). Tilleggsprotokollen for individuell klagerett må også ratifiseres, og den diskriminerende særloven må bort (4, 5: s 25). Ingen skal måtte utsettes for psykiatrisk behandling mot sin vilje – og fram til den praksisen forbys må norske myndigheter som et minste minimum gi enhver som ønsker det adgang til full juridisk reservasjonsrett både mot tvangsmedisinering og nødretts-ECT (elektrosjokk). Se også 1. a, d og e og 2. b, c (over).


4. Hvordan sikrer vi best mulig samhandling og samarbeid mellom ulike hjelpetjenester og ulike tjenestenivå?

La dere inspirere av Stangehjelpa på Hedmark. Lytt til Birgit Valla.



Kilder:

2)      “We are not violating the human rights. -Yes, you are!” Av Anne Grethe Teien. Skrevet i forbindelse med en internasjonal CRPD-kampanje med bidrag fra sivilt samfunn som ble presentert under den 15. CRPD-samlingen i Geneve. Teien fokuserer i innlegget spesielt på Norges forhold til konvensjonen https://absoluteprohibition.wordpress.com/2016/03/15/we-are-not-violating-the-human-rights-yes-you-are-by-anne-grethe-teien/
3)      Se til CRPD, Høie. Av Anne Grethe Teien. Innlegg på Dagsavisen Nye meninger i forbindelse med endringsforslag til psykisk helsevernloven og opprettelse av tvangslovutvalget: http://www.dagsavisen.no/nyemeninger/se-til-crpd-h%C3%B8ie-1.746300
4)      Meld. St. 39 (2015-2016) Individklageordningene til FNs konvensjoner om økonomiske, sosiale og kulturelle rettigheter, barnets rettigheter og rettighetene til mennesker med nedsatt funksjonsevne Åpen høring i Stortingets utenriks- og forsvarskomité torsdag 17. november 2016. Program:  https://stortinget.no/no/Hva-skjer-pa-Stortinget/Horing/Horingsprogram/?dateid=10003986 Opptakhttps://stortinget.no/no/Hva-skjer-pa-Stortinget/Videoarkiv/Arkiv-TV-sendinger/?mbid=/2016/H264-full/Hoeringssal1/11/17/Hoeringssal1-20161117-102544.mp4&msid=256&dateid=10003986




mandag 25. juli 2016

Some thoughts about language policing

I think there is a lot of language policing around: wanting to arrest other's words, language, because their expressions do not suit one's own policy. It is amazing humans can even speak! Not everyone has verbal language. To have a verbal language can in many ways be seen as a luxury. I wish the Language Police could think more about this - that the words, the language that it wants to arrest might be the- or one of the most important links to humanity for this one person. Too much of this too little of that - for whom? A language that does not suit one person can suit someone else. I am not talking about verbal bullying/psychological terror here (- or maybe I am, as the Language Police has its psychologically abusive sides, too). I am talking about all these ways of saying: -Don't use that term, use this instead. -Your language is too academic, your language is too little academic. -You use too many strange words. - You describe your own situation, yourself, with terms that I would not prefer. Why do people try to disturb and interfer with eachothers ways of expressing themselves so much? OK, people can have problems understanding eachother when they live on different language planets, but with a mutual willingness to communicate and ask for clarification when needed, much good dialogue is still possible. And sometimes dialogue may not be possible or something one wishes for either.

Of course there are contexts where - at least the idea of - a 'common ground language' is relevant and important to aim at. My main point is: I think it would be good to replace many projects of narrowing in verbality with more appreciation of the multitude of verbal expressiveness. In my view it is clear that societies benefit from a rich variation of expressions - including in the verbal domain. Orwell's nightmare scenario with the newspeak based on extreme language- and thought policing is, as a contrast to this, not unrealistic -or even unreal. I think that a basic mutual respect and a motivation to listen in to eachother usually is generally a much better foundation for good and dynamic dialogue and exchange of ideas, knowledge, than language policing which, if "successful" in praxis ends up with the opposite: a rigid, fearful, sensored communication style dominated by rules about 'correct' and 'incorrect' language and implicitly 'correct'/'incorrect' opinions and ways of understanding reality. I post this - just as a small verbal water drop into the world - fully aware there are many more aspects to this. Much more to say.

onsdag 29. juni 2016

Se til CRPD, Høie

Innlegg av undertegnede på Dagsavisen Nye Meninger 29. juni 2016

Ingress: "Helse- og omsorgsminister Bent Høie og regjeringen har lagt fram forslag til lovendringer som de mener vil gjøre det vanskeligere å bruke tvang i psykisk helsevesenet. Et utvalg er også nedsatt som skal gjøre en samlet gjennomgang av tvangsreglene i helse- og omsorgssektoren. Utvalget skal levere sin rapport innen 1. september 2018".

