TCI Asia Pacific Open Letter to the Organizers and Partners of the Global Ministerial Mental Health Summit 2018

Dated: 09-10-2018

Open Letter to the Organizers and Partners to the process of the Global Ministerial Mental Health Summit 2018,

London,9th and 10th October, 2018.

Expressing dissent over the process adopted and the expected outcome of the forthcoming Global Ministerial Mental Health Summit

TCI Asia Pacific is a regional DPO of persons with psychosocial disabilities, and users and survivors of psychiatry;  along with peers and supporters from the cross disability movement.  We are an Alliance of national DPOs, DPOs of persons with psychosocial disabilities and emerging leaders of persons with psychosocial disabilities from 21 countries in the Asia and Pacific regions.We are concerned about the Global Ministerial Mental Health Summit happening now; And this is also a cause of concern for the cross- disability coalitions and coalitions of persons with psychosocial disability in our regions, and across the globe.The causes for the concern are manifold.  However, a few crucial aspects are highlighted here:

1. “Creating conditions for inclusion” is one of the work streams planned in the Summit, towards addressing the barriers to inclusion by persons with psychosocial disability.  

The concern is that the barriers experienced by persons with disabilities including persons with psychosocial disability, towards inclusion, cannot be strictly addressed by the medical sector.  Barriers include legal, social, attitudinal, economic and other barriers to our full and effective participation in all areas of Development, and particularly, work, housing, education, social protection, and quality of our standard of living, among other things.     

The Summit has not involved the cross disability movement, other cross sectoral leaders, a wider section of policy makers, representatives of the Government across sectors such as employment, social protection, urban and rural development, and education to come together. Instead we find that only the Health Ministry is striving to connect all the dots and fill all the gaps. This amounts to promoting the existing paradigm of viewing the issues of persons with disabilities as medical, and  not recognising the paradigm shift proposed by CRPD to the social model of disability.

2. There is a lack of clarity on “bringing reforms within the health system”.  It is observed in many countries, there is a lack of respect for the will and preference of the individuals with disability on their choices of treatment and care. There are legally sanctioned involuntary commitments and incapacity disqualifications in mental health care settings, in closed wards, in communities and also various other human rights abuses.This is particularly true of the countries which suffer the long term trauma and aftermath of colonialism.  Commonwealth countries around the globe have it the worst, with old laws, reinforcing archaic stereotypes of persons of \”Unsound mind\”, \”lunatic\”, \”idiot\”, etc.  We are convinced that seclusion, segregation, involuntary treatment found in many parts of the world, are direct results of colonial legal traditions and developments in the war period, having nothing to do with medicine or care. 

The concern is that there is no focussed session plan in the Summit on ensuring full legal capacity  for all persons with disability in all situations under the Health system, nor any attempt to review Guardianship, and allied systems that have seeped into health care, in the light of the CRPD.

3. As a continuation to the above-mentioned point, there is also a lack of reflection in the Summit, on the human rights violations, abuse and violence inflicted upon persons with disabilities in the institutional set up.  In the many countries reviewed so far by the United Nations Monitoring Committee on the Convention on the Rights of persons with Disabilities, it has been repeatedly pointed out that it is the Mental Health laws which violate human rights, and that those laws, along with the associated incapacity laws, which must be repealed.   

While it would be morally questionable these days for governments to take the side of perpetrators of domestic violence or child abuse, it is shocking for us, that the violence caused by, and within the mental health systems – in the UK, US, more generally, the global North; and wherever mental health systems exist worldwide –  is ignored, made invisible, and non-significant.   

Asia Pacific region is not yet exposed nor \”trained in\” the levels of violence the MH systems and its officers perpetrate in the name of \”care\”.  For example, in the US, according to latest reports, the highest number of persons killed in police encounters are persons with disabilities, particularly those considered as mentally ill. The extant use of straight jacket, seclusion, physical restraints, amounting to \”torture\”, not mentioning the inordinate use of sedatives, implants and tranquillizers, has been reported by several officers of the Special procedures mechanisms of the UN.  Such brazen violence, in the name of \”health care\”, will put us to shame, our regions generally valuing compassion and social support especially for the vulnerable; and having several indigenous ways of offering such to people in distress and disturbance.  If the \”import\” of models in the West means for us to prepare to become a more violent society, and within the mental health system, we are of the strong opinion that we don\’t need those kinds of \”services\”.   

Therefore, the Summit has not addressed the need for de-institutionalization, a transition from institutional to community-based quality habilitation and rehabilitation services, and making the MH system violence free.  Where people enter the mental health systems, prohibition on violence needed to be addressed. The iatrogenic damage, health hazards, mental health hazards, deaths caused by psychiatric drugs on populations needed to be fully disclosed, for communities in the Global South to make an informed choice in the matter.            

4. It  is evident therefore that there is no commitment to build evidences on non-medical care and services informed by alternatives to traditional medical treatment and care that are practiced indigenously in many countries of the globe.          

Most importantly, we express our dissent over the process, content and outcome (a global sentiment) of this summit and wish a more holistic involvement of all stake holders concerned and more specifically persons with psychosocial disability, in all processes leading to the summit and its conclusion.

We also express our dissent on the message that this summit would give to the world, which is, a restrictive perspective of viewing the issues of persons with disabilities as only medical and not cross sectoral and developmental.

To conclude, there is a deep concern that this summit neither synchronises with the mandates of CRPD, nor with the SDGs. It does not bespeak of humanitarian approaches, at a time when the mental health systems in the global North, are approaching a humanitarian crisis, with the extent of violence and violations involved inherently, and having the sanction of law. Such outcomes from a system driven by health objectives, is not welcome in our countries and our regions.

TCI Asia Pacific   

(cc to OECD & WHO)