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Dignity and respect for dignity — Two key health professional values: Implications for nursing practice. Nurs Ethics ; Gallagher A, Seedhouse D.

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Dignity in care: The views of patients and relatives. Nurs Times ; Bertolote JM. Legislation related to mental health: A review of various international experiences. Rev Saude Publica ; Is health care a right? Health reforms in the USA and their impact upon the concept of care. Ann Med Surg Lond ; Lepping P, Raveesh BN. The Mysore declaration.

Int Psychiatry ; The Social and Medical Model of Disability. The Chime Framework for Personal Recovery. Scottish Human Right Commission. Celik E. The role of CRPD in rethinking the subject of human rights. Int J Hum Rights ; Ahead of Print.

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Advanced search. What is a Rights Human Rights. Right to Mental Capacity and Men Mysore Declaration. Human Rights Mod Chime Principles. Panel Principles. Criticism of Uni How right is right-based mental health law? How right is right-based mental health law?. Indian J Psychiatry ;61, Suppl S Public participation in psychiatric issues has been expanding in recent years along with a growing belief within the medical profession that a large proportion of people are in need of psychiatric treatment, but few are receiving it. A recent survey published in The Medical Journal of Australia [1] found that This result was similar to other research in Christchurch NZ, which found that The South Australian study also found that only 4.

This finding prompted the authors to agree with US researchers that 'most community residents are not treated for their psychiatric problems. The public participation that accompanies these medical perceptions has two branches. The first is a dominant movement that seeks to expand the reach of psychiatric services so that all the people who are thought to be in need of psychiatric attention can receive it.

Coercive psychiatry and human rights: An assessment of recent changes in the Soviet Union

The advocacy of this expansion is led by a powerful coalition of psychiatric professionals combining with well-organised support groups for the relatives of mentally ill people. But this campaign involves more than just lobbying for an expansion of services.

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A curious aspect to the problem of treating more people is that it is not simply a lack of services that prevents untreated people from receiving attention. More often it is the unwillingness of these people to be treated. The resistance of most people to volunteer for psychiatric treatment gives rise to an ongoing campaign by psychiatrists and relatives to amend mental health legislation in order to make it easier to impose involuntary treatment on them. Not surprisingly, this ongoing campaign to expand psychiatric coercion is countered by a second stream of public participation.

This second stream is much weaker and has been constantly losing ground in recent years. It is mostly comprised of former psychiatric patients who have received involuntary treatment.

Members of this stream have recently begun to call themselves 'psychiatric survivors,' to emphasise the ordeal they claim to have endured. The psychiatric survivor movement is supported by a small number of dissident psychiatrists, civil libertarians and human rights advocates. Their campaign is mainly centred on making attempts to raise public consciousness about the perceived fraudulent nature of psychiatric diagnosis, the injustice of involuntary incarceration and the dangers of psychiatric treatments.

Psychiatric survivors have to deal with a number of major obstacles that impede their public participation. The most serious is a lack of public credibility that is directly linked to the mental illness labels that have been attached to them. A further obstacle is the successful strategy of their opponents to have all mental patients, both past and present, recognised in public forums as members of a mental health 'consumer' movement.

Inclusion in the consumer movement causes very serious problems of recognition for psychiatric survivors because this collective identity suggests that all mental patients are willing beneficiaries of psychiatric treatments. The consumer strategy also provides the opportunity for the mental health establishment to fill any positions that are created for patients' rights advocacy with people who are enthusiastic consumers, i. Voluntary patients are not usually concerned with psychiatric coercion. The result is that psychiatric survivors are marginalised in conventional forms of public participation involving venues like the mass media, public forums, public inquiries and political lobbying.

Although psychiatric survivors are currently trying to adapt to this situation by using new avenues, like the internet, the public participation recounted in this chapter has largely taken place without their input. The two case studies of public participation presented in this chapter involve an inquiry into the human rights of mentally ill people and a campaign of political lobbying to amend legislation to make involuntary treatment easier.

These case studies have been chosen because they clearly demonstrate the ascendancy of the campaign by psychiatrists and relatives. They also show how high levels of credibility in public forums can compensate for flawed arguments. Human rights are the theoretical underpinning for both branches of public participation in psychiatric issues and so, in order to fully understand the positioning of the participants, it will be useful to introduce a brief background to the relationship between human rights and psychiatry. Under the legislative frameworks that are typical of most modern democratic societies, psychiatric practices tread a fine line between benefiting and harming the exercise of human rights.

This is largely because the cultural objectives of psychiatry and human rights are, to some extent, opposed to one another. While the basic principle of human rights is to set limits on the degree of social authority, and social isolation, which is allowed to be imposed on individuals, the speciality of psychiatry is to identify, label and modify deviant individuals so they can be properly fitted into the social fabric.

These fundamental differences sometimes threaten to turn psychiatry and human rights into antitheses. Psychiatry has little trouble in establishing its potential benefit to the exercise of human rights when 'deviant' individuals acquiesce to a diagnosis of mental disease and seek treatment for it.

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Article 12 concerns 'the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. But the 'right to treatment' can have a hollow ring to it when psychiatry is practised on people against their will. The psychiatric systems which classify symptoms and define specific mental illnesses, the methods of diagnosis, and the treatments for mental illnesses, are all subjects of intense controversy, both within medical science and outside in the general community.