Hele innlegget kan leses her:  http://www.dagsavisen.no/nyemeninger/se-til-crpd-h%C3%B8ie-1.746300

mandag 16. mai 2016

Kommentar til "Are Psychiatrists Playing God?" av Peter Breggin


Jeg leste et innlegg av Peter Breggin som heter "Are Psychiatrists Playing God?" Innlegget kan leses her: http://www.madinamerica.com/2016/05/psychiatrists-playing-god/ Innlegget vakte mange tanker og reaksjoner i meg, og jeg skrev en lang kommentar på Erfaringsnettverket (Facebook). Her er den:

For meg var tvangs"behandling" i seg selv en form for langsom, _påtvungen_ eutanasi som jeg overlevde mot alle odds. Jeg vil ellers si at Nederland og Belgia ikke er veldig langt unna, og debatten om aktiv dødshjelp er også på agendaen i Norge. Når en åpner opp for aktiv dødshjelp, som  kanskje _kan_ være berettiget i noen ytterst sjeldne tilfeller*, er faren "the slippery slope". Jeg mener de har falt utfor den bakken i disse landene - og at det sannsynligvis kan komme til å eskalere ytterligere. Med hvilken rett, _med hvilken rett_ stiller Psykiatrien, en høyst vaklevoren og kritikkverdig "vitenskap", seg overfor et menneske som har fått den ene eller annen på ingen måte valide psykiatriske diagnosen og sier: "Du har en uhelbredelig sykdom, du kommer til å være syk livet ut"? Det var et retorisk spørsmål fra min side. Jeg mener helt klart: Med ingen rett. En slik påstand har ikke vitenskapelig belegg, og det kan påføre en person som der og da har det forferdelig smertefullt til å tenke: dette kommer aldri til å gå over. Det har vist seg gang på gang på gang at Psykiatrien har tatt- og gjort så grunnleggende feil at redningen var å komme seg ut av dens forståelses-og handlingshorisont. - Og ja, andre har blitt hjulpet. - På den ene side kan altså Psykiatrien påtvinge "behandling" som kan få fatale iatrogene utslag og kalle det nødvendig helsehjelp, på den annen side er det altså kommet dit hen i Nederland og Belgia, at en del mennesker med psykiske lidelser kan be om aktiv dødshjelp - og få det- bl.a med den betingelse at de anses å være behandlingsresistente / uhelbredelige. Jeg synes dette er meget skremmende. Andre vil kanskje trekke inn rettighetsperspektivet og spørre hvorfor skal ikke enhver borger også ha retten til eutanasi- det er ingen forbrytelse å ta sitt eget liv - og eutanasi er en mer "human" måte. Jeg kommer nok aldri til å bli en pådriver for aktiv dødshjelp, så der skilles våre veier i stor grad ad mht debatt-premissene, selv om de gir logisk mening. Jeg får ikke skrevet alt jeg kunne si om denne tematikken her, min kommentar har allerede blitt veldig lang. Men mitt poeng er uansett her at de lovmessige kriteriene som brukes mht psykiske lidelser og eutanasi i Belgia og Nederland er basert på falske antagelser. Innen recoverytankegangen trekker en inn viktigheten av håp. Psykiatrien er kjent for å ha fratatt mange - nettopp - håp. Dette med håp er ikke noe en kan dytte på et menneske som en slags gavepakke, det er noe som, tross tilsynelatende håpløse omstendigheter, kan oppstå i personen selv når betingelsene endrer seg, når NOE endrer seg. Dette noe kan være at en møter et menneske som betyr en forskjell, noen som bryr seg, noen som ser og forstår. Og det kan være veldig mye annet. Hjelp som hjelper - det har blitt et slags mantra for meg. Og fasiten på hva som er hjelp som hjelper, den sitter ikke Psykiatrien inne med. Dører kan åpne seg, litt for litt, eller plutselig, når en som sliter psykisk møtes utfra hvem nettopp dette enkeltmennesket er, og hva nettopp dette mennesket formidler at det behøver. Der har psykisk helsevern fortsatt mye å lære. Jeg er motstander av både tvangs"behandling" og eutanasi i møte med mennesker som sliter psykisk. #hjelpsomhjelper

