TCI-Asia and countries represented therein, have been deliberating on whether there should at all be a mental health law. There is confusion in Asia concerning a mental health law. Advocacy in India has been around repealing the Mental Health Act of 1987, and inclusion in disability law and health care law.
‘NO’ TO MENTAL HEALTH LAWS THAT ARE NON-COMPLIANT WITH INTERNATIONAL HUMAN RIGHTS CONVENTIONS
Position Paper to All Mental Health Bills in the 16th Congress
March 3, 2015
Reference: Janice Sarmiento Cambri, M.A.
Founder: Transforming Communities for Inclusion of Persons with Psychosocial Disabilities-Philippines (TCI-Phil)
Persons with Disabilities (PWD) in general are the most marginalized sector in society. None, however, has suffered the extent of exclusion, discrimination, poor health care, and human rights violation worse than users or survivors of psychiatry and persons with psychosocial disabilities.
TCI-Phil is the sole political and human rights organization of users/survivors of psychiatry and persons with psychosocial disabilities in the country. It was founded on November 20, 2014 in response to the growing violations against Persons with Psychosocial Disabilities. Many of our members also serve as leaders of our respective peer support groups. Anchored on the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) which the Philippines has adopted in 2008, TCI-Phil aims to revolutionize the existing mental health situation in the country, eradicate stigma, champion human rights, provide support, and essentially help create a more inclusive society for persons with psychosocial disabilities through advocacy, education, research, organizing, building alliance with the cross disability movement, legislation, claiming our rightful place in policy-formation with government institutions, as well as engagements with health service providers and international work. We have been actively engaging with several government agencies for advocacy and policy development such as the National Council on Disability Affairs (NCDA), Phil. Commission on Women (PCW), Dept. of Health (DOH) and the Dept. of Justice (DOJ). We have been serving as NCDA’s resource speaker for their Disability Awareness and Sensitivity Workshops for the psychosocial constituent. TCI-Phil is a member of the larger international formation called TransAsia Alliance on Transforming Communities for Inclusion of Persons with Psychosocial Disabilities (TCI-Asia) with member countries namely Japan, Korea, China, India, Nepal, Sri Lanka, Thailand, Indonesia, Bangladesh, and the Philippines.
We, the users/survivors of psychiatry and persons with psychosocial disabilities, are opposing the Mental Health Bills filed in both Houses of Congress due to the presence of provisions that either contravene the UN Convention on the Rights of Persons with Disabilities (UNCRPD) as well as the International Convention on Civil and Political Rights (ICCPR) or lacking substantially in incorporating the mandates of these international treaties both of which the Philippines is a signatory of. These articles of the UNCRPD are the following:
Article 5: Equality and non-discrimination
Article 6: Women with Disabilities
Article 7: Children with Disabilities
Article 8: Awareness-raising
Article 12: Equal recognition before the law
Article 14: Liberty and security of persons
Article 15: Freedom from torture of cruel, inhuman or degrading treatment or punishment
Article 17: Protecting the integrity of person
Article 19: Living independently and being included in the community
Article 25: Health
The primary objective of mental health legislation is the protection and improvement of the mental wellness of a nation’s people. However, the World Health Organization (WHO) admits that the presence of these laws do not secure respect and the safeguard of human rights. In WHO’s 10 Facts on Mental Health, Fact 7 states:
“Human rights violations of people with mental and psychosocial disability are routinely reported in most countries. These include physical restraint, seclusion and denial of basic needs and privacy. Few countries have a legal framework that adequately protects the rights of people with mental disorders.”
These bills in both Houses of Congress are poorly crafted, bereft of any genuine consultative and participatory engagement with organic and primary stakeholders who are the users/survivors of psychiatry and persons with psychosocial disabilities. Several of them are simply rehash of previously filed bills in past Congress such as the National Mental Health Act of 2009 filed by Sen. Juan Ponce Enrile. It is safe to assume that legislators simply took the word of the psychiatrists who peddled these bills to them. As evidence, when questioned as to why the filing of the bill which is a carbon copy of two more House Bills as well as a draft submitted to another senator, a chief of staff of one of the co-authors admitted finding nothing wrong with the bill when the doctors presented the draft, did not conduct any further study or consultation with the sector at all, and simply signed.
