
Is involuntary treatment for mental illness allowed under CRPD? - DanBC
https://www.nationalelfservice.net/mental-health/disability-rights-mental-health-treatment-and-the-united-nations-ronr2019/
======
DanBC
The Convention on the Rights of People with Disabilities (CRPD) is here:
[https://www.un.org/development/desa/disabilities/convention-...](https://www.un.org/development/desa/disabilities/convention-
on-the-rights-of-persons-with-disabilities/convention-on-the-rights-of-
persons-with-disabilities-2.html)

Read Article 14:
[https://www.un.org/development/desa/disabilities/convention-...](https://www.un.org/development/desa/disabilities/convention-
on-the-rights-of-persons-with-disabilities/article-14-liberty-and-security-of-
person.html)

Art14 says "Are not deprived of their liberty unlawfully or arbitrarily, and
that any deprivation of liberty is in conformity with the law, and that the
existence of a disability shall in no case justify a deprivation of liberty."

The committee for the CRPD have said this means that involuntary treatment for
people with mental illness is not allowed, and any laws that contain provision
for involuntary treatment must be repealed. In England those would be the
Mental Health Act and the Mental Capacity Act.

The committee have also said that work arounds - detaining people not because
they are mentally ill but because they pose a risk of danger to themselves or
others - are also forbidden.

Here's the thoughts of the committee:
[https://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesA...](https://www.ohchr.org/Documents/HRBodies/CRPD/GC/GuidelinesArticle14.doc)

~~~
dmitrygr
> detaining people [...] because they pose a risk of danger to themselves or
> others - are also forbidden.

What he actual fuck? If someone is out waving a knife around in the street
because the voices in their head are telling them to, we very much DO need to
detain them, for their safety and the safety of others. Who cares what any
"committee" says about it?

~~~
notfashion
You could have read the document before spewing toxic FUD about the kind of
things mentally ill people supposedly do.

Here's the section that addresses your concern: "All persons, including those
with disabilities, have a duty to do no harm. Legal systems based on the rule
of law have criminal and other laws in place to deal with the breach of this
obligation. Persons with disabilities are frequently denied equal protection
under these laws by being diverted to a separate track of law, including
through mental health laws. These laws and procedures commonly have a lower
standard when it comes to human rights protection, particularly the right to
due process and fair trial, and are incompatible with article 13 in
conjunction with article 14 of the Convention."

~~~
morpheuskafka
A somewhat analogous issue has been pointed out with the juvenile justice
system in the US. Ostensibly, these "softer" courts allow for a less formal
approach that will help young offenders; in reality, that lack basic due
process protections, hurting the innocent and helping only the guilty. Really,
it's the same as any other argument for fewer protections against government:
these hassles get in the way, so just get rid of them and trust us more.

> What results is an environment where boundaries are blurred and children
> accused of crimes are made to believe that everyone in the courtroom is
> there to “help” them when, in reality, defense attorneys are the only
> parties obligated to advocate on their behalf.

\- The Marshall Project, [https://www.themarshallproject.org/2017/05/15/give-
juveniles...](https://www.themarshallproject.org/2017/05/15/give-juveniles-
their-due)

------
williamscales
The discussion in the article gets to an interesting point: while the CRPD
takes an absolute position on the issue of involuntary confinement of mental
patients, it also takes an absolute position on requiring the state to provide
the right to independent living and the right to health to folks with mental
illnesses.

"if one of his (legal) tools as a psychiatrist is to be removed, there needs
to be a corresponding commitment from society to do better by all its members.
It is precisely this commitment that the CRPD demands through, for instance,
the obligation it imposes upon states to secure the right to independent
living for those with disabilities (Article 19) and the obligation that it
imposes upon states to secure the right to health of those with disabilities
(Article 25). If those obligations are carried through, and proper attention
paid to the socio-economic factors underpinning mental ill-health, then it is
not too much to suggest that the need for coercion will be dramatically
reduced as the (perceived or actual) choice for clinicians such as Dr Gosney
will not be between detention and watching a patient die."

Interpreted this way, involuntary confinement should never be necessary
because the state must have already provided something that would obviate it.
I'm not sure what that something is, however.

------
soup10
Psychiatrists and their colleagues have been lobbying for increased discretion
to detain people in spartan psych wards and administer drugs and other
dubiously ethical procedures like ECT and lobotomies without consent or
through coercion since the dawn of the profession. That is how they are taught
and that is the culture they work in.

~~~
outlace
Resident psychiatrist here. That is simply not true. [See similar comment
below]. I'm a resident psychiatrist, almost all patients we admit at my
institution sign in voluntarily. The times we involuntarily admit patients are
when they are so symptomatic that they would very likely die without treatment
(e.g. they refuse to eat because they think their food is poisoned).