*Hva slags tilfeller har jeg ingen klare formeninger om. Jeg er generelt meget kritisk til aktiv dødshjelp.

Lesning:
Euthanasia for 'Untreatable' Mental Illness: New Data. Medscape Medical News, February 10, 2016
http://www.medscape.com/viewarticle/858786

onsdag 27. april 2016

Aftenposten-kommentar. #tvang #crpd

Det er for tiden en del politisk og medialt fokus på psykiatriens tvangsbruk - med et kritisk blikk. Bra! Dette henter jo da også fram dem som mer eller mindre ønsker å forsvare dagens regime. En av disse heter Steinar T. Olsen og er vernepleier. Lenke til hans innlegg er her: http://www.aftenposten.no/meninger/debatt/Tvang-i-psykisk-helse-er-omsorg-Man-beskytter-mennesker--Vernepleier-Steinar-T-Olsen-8444849.html Jeg skrev en kommentar under innlegget og pga en tilbakemelding (ikke fra forfatteren) skrev jeg en kommentar til - og den ble ganske lang! Vel, her er den:

At personer med funksjonsnedsettelser diskrimineres og at deres menneskerettigheter brytes er selvsagt ikke et fenomen som er forbeholdt Norge. CRPD er en internasjonal konvensjon, en FN-konvensjon, i skrivende stund ratifisert av 163 stater, som blant annet utfordrer staters nasjonale lovverk og praksiser anvendt på personer med psykiske problemer, altså psykososiale funksjonsnedsettelser. Norge har foreløpig avgitt noen tolkningserklæringer knyttet til konvensjonen som i praksis fungerer som reservasjoner, og som LDO har bedt myndighetene snarest om å trekke tilbake. Norge ligger høyt internasjonalt på tvangsbruk i psykisk helsevern, og behandlingskriteriet, der en verken trenger være til fare for seg selv eller andre for å bli utsatt for tvang, anvendes ofte. I 2014 ble behandlingskriteriet alene brukt ved 72% (!) av tilfellene av etablering av tvungent psykisk helsevern blant voksne innlagte (1: s.37).

Det finnes gode alternativer til tvang og medisinering, og brukerfeltets langvarige krav om medisinfrie tilbud er nå i ferd med å bli realisert. Helse- og omsorgsminister Bent Høie forventer at alle regionale helseforetak skal ha etablert tilbud om medikamentfri behandling innen 1. juni 2016. Det skal også gis tilbud om nedtrapping av medisiner for dem som ønsker det. Det vil ta lenger tid å få disse behandlingsmiljøene til å vokse og få mer rom i psykisk helsevern. Og det trengs et forbud mot psykiatrisk tvangsmedisinering, ikke, som Høie har varslet, en bevegelse bort fra diagnosekriterie til å fokusere mye på det han gammeldags og paternalistisk nok kaller «samtykkekompetanse». Ikke nok med at en mangler evidensgrunnlag for psykiatrisk tvangsbehandling, og at tvang skader og re/traumatiserer: Antipsykotika-behandling kan i seg selv påføre mye skade og bli til lite til ingen gagn. Leder av Nordisk Cochrane-institutt, prof. Peter Gøtzsche, argumenterer både forskningsbasert imot psykiatrisk tvangsbehandling og i tråd med CRPD. I et innlegg til en CRPD-kampanje nylig konkluderer han med følgende: "Abandoning using force will be harmful to some patients but it will benefit vastly many more. We will need to work out how we may best deal with those patients who would have benefited from forced treatment in a future where force is no longer allowed." (2).