Our sector does not ask for special treatment. “Special treatment” on the basis of our disability often results to discrimination. We demand that we be recognized as individuals on equal basis with others in terms of right to life, liberty, independent living, and legal capacity as well as inclusion in the community and development. We also call for equal treatment as other people within the healthcare system. Most constituents in the cross disability movement demand for livelihood, housing, social protection, and accessibility. What “disability inclusive development” means to persons with psychosocial disabilities is for our primary call to be heeded to eliminate all legal barriers on assumption of “incapacity” and facilitate our entry into the Development arena.
In 2008, the Philippine government adopted the UNCRPD. This instrument sets the global standard for the inclusion and full and effective participation of persons with disabilities. In essence, an international treaty signed by the government becomes part of the laws of the land. The provisions in the UNCRPD simply need to be harmonized with our domestic laws through legislations by abolishing or repealing laws that are not compliant with the UNCRPD and incorporating its mandates in existing policies and practices of all government agencies. With local psychiatry at its poorest quality and accountability for gross human rights violations, there is a state obligation to accelerate the shift from the medical model to the human rights based approach to mental health care.
The statistics from WHO have been spoken. 1 in 4 individuals globally will experience a mental health problem in their lifetime. Serious mental illness costs America alone $193.2 billion in lost earnings per year. 20% of the world’s children & adolescents have mental disorders or problems. About half of mental disorders begin before the age of 14. Neuropsychiatric disorders are among the leading causes of worldwide disability in young people. Over 800, 000 a year die due to suicide. Every 40 seconds a person dies by suicide. It is the 2nd leading cause of death among young people 15-29 years of age. For each adult who died of suicide there may have been more than 20 others attempting suicide. Regions of the world with the highest percentage of population under the age of 19 have the poorest level of mental health resources. Most low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people. Globally, there is huge inequity in the distribution of skilled human resources for mental health. Shortages of psychiatrists, psychiatric nurses, psychologists and social workers are among the main barriers to providing treatment and care in low- and middle-income countries. Low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people. The rate of psychiatrists in high income countries is 170 times greater and for nurses is 70 times greater. Mental and substance use disorders are the leading cause of disability worldwide. By 2020 depression will become the number two cause worldwide of years lost due to disability. Rates of mental disorder tend to double after emergencies such as wars and disasters. Persons with mental illness lose as much as 9-20 health years. About 23% of all years lost because of disability is caused by mental and substance use disorders. Unipolar depressive disorders, schizophrenia, bipolar mood disorder, and alcohol use disorder are among the top 10 causes of disability due to health-related conditions.
In the Philippines, Between 17 and 20 percent of the country’s adult population have psychiatric disorders. In National Center for Mental Health, there is an average of 56, 000 outpatients per year in addition to 3,000 inpatients. In 2007 DOH survey, 3 out of 10 government employees in NCR have mental health problems, mostly depression and anxiety disorder. 1 or 2 were even possibly suicidal.
Despite the adoption of the UNCRPD and the WHO’s declaration of global human rights emergency in mental health, majority of us continue to suffer excruciatingly in silence largely because of the stigma which is oftentimes more disabling than our mental health condition itself. We are portrayed in society as violent, dangerous, highly potential criminals, not in touch with reality, and incapable of making decisions for ourselves or carry out responsibilities. No study has given merit to these centuries-old biases.
We are denied of personhood and dignity by being robbed of our legal rights on the basis of our disability through substituted decision by our families, courts, doctors, hospitals, and local government units such as the barangay office or local DSWD with justification based on discrimination against our legal capacity. In her article, Legal Frameworks for and against People with Psychosocial Disabilities (2012), global mental health advocate and Director of Bapu Trust for Research on Mind and Discourse, Bhargavi Davar asserts:
“The macro-environment within which the mental healthcare system works is that of custodial law. Unlike healthcare patients, who are distal from the universe of law and courts, psychiatric patients become medico-legal subjects the moment a psychiatric diagnosis is received… Mentally ill people are the only ones subject to arrest without warrants, making hospital admission a penal matter more than a matter of care… When a legally incapacitated person goes before a court on an “insanity” petition, this is like an accusation of crime, which must be proved before the court. The police often have a role to play in mental hospital commitments, which is another peculiarity.”
