Article 19 addresses the right to live independently and be included in the community. What does this entail for people with psychosocial disabilities?
Some advocates have equated Article 19 to deinstitutionalization and community-based mental health services. I vehemently disagree if we are simply shifting the organization of mental health services, but agree that these measures are part of the totality of Article 19 obligations, which also include affordable housing, user-designed supports outside the mental health system, and an end to discrimination and exclusion in communities.
The mental health system is not the only way that individuals or communities can respond to our experiences of deep distress and alterations of consciousness, or to relational difficulties and conflicts that accompany such experiences or may give rise to them. Is Article 19 a good reference point to open up the discussion?
What kinds of supports do we find helpful, what do we imagine finding helpful if they were available? What do we need to ensure that we are not excluded from community? How do we hold ourselves and others mutually accountable in our relationships and interactions?
What is or should be the relationship of mental health services to Article 19 supports? Are they outside Article 19, covered better under Article 25 or 26? What are the advantages and disadvantages to bringing them under the community living framework as compared with health? Are there other alternatives?
Look back to the paradigm of supported decision-making studied in segment 3 on legal capacity. How does this paradigm relate to support for living in the community? Is it, for people with psychosocial disabilities, one and the same? What are the different kinds of support people with psychosocial disabilities may find helpful?
(Spring 2017 Introductory material:
This segment is meant to consider the CRPD framework in relation to changing practices of support and services provided to people through the mental health system. The nature of services in the current system is managerial, top-down, paternalistic and controlling. One strand of the problem is the medical model of psychiatry, which pathologizes psychic pain and inner conflict (and divergence, and much more). Another is the legalized coercion which, we have already seen, is prohibited by Articles 12, 14 and 15.
What would true support look like? Can Article 19, on living independently and being included in the community, offer a paradigm for a new approaches to services for people with psychosocial disabilities and/or people experiencing any kind of distress or trauma?
What about the words we use, like psychosocial disability, mental health condition, madness, distress, crisis, etc.? How do the different terms reflect and produce different ways of thinking about what is going on, and different ways of acting?
Does Article 19 overlap with Article 12.3 on the obligation to provide support in exercising legal capacity, which respects the person’s autonomy, will and preferences? Does it matter whether we think about supports desired by people with psychosocial disabilities under Article 19 or Article 12?)
*CRPD Article 19 and Article 25
*CRPD General Comment No. 1, paragraphs 44-46 & 52
CESCR General Comment No. 14 on right to health – including freedom to control one’s own health and body; *pre-CRPD and needs to be updated on forced mental health interventions, also *consider the impact of treating freedoms as part of a right subject to CESCR limitations clause (CRPD jurisprudence is better, addressing free and informed consent under Articles 12, 14, 15, 17 all core civil rights of the person)
*Special Rapporteur on Health, Report on Mental Health (Note: the report is not CRPD compliant in all respects; it proposes gradual elimination of coercion. Nevertheless a reference point for its elaboration of shift away from medical model, under UN auspices. See critical blog post for further context.)
Special Rapporteur on the Rights of Persons with Disabilities, Report on access to rights-based support for persons with disabilities and/or Easy-to-Read version
OHCHR Report on right to live independently & be included in community
Materials from Joint Side Event on Human Rights, Mental Health and Alternative Supports (Please explore as much as you can of the videos and written materials)
Initiatives and practices related to support:
*CHOOSE ANY THREE of the following:
Intentional Peer Support, What is IPS? (feel free to explore rest of site)
PO-Skåne, personal ombudsperson (Article 12, Article 19 or both?)
Report on Transforming Communities for Inclusion-Asia (good background information on issues, using Article 19 for rights of people with psychosocial disabilities – long paper)
Sarah Knutson, Peerly Human: Why We Need a New Recovery
WHO Quality Rights guidance and training modules (pilot version) – I am not endorsing the contents but an important initiative to apply CRPD to mental health policy and practices – large volume of material, worth studying to consider questions raised in this segment
European Network on Independent Living Manual
Indicators (CHRUSP/Absolute Prohibition campaign), see under Articles 19 and 25
Spring 2017 materials:
1-2 page papers
Discuss your response to questions raised in the Introductory material above, taking into account General Comment No. 5, any part you may read of the WHO training modules, other readings, and your own experience.
What are the steps needed in your country to implement Article 19 for people with psychosocial disabilities, taking into account the guidance provided by General Comment No. 5?
Consider the initiatives and practices in support that you have read about (from choices above), along with others that you may have experienced or know about. What kinds of support practices do you think are needed to build a comprehensive menu of supports for people with psychosocial disabilities to live independently and be included in the community?
(c) Tina Minkowitz 2017