Mest grunnleggende, mer enn evidensargumentene imot psykiatrisk tvangsbehandling, er CRPD-konvensjonen som skal sikre menneskerettighetene til personer med funksjonsnedsettelser. Artikkel 14 i konvensjonen sier at nedsatt funksjonsevne under ingen omstendighet rettferdiggjør frihetsberøvelse. Dette er en av artiklene Norge foreløpig har avgitt en konvensjonsstridig tolkningserklæring til. Psykisk helsevernloven har nedsatt funksjonsevne, «alvorlig sinnslidelse», som kriterium. Dette lovverket er derfor diskriminerende i seg selv. Videre sier altså CRPD's General Comment No 1 at psykiatrisk tvangsbehandling bryter med flere menneskerettigheter, inkl. tortur-forbudet og at alle må gis tilgang til nødvendig støtte, såkalt 'supported decision making', for å få ivaretatt egne valg mht behandling/ikke-behandling, også i krisesituasjoner, og at medisinfrie tilbud må være tilgjengelige.

Du spør om gode eksempler fra utlandet mht behandling. Jeg vil da trekke fram Open Dialogue (Jaakko Seikkula) i Nord-Finland. Open Dialogue er en nettverksbasert, dialogorientert og individuelt tilpasset tilnærming til mennesker i psykiske kriser. Tilnærmingen har vist oppsiktsvekkende gode utfall for personer med psykoser, med en recovery-rate på rundt 80% av deltagerne - majoriteten uten medisiner. Tankegodset fra Open Dialogue er også importert til Norge og andre land, i deler av psykisk helsefeltet som jobber for gode, humane endringer. Andre gode eksempler fra utlandet er Trieste i Italia og Familjevårdsstiftelsen i Sverige (3,4). Jeg tillater meg også å nevne Stangehjelpa (Birgit Valla)- på Hedmark.

Vedr fengsel: CRPD-konvensjonen krever at mennesker skal få tilgang til nødvendig støtte for å anerkjennes som rettssubjekter og få en rettferdig rettergang om de gjør noe kriminelt. Ingen skal kunne avskrives som psykotisk, utilregnelig, uten likeverdige juridiske rettigheter, og utsettes for psykiatrisk tvangsbehandling som sanksjon. Dommen skal være basert på en helhetsvurdering utfra ikke-diskriminerende kriterier. Om vedkommende havner i fengsel bør hen ha tilgang på god, frivillig psykisk helsehjelp, som innbefatter medisinfrie tilbud. CRPD representerer et paradigmeskifte som mange ikke har tatt innover seg enda. Det er en lang tradisjon og mye vanetenkning knyttet til at når diskriminering og menneskerettsbrudd skjer mot personer med funksjonsnedsettelser så anses det ikke som ekte diskriminering , ekte menneskerettsbrudd. Mette Ellingsdalen og Liv Skree, to som lenge har jobbet for implementering av CRPD i Norge, har sagt følgende: -Velferdsmodellen sier at vi er snille, og velger å hjelpe stakkars deg slik vi mener du har best av. Menneskerettsmodellen sier at vi er forpliktet til å hjelpe deg på dine premisser. (5)

Kilder:
1) https://helsedirektoratet.no/publikasjoner/bruk-av-tvang-i-psykisk-helsevern-for-voksne
2) https://absoluteprohibition.wordpress.com/2016/03/15/peter-gotzsche-forced-admission-and-forced-treatment-in-psychiatry-causes-more-harm-than-good/
3) http://www.triestesalutementale.it/english/mhd_department.htm
4) http://www.familjevardsstiftelsen.se/ 
5) http://napha.no/content/13795/-Ma-tale-mer-annerledeshet

søndag 13. mars 2016

- We are not violating the human rights. - Yes, you are!



Introduction
Psychiatric human rights violations are often  denied and trivialized, even distortedly re-defined as “human rights” and “right to necessary health help”. The UN convention for the rights of persons with disabilities, CRPD,  is changing that. CRPD demands an absolute prohibition of forced psychiatric treatment and involuntary commitment. These are important requirements in giving people with psychosocial disabilities equal human rights. In this text, I will look at different aspects of the CRPD related to that demand. I will illustrate with some references to Norway, the country where I live, showing ways in which the Norwegian Mental Health Act does not comply with the convention. I will also share some further reflections. Towards the end I have written a short version of my own experiences from forced psychiatry.  Mental health laws may vary between countries, but some elements are prevalent: the laws are typically directed specifically towards people with psychosocial disabilities and involve forced treatment and involuntary commitment . This text is written for the Campaign to Support CRPD Absolute Prohibition of Forced Treatment and Involuntary Commitment (17). Procrastinations must stop – CRPD-based law reforms must begin!