There are no laboratory tests to identify or confirm most mental illnesses. Psychiatric diagnoses are usually made after interviewing people and then subjectively comparing them to personality profiles sketched in diagnostic manuals. Many people whose thinking patterns are said to deviate from the norm deny they have a mental illness or, if they accept a diagnosis, prefer not to have it treated. Specific human rights problems arise for psychiatry from the tendency of most modern industrial societies to have mental health laws which empower psychiatrists to make clinical judgements about the mental health of the people they encounter in their work and to impose treatment on them, without their consent, if the psychiatrist thinks it is necessary.

In , for instance, there were involuntary admissions to mental hospitals in the state of New South Wales [5] NSW which amounted to about one third of the total admissions. Involuntary mental patients often find themselves in a situation in which they are incarcerated for an indefinite period without being charged with a criminal offence, interrogated, coerced into changing their thoughts and beliefs, subjected to painful and uncomfortable treatments if they cannot or will not make the required mental changes, and denied freedom until their behaviour has been sufficiently modified.

Although there are a number of human rights provisions that appear to address this type of situation--i. In the UN Commission on Human Rights appointed a 'Sub-Commission to study, with a view to formulating guidelines, if possible, the question of the protection of those detained on the grounds of mental ill-health against treatment that might adversely affect the human personality and its physical and intellectual integrity.

Unfortunately, despite the brave start, the final document was repeatedly rewritten and massaged by numerous committees to such an extent that the original focus was lost. The primary tasks of attending to involuntary detention and the risks of treatment were eventually buried by cross-referencing and other priorities.

The final version of the 'Principles' adopted by the United Nations General Assembly in is primarily designed to protect the rights of voluntary patients, not involuntary patients. Principle 1 begins with an assertion of the 'right to treatment. Where the 'Principles' do address the problems of involuntary patients, it is done in a way that tends to undermine their rights rather than protect them.

Principle 11, for instance, deals with 'Consent to Treatment' and specifies that 'No treatment shall be given to a patient without his or her informed consent, except as provided for in paragraphs 6, 7, 8, 13, and Involuntary admission is not only permitted under the 'Principles' but the criteria which are specified for correct procedure are considerably less restrictive than those currently contained in the NSW Mental Health Act MHA.


The Inquiry's Report clearly demonstrates an apparent lack of significance given to the rights of involuntary patients when they conflict with the needs of their frustrated relatives. Under the heading of 'Involuntary Detention,' for instance, the Burdekin Report observed that,. Even so, after only one more brief sentence on the subject the report moves on to a lengthy discussion in support of denying the very same 'fundamental rights' the Inquiry had just recognised:.

This clear bias of the Inquiry towards investigating the rights of voluntary patients--and the relatives of patients--at the expense of involuntary patients, doesn't appear to have been built into the original design of the Inquiry. When the Terms of Reference are examined it is apparent that coercive psychiatry was originally intended as a focus. The first Term of Reference listed the classes of people the Inquiry had initially intended to deal with: 'To inquire into the human rights and fundamental freedoms afforded to persons who are or have been or are alleged to be affected by mental illness, having due regard for the rights of their families and members of the general community.

What is meant by alleged to be affected by mental illness is not defined but an earlier usage of 'alleged mental illness' can be found in a published dialogue between US patient rights activist Leonard Roy Frank and American Civil Liberties Union attorney and mental patient advocate Bruce Ennis. Ennis explains in the interview that he uses 'alleged mental illness' because 'I personally have seen no evidence at all that there is such a thing as mental illness. Although the Terms of Reference made no attempt to explain what was meant by alleged it is unlikely that it would have been used to question the existence of all mental illnesses in the way that Ennis used the term.

What is more likely is that in the planning stage of the Inquiry it was thought necessary to distinguish between certainty in the accuracy of diagnoses of mental illness when applied to some people and uncertainty when the diagnoses are applied to other people. There are at least two ways the Inquiry might have originally intended to utilise this distinction. The first possibility may have been an intention to examine the problem of false positive diagnosis.

The misreading of non-pathological thoughts, beliefs or behaviour as being symptoms of mental illness is a perennial problem for psychiatry and arises from the subjective nature of psychiatric diagnostic techniques. The second possibility may have been an intention to review patients diagnosed with certain varieties of mental illness--like the infamous 'sluggish schizophrenia' used in the Soviet Union to control political dissidents [17] --which are not generally recognised by international standards but which some psychiatrists may allege to exist.

Perhaps the Inquiry had originally planned to investigate both problems. There are well established concerns about Western psychiatric practice regarding both the problem of false positive diagnosis [18] and the proliferation of new varieties of mental disease. Regardless of what the Inquiry's original interpretation of alleged mental illness might have been, it certainly seems appropriate that an Inquiry into Human Rights and Mental Illness should give hearing to any person who might have suffered the discomfort and humiliation of a psychiatric diagnosis, and possibly incarceration and imposed treatment, on the basis of a mere allegation.

But despite the nomination of this category in the Terms of Reference, as it transpired, the Inquiry completely ignored these people. They were not mentioned in the Inquiry's report at all outside of the Terms of Reference.