Psychiatrists have no interest in detaining people, quite the opposite. Most
of the time I'm dealing with patients who are feigning symptoms e.g.
pretending to be suicidal to get admitted because they're homeless, and so we
have to admit them lest we get sued, despite the fact there is good evidence
many times an admission would be counter-productive. You have people who will
sue psychiatrists if they don't admit someone and that person ends up killing
themselves, and you have people who think psychiatrists are wantonly admitting
too many people.

Also there's nothing dubiously ethical about ECT. It's one of the safest
procedures in psychiatrist and the most effective. Many many patients consent
to do ECT voluntarily.

~~~
SuoDuanDao
Something you may not see being inside the industry is that there is a
tendency and a fear of mental health professionals being used as a threat to
enforce the overton window. "You believe Epstein was murdered? You'll be
committed if you say that too publicly".

It would probably be better both for your aims and those of the parent
commentator if rather than defend your practices and instances where you do
practice involuntary committal, if you specified the wide range of cases where
the public believes involuntary committal would happen and it wouldn't
actually.

And for all our peace of mind, please do keep an eye on whether that list
starts to shrink. Acquaintances who want to change the subject aren't the only
ones who want to enforce the overton window.

~~~
outlace
That's completely absurd, at least here in the U.S. If a psychiatrist
involuntarily admitted someone just because the patient believed in a
conspiracy theory they should be rightfully sued by the patient and would
certainly win the case. That would be gross malpractice.

Moreover, there is no incentive for psychiatrists to be admitting people
inappropriately. Psychiatrists are physicians and want to feel like they're
actually doing something useful like everyone else. I have no interest in
admitting a patient that doesn't have a treatable illness. There are plenty of
patients with real illnesses to treat.

~~~
SuoDuanDao
I would also guess the person you originally responded to is European. I'm a
Canadian child of German immigrants and the different attitudes towards mental
wards on the two continents is striking. That said, the kind of abuses ryacko
described are real, even if there are fewer incentives to commit them on this
side of the pond.

The concern I find more reasonable, having seen the role it plays in the old
world, is that the mental healthcare community over here will seek to expand
its opportunities to commit that kind of abuse. And why not? You seem fairly
secure in your belief that none of your colleagues would actually abuse that
power if you had it.

------
olliej
I recognize there is a history of over application of medication for mental
health "defects" \- I mean for HN crowd the involuntary "treatment" of Turing
for the "mental illness" of being gay.

But at the other end of the spectrum you have paranoid schizophrenia who for
obvious reasons don't trust doctors. The CRPD seems to take the view that
treating, even temporarily, is illegal and so you couldn't treat the patient
to get them lucid enough to consent.

Imagine a case where someone has been unable to get there meds (through some
disaster or whatever), and so relapses and becomes paranoid and won't allow
treatment. Even if when not relapsed they do want to take the medication. The
CRPD appears to say that the patient can never be treated so any relapse must
in effect be permanent and their life is functionally over.

It also prohibits incarceration: so you're only option is the American system
of _waiting for someone with mental illness to commit a crime_ and then
putting them in jail - they CRPD apparently explicitly prohibits putting them
in a mental health facility.

It is hard to see how that interpretation is possibly good for anyone - the
patient, the patient's family, victims of any crimes that they commit, etc.
You could extend the argument to say someone with diminished mental capacity
should not be able to claim that in their defense because by definition that
would be discriminatory. It's also hard to see how an untreated patient could
possibly provide a meaningful defence of themselves if put on trial.

Again, the rationale for the CRPD is sensible: it's trying to prevent things
like how LGBT people have been "treated" by physicians, or things like the
holocaust which also targeted people with mental health issues.

But the apparent extremism seems hugely problematic.

~~~
candiodari
You mean to say that it was an important component of both the emancipation
movement, the anti-racism movement AND and the LGBTQ movement to ... ban
psychiatry out of the lives of these people.

Psychiatry has a history of being abused for social control, mostly by
psychiatrists. Freud defended rapists, often by using physical violence and
long term incarceration against their victims. Hans Asperger mass-executed
children at "Am Spiegelgrund". His signature is on the paperwork for locking
children into a ward for execution. Jo Erik Brøyn, Norways "top child
psychiatrist" (chairman of the council that decides to place children) ... was
convicted last year to 22 years for child porn. He had placed 2 children
ripped from their parents ... into his own care.

It is not a temporary thing. Psychiatry served to violently abuse children
when it was originally created. In fact you can make a decent argument that's
WHY it was created. And last year VERY important psychiatrists were convicted
for doing ... the same ... also to tens of thousands of children, just in
Norway alone.