Under Article 12 of the Convention which accords to people with disabilities recognition equal to others as full persons before the law, legal capacity cannot be questioned or challenged based on disability. The UN Committee on the Rights of Persons with Disabilities has affirmed in General Comment No. 1 that legal capacity cannot be deprived on the basis of a person’s actual or perceived mental capacity or decision-making skills. The Committee on its Introduction on the General Comment on Article 12 states:
“The right to equal recognition before the law implies that legal capacity is a universal attribute inherent in all persons by virtue of their humanity and must be upheld for persons with disabilities on an equal basis with others. Legal capacity is indispensable for the exercise of economic, social and cultural rights. It acquires a special significance for persons with disabilities when they have to make fundamental decisions regarding their health, education and work. (The denial of legal capacity to persons with disabilities has, in many cases, led to the deprivation of many fundamental rights, including the right to vote, the right to marry and found a family, reproductive rights, parental rights, the right to give consent for intimate relationships and medical treatment, and the right to liberty.)”
People with disabilities who need support to exercise legal capacity have a right to be provided with such support by the government. The International Disability Alliance (IDA) in its Principles for Implementation of CRPD Article 12 explains:
“Support means the development of a relation and ways of working together, to make it possible for a person to express him or herself and communicate his or her wishes, under an agreement of trust and respect reflecting the person’s wishes. The government has the obligation to dismantle substitute decision making systems. All laws and mechanisms by which a person’s capacity to act can be deprived or restricted; or disqualifying a person from enjoying rights or performing legal acts or responsibilities based on differences in capabilities or based on disability must be abolished or replaced with laws that recognize the right to enjoy and exercise legal capacity. This includes abolishing the legal status of guardianship as permitting any person to override the decisions of another.”
Several other existing Philippine laws directly violate the UNCRPD. For instance, Rule 101 of the Rules of Court entitled “Proceedings for Hospitalization of Insane Persons” allows for involuntary institutionalization. Similarly, the Insanity Defense plea in the Revised Penal Code which exempts a person with psychosocial disability from criminal liability and is directed to an automatic confinement in hospitals is also non-compliant with Articles 12 and 14 of the UNCRPD. According to National Center for Mental Health (NCMH) chief, Dr. Bernardino Vicente, there were 400 forensic patients at NCMH in March 2012.
In the July 28, 2008 Report of UN Special Rapporteur on Torture, it declared that psychiatric institutionalization may constitute torture or ill-treatment when it amounts to indefinite detention or continues for long periods of time. This is reiterated in the UN Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment (2013):
“Medical treatments of an intrusive and irreversible nature, when lacking a therapeutic purpose, may constitute torture or ill-treatment when enforced or administered without the free and informed consent of the person concerned.”
The said document also states absolute ban on restraints and seclusion:
“The mandate has previously declared that there can be no therapeutic justification for the use of solitary confinement and prolonged restraint of persons with disabilities in psychiatric institutions; both prolonged seclusion and restraint may constitute torture and ill-treatment (A/63/175, paras. 55-56). The Special Rapporteur has addressed the issue of solitary confinement and stated that its imposition, of any duration, on persons with mental disabilities is cruel, inhuman or degrading treatment (A/66/268, paras. 67-68, 78). Moreover, any restraint on people with mental disabilities for even a short period of time may constitute torture and ill-treatment. It is essential that an absolute ban on all coercive and non-consensual measures, including restraint and solitary confinement of people with psychological or intellectual disabilities, should apply in all places of deprivation of liberty, including in psychiatric and social care institutions. The environment of patient powerlessness and abusive treatment of persons with disabilities in which restraint and seclusion is used can lead to other non-consensual treatment, such as forced medication and electroshock procedures.”
How often do we hear of medical practitioners or local authorities apprehended for arbitrary detention as well as inhumane and forced treatment of individuals alleged to have mental illness which is disability-based discrimination in nature? According to the Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law, UN Commission on Human Rights Resolution 2005/35:
“Under their obligations to take effective measures to prevent torture and ill-treatment, States Parties must enact and enforce criminal sanctions against perpetrators of psychiatric detention and compulsory treatment, and must provide reparations to victims and survivors.”