Norway and the CRPD
Norway ratified the CRPD June 3rd 2013, but came up with some interpretative declarations of article 12, 14 and 25 that undermine central parts of the convention (1).  Norway uses these declarations to try to defend the Mental Health Act and forced psychiatric treatment. In February 2015, the president of the Norwegian Psychological Association, Tor Levin Hofgaard, wrote an article asking for a clarification from the government whether health personnel violate the human rights when they follow the coercion regulations in the Mental Health Act (2). He referred to a report sent to the authorities in December 2013 by the then Equality and Anti-Discrimination Ombud -  LDO, Sunniva Ørstavik (3). The report said that the Mental Health Act is discriminatory and does not comply with the CRPD. LDO also urged Norway to quickly withdraw its interpretative declarations. In public, the LDO report was met with a noisy silence by the authorities.  So, as time had went on, Hofgaard asked for the mentioned clarification.  Anne Grethe Erlandsen, State Secretary in the Ministry of Health and Care Services, answered on behalf of the Norwegian authorities: “Vi bryter ikke menneskerettighetene” / - We are not violating the human rights (4). That answer is absolutely not right.

Norway uses much coercion in psychiatry. In spite of reduction strategies, the use of coercion stays at stably high levels (3: p.6-8; 5: p.20-23). Also, reduction strategies instead of CRPD-based abolishment strategies do not go to the core of the issue. Norway is used to see itself as a human rights protective nation and often does not hesitate to criticize other countries for their human rights violations. So it is maybe hard for the authorities to take in that the state of Norway  is actually accepting torture and other severe human rights abuses in its own mental health system, via the Mental Health Act.  Point 42 of the CRPD General Comments No 1 says as follows:

As has been stated by the Committee in several concluding observations, forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the rights to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). This practice denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the Convention. States parties must, instead, respect the legal capacity of persons with disabilities to make decisions at all times, including in crisis situations; must ensure that accurate and accessible information is provided about service options and that non-medical approaches are made available; and must provide access to independent support. States parties have an obligation to provide access to support for decisions regarding psychiatric and other medical treatment. Forced treatment is a particular problem for persons with psychosocial, intellectual and other cognitive disabilities. States parties must abolish policies and legislative provisions that allow or perpetrate forced treatment, as it is an ongoing violation found in mental health laws across the globe, despite empirical evidence indicating its lack of effectiveness and the views of people using mental health systems who have experienced deep pain and trauma as a result of forced treatment. The Committee recommends that States parties ensure that decisions relating to a person’s physical or mental integrity can only be taken with the free and informed consent of the person concerned.“ (6: #42)

Neglected harms and traumas - and the need for reparations
Long-term studies have shown higher recovery rates for people who were not on neuroleptics and on very low doses (14, 15). The list of potential harmful effects from neuroleptic drugs is long, including tardive dyskinesia, brain damage, cognitive decline, neuroleptic-induced supersensitivity psychosis, Parkinsonism, sexual dysfunction, weight gain, diabetes, demotivation, anxiety, aggression, suicide, akathisia [ an extreme form of restlessness which in itself can lead to suicide], neuroleptic malignant syndrome — a potentially lethal complication of treatment etc (14, 18). In a research summary on possible harms from forced psychiatry done by nurse and researcher Reidun Norvoll, she listed the following main categories:  1) violation of autonomy and of psychological and physical integrity. Deprivation of freedom of movement (deprivation of freedom). 2) Physical harm and death. 3) Violence and abuse. 4) Trauma, retraumatisation and posttraumatic stress syndrome. 5) Offences/violations, loss of dignity and experiences of punishment. 6) Psychological agony in the forms of shame, anxiety, feeling unsafe, anger, powerlessness, depression and loss of self esteem. 7) Social problems  and loss of social identity. 8) Loss of access to own coping skills and of possibilities to self development. 9) Loss of access to voluntary treatment. 10) Harmed therapeutic relationships, resentment against- and distrust in mental health services. (7: p. 16; 8: #5.3).  