In her article, Why Mental Health Laws Contravene the UN Convention on the Rights of Persons with Disabilities (UNCRPD) – An Application of Article 14 with Implications for the Obligations of States Parties, Tina Minowitz of Center for the Human Rights of Users and Survivors of Psychiatry and the World Network of Users and Survivors of Psychiatry (WNUSP) who led the international team in the negotiations and drafting of the CRPD at the United Nations in New York asserts:
“The plea of not-guilty by reason of insanity also deprives individuals of a clear determination of their responsibility, and relegates insanity acquittees to further segregation and marginalization, as well as to indefinite detention in psychiatric institutions under the harshest conditions and often for extremely long duration.”
Several private mental health facilities in the Philippines continue to detain ‘patients’ despite eligibility for release for profiteering reasons in conspiracy with the families of the latter who wish to pass the burden of care.
In an interview with the Manila Times on March 16, 2014, Carolina Uno-Rayco, project manager of the Philippine Mental Health Association (PMHA), a non-government organization, said:
“We must recognize that seeking help and support from family, friends and mental health professionals are important to lessen their negative thoughts and to make them feel more positive about themselves. There is no better way to accept that one has a problem on his mental health than to seek help.”
In many cases, families are primary stress oppressors and oftentimes facilitate involuntary admission to mental facilities of a person with mental illness. To further frustrate matters, those close to us are not likely to offer as much support as they would if we had cancer or even AIDS instead. As already mentioned, most mental health professionals are ignorant of our human rights stated in international laws and perpetuate old harmful practices. A lot of us who sought assistance from medical professionals ended being further violated, abused, and traumatized.
It is remarkably ironic that Filipino psychiatrist and professor, Dr. June Pagaduan-Lopez, one of the twelve new members of the UN Subcommittee on Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (SPT) elected in 2012, pushes for a bill that warrants substituted-decision through a ‘legal representative’, involuntary treatment and restraint during ‘psychiatric emergencies’ as well as the dismissal of getting an informed consent in an instance of ‘mental or psychological incapacity’ all of which are in violation of the UNCRPD as well as ICCPR.
Dr. Edgardo Juan Tolentino, Jr, Phil. Psychiatric Association (PPA) president and another ardent lobbyist for mental health laws laments that the Philippines remains a mental health law-free ASEAN country. He advised to explore Thailand and Singapore for examples. Nepal, Sri Lanka, Bangladesh, Indonesia, Cambodia, Laos, Vietnam, Timor-Leste, and China also have no national mental health law.
According to TransAsia Alliance on Transforming Communities for Inclusion of Persons with Psycho-social Disabilities (TCI-ASIA):
“High income and Common Wealth Asian countries e.g. Korea, China, Japan, India, and other nations of erstwhile colonies, have mental health legislations with accompaniment of many tens of penal type of mental institutions, using forced treatment. In such countries Psychosocial Disability is criminalized. On the other hand, many countries in Asia are bereft of any kind of community support systems for people with psychosocial disabilities. Some of those countries are poised for drafting and adopting a Mental health law, contrary to world experience of vast human rights violations within institutions. The Asian region is geographically, culturally and linguistically diverse with complex social systems. Devising strategies for Inclusion of persons with disabilities has to factor in this dynamism through local mental health programs integrated with community development.”
In addition, delegates of various mental health advocacy and psychosocial disability groups from 11 countries to TCI-Asia’s 2nd Regional Conference last November 2014 namely Nepal, Sri Lanka, India, China, Hongkong, Korea, Japan, Bangladesh, Indonesia, Thailand, and the Philippines all presented similar documented cases of human rights violations most especially in mental institutions. Korea, a wealthy nation, has suicide rates at its highest.
Article 8 of the Convention mandates awareness raising and combatting these harmful stereotypes and prejudices. Among the PWD constituents, we have the longest list of derogatory labels such as abnoy, brenda, siraulo, baliw, luka-luka, may sayad, psycho, retarded and mental, to name a few. All bills call for awareness campaign yet none of these bills use the global politically term for our sector which is “persons with psychosocial disabilities/user or survivor of psychiatry”. Agencies concerned with PWDs such as the NCDA, DOH, and local Phil. Disability Affairs Office (PDAO) officially use the term “psychosocial.” In the issuance of PWD ID in local DSWD or local government units’ social services divisions, the term “psychosocial” is among the classification for disabilities. In a 2011 survey, 90 out of the 95 psychiatrist respondents were not familiar with the Magna Carta for PWDs. These blunders only go to show how alienated these doctors really are from the sector.
For the last 15 years, psychiatrists are primarily the ones lobbying for mental health legislation in the Philippines, pretending to be champions of our rights. For the longest time, they speak on our behalf, telling everyone what is best for us. They banked on the confidence society has bestowed upon them. They took advantage of the absence of visible leaders, the trend of discrete peer support groups instead of open organizations of persons with psychosocial disabilities, and the snail-paced mainstreaming of PWDs in the human rights movement. They present compelling statistics to legislators that rationalize the need for higher budget allocation or the creation of mental health councils based on their concept of community based services which simply reflect decentralization of mental institutions. What they deliberately hide from their reports is the fact that the number one perpetrators of human rights violations against persons with psychosocial disabilities to date are still the mental health workers themselves including psychiatrists. Their proposals remain anchored on the medical model to mental health instead of the human rights or social approach which is the core principle of the UNCRPD. They are self-imposed experts and specialists about us when in truth, they are simply among the several mental health service providers we can choose from. There are support systems in communities, healing and recovery alternatives, psychologists, therapists, and skilled and non-formal care givers who can create enabling emotional environments for families, communities and neighborhoods. The State should recognize the significance of and support these available non-formal care givers and social workers, self-advocates, and the expertise of people who have recovered using non-medical alternatives instead of solely relying on what psychiatrists say.
According to David Ingleby of the University of Amsterdam in his article, How ‘evidence-based’ is the Movement for Global Mental Health? (2014), the supremacy of biological models is courtesy of the pharmaceutical industry-funded research in psychiatry. Drug companies benefit the most when we are turn into medicine-dependents. He aggressively argues that contemporary psychiatry is hardly evidence-based since no single laboratory marker is proven to be diagnostically suitable for making DSM diagnosis for mental illnesses. To illustrate, doctors will always tell us, people diagnosed with mood disorder and the public that it is because of chemical imbalance in the brain but there is no actual biomarker to show evidence of this alleged imbalance.
Some of the mental health bills pending in Congress have provisions violating the Convention such as involuntary admission in cases of ‘psychiatric emergencies’ as well as the appointment of legal representatives in times of ‘mental/psychological incapacity.’ Article 17 of the UNCRPD mandates the respect for the mental integrity of PWDs on an equal basis with others.
Currently, mental health laws globally, highly characterized by paternalistic asylum-based social response to mental health care are in place to legitimize arbitrary detention of people with psychosocial disabilities. Minowitz stresses:
“Psychiatric detention violates other norms of international law in addition to CRPD Article 14. Psychiatric detention is both arbitrary and indefinite as a consequence of the legal standards that give significant weight to the opinions of psychiatrists for the initiation and continuation of such detention (ICCPR Article 9, also incorporated in CRPD Article 14.1(b)). There are no defined behavior standards that would give notice to individuals wishing to avoid psychiatric detention or to obtain their release, only the opinions of psychiatrists abstracting from observation or reports about the person’s behavior, subject to review by tribunals and courts that is almost always highly deferential.”
WNUSP delineates in their Implementation Manual for the UNCRPD (2008):
“Article 17 grants to all persons with disabilities the right to respect for their physical and mental integrity on an equal basis with others. It is this right which protects persons who do not have disabilities from unwelcome treatment, forcible confinement or any other unwelcome invasion of their body and mind. Article 17, by its guarantee of equality and nondiscrimination, also makes these available to us. This guarantee is further strengthened by the fact that article 25 obliges health care professionals to provide treatment only on the basis of free and informed consent. Free and informed consent can only be given by the person concerned, and not by family members, courts or others.”
In reality, we are often prescribed drugs by psychiatrists and are coerced to take them without being adequately informed of their crippling side effects. We are brainwashed that only through compliance with medications can we find ‘cure’ or salvation from our condition. You can watch a psychiatrist such as Dr. Bernadette Manalo-Arcena in the episode Sino ang Baliw of then daily show Sharon Kasama Mo, Kapatid publicly bullying celebrity guest, Ms. Cita Astals, who has Bipolar Disorder, to medicate and claiming she wouldn’t stop until they fix us (referring to persons with mental illness). This display of grandiose psychiatry and medication supremacy has been echoed in other TV shows where she was interviewed as a resource person.