It can be hard to process traumas that are not acknowledged and understood as such by society in general. When mental health services represents the abuser and as it is officially seen as the mental health helper, one can be left in a very lonely situation trying to handle psychiatry-induced traumas.  I think, as part of the implementation of CRPD, there should be provided access to help and support to those who struggle with traumas and other harms from forced psychiatry.  I imagine a reality where it is possible for everyone to ask for help when they feel they need it, knowing that they have the CRPD on their side; that the state can not expose them to torture and other terrible human rights violations for being in mental pain (!). 

When the necessary abolishment of discriminatory mental health laws and the prohibition of forced psychiatric treatment and commitment has become reality, I think that representatives from politics and psychiatry should publicly perform statements about- and apologies for -the severe human rights abuses that have been going on for so long towards people with psychosocial disabilities. After all the societal acceptance, silence and denial of these kinds of abuses, I think such an acknowledgement and apology is of significant importance for starting reparation work. Compensations  is also a relevant part of this.  At the same time, there should be no pressure towards victims of forced psychiatry to forgive and get over.  I strongly recommend survivor and lawyer Hege Orefellen’s appeal on the urgent need for effective remedies, redress and guarantees of non-repetition regarding torture and other ill-treatment in psychiatry (9). Her appeal was held during a CRPD side-event about article 15 and its potential to end impunity for torture in psychiatry (10). Also, in Guidelines on article 14 of the CRPD, point 24 (a-f) one can read about “access to justice, reparation and redress to persons with disabilities deprived of their liberty in infringement of article 14 taken alone, and taken in conjunction with article 12 and/or article 15 of the Convention” (11).

Danger- and treatment criteria
The Norwegian Mental Health Act has, in addition to its danger criteria, a criterion called the treatment criterion, which does not require danger to oneself or others. The treatment criterion allows for psychiatric coercion if the person is claimed to have a severe mental disorder,  and application of forced psychiatry is seen as necessary to prevent the person from having his/her prospects for recovery or significant improvement seriously reduced; alternatively that it’s seen as very possible that the person’s condition in the very near future will significantly deteriorate without coercion (12: Section 3 – 3. 3 a). A very wishy-washy criterion indeed, which is much in use. In 2014 the treatment criterion alone was used in 72% of the cases among people commited (16: p.37).

Both the treatment criterion and the criteria regarding danger to oneself or others discriminate against people with psychosocial disabilities in that disability, or ‘serious mental disorder’,  is a premise for psychiatric coercion to apply. In other words, this discrimination is a violation of CRPD article 14 which says that the existence of a disability shall in no case justify a deprivation of liberty (13). Secondly, as the Mental Health Act allows for forced psychiatric treatment, it violates the right to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16). (6:#42).
Points 13-15 in the Guidelines on article 14 are also relevant in this context:

VII. Deprivation of liberty on the basis of perceived dangerousness of persons with disabilities, alleged need for care or treatment, or any other reasons.

13. Throughout all the reviews of State party reports, the Committee has established that it is contrary to article 14 to allow for the detention of persons with disabilities based on the perceived danger of persons to themselves or to others. The involuntary detention of persons with disabilities based on risk or dangerousness, alleged need of care or treatment or other reasons tied to impairment or health diagnosis is contrary to the right to liberty, and amounts to arbitrary deprivation of liberty.

14. Persons with intellectual or psychosocial impairments are frequently considered dangerous to themselves and others when they do not consent to and/or resist medical or therapeutic treatment. 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.