Media documentaries about mental illness often echo the necessity of medications and hardly mention much less showcase positive results of non-medical alternatives such as physical fitness programs, sports, emotional support animals, journal writing, occupational therapies, art and music therapies, gardening, traveling, meditations, talk therapy, joining peer support groups, developing an inner circle of trust, productive manual labors, traditional healing/spiritual centers, and the likes that even a lot of psychologists advocate for.
In contrast, psychiatric drugs and other invasive methods such as electroshock therapy are inherently experimental. They are not administered in the same fashion as more established medicines such as paracetamol, cough syrups, or antibiotics. Dosage prescriptions are subjective and one has to endure all the bad and disabling side effects including mobility and concentration struggle, tremors, difficulty in breathing, loss of sexual drive, numbness, or grogginess which last sometimes for days or weeks until the ‘right’ dosage is finally found for us by our psychiatrist rendering us more dysfunctional, incapacitated, and downright unproductive. Other than the very high cost of the medicines and psychiatric services such as consultations, these drugs’ side effects discourage a lot of us to continue medication. Several media documentaries and field works have presented patients being tied down as standard procedures in mental facilities in addition to having triple barricades resembling prison cells and curtailment of basic civil liberties.
In various peer support groups sessions, harrowing testimonials of being tricked into admission, restrained, and drugged until one had to crawl due to immobility in mental facilities are common. Majority of us were never informed that it is an exercise of our legal capacity enshrined in the Convention to accept or refuse treatment including taking medications. We are never told that we have the right to opt for non-medical alternatives. Therefore, a free and informed consent was never obtained from us.
Our families, local authorities, employers, and health workers can simply commit us to institutions or invoke a specialized detention regime against us at any time despite our refusals when perceived as ‘danger’ to ourselves and to others. There is no valid reason to distinguish between people with psychosocial disabilities and others with respect to the imposition of preventive detention for public safety reasons, or paternalistic detention said to be in the person’s best interest. The pending bills still have these in their provisions.
This is why it poses more danger when you have mental health bills concerning minors given existing laws that remain not in sync with the UNCRPD and the trend in psychiatry when adults cannot even exercise their rights because they are overridden by substituted-decision makers. Chapter 2 of the Special Categories of Children in The Child and Youth Welfare Code, a law that contravenes the UNCRPD by enacting admission to institutions of ‘disabled children’ by the Dept. of Social Welfare and Development on the basis of parental or guardian consent. These children refer to “mentally retarded, physically handicapped, emotionally disturbed, and severe mentally ill children.” Furthermore, the law states that even those children without diagnosis of any mental illness so long as they cannot maintain normal social relations with others due to emotional problems can also be institutionalized.
The current bills on “Early Detection and Intervention for Children with Mental Illness” fail to make any reference to Article 7 to ensure that such violations are no longer reflected in their intervention proposals. Their definition of “intervention” which constitutes “educational methods and positive behavioral support strategies to improve the condition of a child suffering from mental disorder” is very vague, thus, alarming. The UNCRPD recognizes the evolving concept of children’s rights. IDA expounds:
“All children, including those with disabilities, have an evolving legal capacity, which at birth, begins with full capacity for rights, and evolves into full capacity to act in adulthood. Children with disabilities have the right to have their capacity recognized to the same extent as other children of the same age, and to be provided with age- and disability-appropriate supports to exercise their evolving legal capacity. Parents and guardians have the right and responsibility to act in the best interests of their children while respecting the child’s evolving legal capacity, and the state must intervene to protect the legal capacity and rights of children with disabilities if the parents do not do so, in accordance with the Convention on the Rights of the Child. The parents’ or guardians’ rights to act on behalf of their children cease when the child reaches the legal adult age. This must be the same for all persons to avoid classifying people with disabilities as children at an older age than others.”