15. The freedom to make one’s own choices established as a principle in article 3(a) of the Convention includes the freedom to take risks and make mistakes on an equal basis with others. In its General Comment No. 1, the Committee stated that decisions about medical and psychiatric treatment must be based on the free and informed consent of the person concerned and respect the person’s autonomy, will and preferences.  Deprivation of liberty on the basis of actual or perceived impairment or health conditions in mental health institutions which deprives persons with disabilities of their legal capacity also amounts to a violation of article 12 of the Convention.” (11: #13-15)

The laws that apply to people in the rest of society regarding acute situations and in the criminal justice system, must apply to people with disabilities too in non-discriminatory ways. The CRPD’s demand for absolute prohibition of forced treatment and involuntary commitment means that it applies both in criminal justice- and civil contexts. (11: #14, 16, 20-21, also 10-12). For people with psychosocial disabilities who come in contact with the criminal justice system, necessary support must be provided to ensure the right to legal capacity, equal recognition before the law and a fair trial. Forced psychiatric treatment and involuntary commitment can not be applied as sanctions for criminal acts and/or for the prevention of such.

Replacing substituted decision-making with supported decision-making
Substituted decision making must be replaced by supported decision making systems. Giving access to supported decision-making for some but still maintaining substitute decision-making regimes, is not sufficient to comply with article 12 of the CRPD (6: #28). From General Comment No 1:

A supported decision-making regime comprises various support options which give primacy to a person’s will and preferences and respect human rights norms. It should provide protection for all rights, including those related to autonomy (right to legal capacity, right to equal recognition before the law, right to choose where to live, etc.) and rights related to freedom from abuse and ill-treatment (…).” (6: #29)

Some who agree with the CRPD in that diagnostic criteria for coercion should be abolished, still seem fine with the idea that ‘mental incapacity’ can be used as criteria for psychiatric coercion. This is not in line with the CRPD, which neither accepts disability criteria for the deprivation of freedom nor psychiatric coercion. Here is a relevant point to note, from General Comments No1:  “The provision of support to exercise legal capacity should not hinge on mental capacity assessments; new, non-discriminatory indicators of support needs are required in the provision of support to exercise legal capacity.” (6:#29 i)

A summary of my own experiences from forced psychiatry
I was not suicidal when psychiatry put me under the Mental Health Act and decided I should get forced neuroleptic “treatment”. I had never been suicidal. The former mentioned treatment criterion is the criterion that was used on me.  Forced psychiatry, with its locking me up, restraining me, drugging me, and keeping me on CTO when discharged from hospital, certainly did not make my life better  in any way– everything became indescribably much worse. I experienced forced psychiatry as one long punishment for having mental problems. After having been on neuroleptics for a while, my cognition, my intellectual abilities, were severely affected and reduced - and so was my language: from usually having a rich vocabulary I could just utter short, simple sentences. My body became rigid and lost its fine motor skills so I couldn’t dance anymore. A period I also had akathisia, a terrible restlessness which made me walk endlessly back and forth, back and forth. I’m trained a professional dancer and having my dance abilities medicated away was a big loss in itself. The medication took away my vitality, my sensitivity. My emotions were numbed. My personality faded away.  Then a severe depression set in - just a complete state of hopelessness - and for the first time in my life I became suicidal. Again and again I said to the staff, psychologists, doctors: - I can not be on meds. I tried to have them understand that the neuroleptics were destroying me and my life.  They communicated to me that they thought I was being fussy. They were a big wall that just would not listen to me. Respectlessly enough, some even told me –yes,  told me -that I was doing better. The doctors said I would need to be on meds for the rest of my life. That was a message which just manifested the complete hopeless situation. From entering psychiatry, indeed having mental problems, but being a vital, thoughtful, and expressive person who was dancing several times a week, psychiatry  had coercively medicated me away from myself and iatrogenically made me severely depressed and suicidal . In effect a slow form of forced euthanasia . One day, while on CTO, shortly after a new forced injection in the buttocks with those horrible meds, I did a dramatic suicide attempt. I was put back into the hospital. I am very glad that I survived. Because unbelievably, a couple of months later, I was told that someone had made a bureaucratic mistake: the coercion documents had not been renewed in time, so there was nothing they could do to hold me back. Of course they would recommend me to stick to the treatment (Ha!) and not leave the hospital too fast (Ha!). I left the hospital the same day. It took me about half a year to become myself again, to be able to think and speak freely, to get my sensitivity, my emotions back, to dance, to feel human again, to feel life. I have never been in a mental hospital since then. I have never had another dose of neuroleptics. And I have never been suicidal again.  More than a decade later, I am still traumatized by my experiences from forced psychiatry.