Persons with psychosocial disabilities have the right to personal autonomy and self-determination to govern our own lives. We have the right to live independently and be included in the community. We can choose our residence and with whom to live. We are entitled to community support services including personal assistance necessary to support living and inclusion in the community. These rights are all articulated in Article 19 of the UNCRPD. If we do violate others, we have the right to be treated on an equal basis with others by the police and penal law systems, including the provision of reasonable accommodation as granted by Article 12.
However, we are deprived of any kind of community support systems despite our right to reasonable accommodation and are subjected to involuntary admission and dehumanizing procedures in mental facilities together with forced treatments such as medications and shock therapy. Majority of mental health service providers including psychiatrists remain oblivious to the provisions of the Convention, thus, the continuing vicious cycle of abuse against us.
Existing mental health facilities and institutions must be converted into centers that could actually function as community centers for persons with mental health problems and disabilities. The kind of alternatives and community support systems, fitness and well-being, and disability sporting/exercise activities, psychotherapies and psychosocial interventions, peer support work, family work, and other community work, along with trainings, could happen in those centers. In Pune, India, for example, Bapu Trust has taken over some government health centers and is running fitness and wellness orientated community based programs. Similar moves are being done in China. Those centers were also doing trainings, but had large outreach into communities. In the Philippines, we are at an infancy stage relative to this kind of community support.
People should draw lessons from the life of John Forbes Nash Jr., an American mathematical genius with schizophrenia who later won the Nobel Memorial Prize in Economic Sciences. Mr. Nash suffered a series of involuntary hospitalizations and insulin shock therapies which could now be described as psychiatric crude. He later refused further institutionalizations and medications. In his words, “I learned to discard the paranoid thoughts the way a dieter stays off sweets.” A major element in his remission was his former wife, Alicia, who remained steadfast in providing him with the support he needed such as a stable domestic arrangement despite their divorce. Sylvia Nasar, Nash’s biographer who wrote A Beautiful Mind, pointed out that:
“On one level, John Nash’s story is the tragedy of any person with schizophrenia. Many people with the disease can no longer sort and interpret sensations or reason or feel the full range of emotions. Instead, they suffer from delusions and hear voices. But in Mr. Nash’s case, the tragedy has the added dimensions of his early genius — and of the network of family and friends who valued that genius, wrapping themselves protectively around Mr. Nash and providing him with a safe haven while he was ill. There were the former colleagues who tried to get him work. The sister who made heartbreaking choices about his treatment. The loyal wife who stood by him when she no longer was his wife. The economist who argued to the Nobel committee that mental illness shouldn’t be a bar to the prize. Princeton itself.”
Mr. Nash’s life is a proof that even without medicines or psychiatry, a person with mental illness can not only survive but thrive when provided with reasonable accommodation, sufficient support system, an inclusive environment, and most importantly respect for his human rights.
To reiterate, persons with psychosocial disabilities do not appeal for any special treatment. What we clamor for are the following:
1. We demand equality as defined by the UNCRPD – that we be recognized as individuals who are on equal basis with others in terms of right to life, liberty and legal capacity; that we also have the right, on equal basis with others, to inclusion (living independently and being included in communities) and disability-inclusive development;
2. We advocate for inclusive mental health care law with robust community based services and to be included in rights based disability law and health care law. These mental health laws must be compliant with international human rights standards that the Philippines adopted;
3. We strongly call for the observation of reasonable accommodation;
4. We want recognition of other mental health well-being providers, non-formal caregivers, and the expertise of self-advocates who have recovered using non-medical alternatives to treatment;
5. We demand that persons with psychosocial disabilities who became victims of human rights violations be given justice and their perpetrators be held accountable;
6. The State must be aggressive in fulfilling its obligation of harmonizing the UNCRPD and ICCPR with our domestic laws and to compel government institutions concerned with mental health, disability, and human rights such as the Commission on Human Rights, NCDA, DOJ, DOH, DOLE, and other related agencies for a comprehensive investigation and awareness raising to re-educate not only the judiciary, private and public mental health professionals, social workers, legislators, and policy-makers but to facilitate, in compliance with their mandate based on international human rights standards, to overhaul the society’s prejudicial perception of persons with psychosocial disabilities.
Until the government shifts to the human rights paradigm, no amount of higher budget allocation or infrastructural improvements of mental facilities will change the shameful state of psychiatric care in the Philippines.