Conclusion
I am very thankful to the CRPD committee for their important work. The CRPD represents a paradigm shift, and there is clearly a resistance out there to accept the full width and depth of the convention. That human rights and non-discrimination applies equally to people with disabilities should not be seen as a radical message in 2016, but sadly, it still is. Societies with their leaders need to realize that systematic, legalized discrimination and abuse of people with disabilities is based on tradition and habitual ways of thinking –not on human rights. That something has been brutally wrong for a long time does not make it more right. Forced psychiatric treatment and involuntary commitment need to be absolutely prohibited.  

Thank you for your attention.



References: 


1) MDAC:  Legal Opinion on Norway’s Declaration/Reservation to the UN Convention on the Rights of Persons with Disabilities http://mdac.org/sites/mdac.org/files/norway_declaration_-_legal_opinion.pdf

2) 
Tor Levin Hofgaard:  Bryter vi menneskerettighetene?

3)
In Norwegian: Equality and anti-discrimination ombud (LDO): CRPD report to Norwegian authorities 2013 – summary http://www.ldo.no/globalassets/brosjyrer-handboker-rapporter/rapporter_analyser/crpd--2013/crpd_report_sammendrag_pdf_ok.pdf

4)
Anne Grethe Erlandsen: Vi bryter ikke menneskerettighetene http://www.dagensmedisin.no/artikler/2015/02/27/vi-bryter-ikke-menneskerettighetene/

5) 
In Norwegian: LDO’s report to the CRPD committee 2015 – a supplement to Norway’s 1st periodic report http://www.ldo.no/globalassets/03_nyheter-og-fag/publikasjoner/crpd2015rapport.pdf

6)
Link to download of CRPD General Comment No 1:  http://www.ohchr.org/EN/HRBodies/CRPD/Pages/GC.aspx

7)
In Norwegian: Equality and anti-discrimination ombud (LDO): CRPD report to Norwegian authorities 2013- full version  http://www.ldo.no/globalassets/brosjyrer-handboker-rapporter/rapporter_analyser/crpd--2013/rapportcrpd_psykiskhelsevern_pdf.pdf

8) 
NOU 2011: 9. Økt selvbestemmelse og rettssikkerhet — Balansegangen mellom selvbestemmelsesrett og omsorgsansvar i psykisk helsevern. 5. Kunnskapsstatus med hensyn til skadevirkninger av tvang i det psykiske helsevernet. Utredning for Paulsrud-utvalget https://www.regjeringen.no/no/dokumenter/nou-2011-9/id647625/?q=&ch=12

9)
Hege Orefellen: Torture and other ill-treatment in psychiatry – urgent need for effective remedies, redress and guarantees of non-repetition https://absoluteprohibition.wordpress.com/2016/02/06/hege-orefellen-on-reparations/

10) 
CRPD 13: WNUSP side event on Article 15: Its Potential to End Impunity for Torture in Psychiatry  http://www.treatybodywebcast.org/crpd-13-wnusp-side-event-on-article-15-english-audio/

11) 
Link to guidelines on article 14 of the CRPD under “Recent Events and Developments” http://www.ohchr.org/EN/HRBodies/CRPD/Pages/CRPDIndex.aspx

12) 
Norwegian Mental Health Act translated to English http://app.uio.no/ub/ujur/oversatte-lover/data/lov-19990702-062-eng.pdf

13)

14)
Via Mad in America / ‘Anatomy of an Epidemic’ (Robert Whitaker):  List of long-term outcomes literature for antipsychotics http://www.madinamerica.com/mia-manual/antipsychoticsschizophrenia/

15)
Lex Wunderink et al: Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy. Long-term Follow-up of a 2-Year Randomized Clinical Trial http://archpsyc.jamanetwork.com/article.aspx?articleid=1707650

16) 
Bruk av tvang i psykisk helsevern for voksne i 2014 (report on the use of coercion in psychiatry in Norway 2014) https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/1161/Rapport%20om%20tvang%20IS-2452.pdf

17) 
Campaign to Support CRPD Absolute Prohibition of Forced Treatment and Involuntary Commitment https://absoluteprohibition.wordpress.com/

18)


Other:

Status of Ratification Interactive Dashboard - Convention on the Rights of Persons with Disabilities http://indicators.ohchr.org/