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Press Release – Oppose Protocol for Detention, Forced Treatment; Provide Alternatives #WithdrawOviedo

(Brussels) – Council of Europe member states should oppose new proposed standards regulating the detention and forced treatment of people with disabilities, Human Rights Watch said today. The body in charge of developing the standards, the Council of Europe’s Committee on Bioethics (DH-BIO), consisting of experts from each member state, is to meet on November 21, 2018 in Strasbourg.

The new standards are being developed as a draft Additional Protocol to the Oviedo Convention on Bioethics, a Council of Europe convention that regulates human rights in the framework of biology and medicine. The Additional Protocol aims to provide a framework for involuntary hospitalization and treatment of people with so-called “mental disorder” in Europe. The Council of Europe is an inter-governmental human rights organization consisting of 47 member countries, including the 28 European Union states. 

“The Council of Europe prides itself in promoting the highest human rights standards, but the draft Additional Protocol to the Oviedo Convention goes against decades of hard-fought progress towards equal rights for people with disabilities.” said Lea Labaki, of the Disability Rights Division at Human Rights Watch. “European governments should publicly oppose the protocol and stop its further development.”

Read more here.

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#WhatWENeed Tonga

#WhatWENeed in Tonga


Colonialism and Tonga

Tonga was never colonized by any country. It did not have a mental health law until 1992. However, it had ‘friendship’ status for 70 years with Britain. It was a British ‘protectorate’ from 1900 until 1970, when it attained full Independence. It always retained its political sovereignty; However, many of its land, foreign, tax, trade, and various other civil policies were derived from the British. Therefore, along with other erstwhile British protectorates and colonies in the Asia Pacific, Tonga is a commonwealth nation. Following the exit of the British in the 1970s, Tonga reinstated monarchy. It is the last Polynesian monarchy in the Pacific Islands. In 2010, the Kingdom of Tonga became a constitutional monarchy rather than being an absolute kingdom [1].

Development Linkages in Tonga

TCI Asia Pacific advocates that the action field for persons with (psychosocial) disabilities is not the ‘mental health’ sector, but the ‘development’ sector. Tonga comprises of 169 islands, of which 36 are inhabited. It has a population of around 103000 people, of whom majority live in Tongatapu, the main island. Tonga is classified as ‘Lower\Middle’ income country by the World Bank, in their classification of 2016 [2]. The economy is aid dependent. Most aid assistance for Tonga comes from Australia, New Zealand and Japan. Environment, climate change, energy, agriculture, are attracting bilateral funding. The state continues to be the dominant service provider in the kingdom. There is no social protection scheme in Tonga, traditional social systems, extended family system and kinship ties however act as safeguards for socio-economic adversity that individuals and families may be facing. NGOs exist and women’s empowerment is negotiated by the WIDC, which works from within the Prime Minister’s office and is involved in development activities and political decision making. 

Needed: Disability in Development and Abiding by International Commitments 

There are 3 national disability organizations, trying to work out co-operations among themselves and with larger movements. However, there is no motivation as the CRPD is not ratified yet. There is a good presence of UN Bodies such as UNDP who have contributed to development projects in Tonga, and also the WHO, with a health focus. Tonga has a history of signing international conventions and treatises, however, ratification is pending on several. CEDAW, now, remains to be ratified. Tonga has signed, but not ratified the UN-CRPD. Psychosocial disabilities and mental health remain on the fringes of policy and of the cross disability movement. There is a national disability policy; as well as an Ombudsman as a process under the Public Relations Act.

Needed: A Social Model of Support for Persons with Psychosocial Disabilities[3]

One of the reasons that TMHDA invited TCI Asia – Bapu Trust in October of 2017 was to share a community/arts based/support perspective into their public discourse on mental health. The mental health system is still very much medical in model with no other available community based services. A provision of services is mandated by the Mental Health Act 1992 (Kingdom of Tonga, 2001c). There are no large, warehousing type of mental asylums as usually found in the Commonwealth. Tonga’s main and only psychiatric unit is attached to Vaiola Hospital (located in the capital city Nuku’alofa) and is a general hospital psychiatric unit (GHPU). However it has been called a “hotch-potch mini institution” by the senior psychiatrist Mr. Mapo. The unit is staffed by a medical officer, a mental health welfare officer, psychiatric assistants and a social worker, and is headed by the region’s senior psychiatrist, Dr. Mapo. He has been appointed as Tonga’s national focal point for mental health and disability by the Prime Minister. The facility has 12 beds, although it frequently exceeds this number of patients. The unit works to “medically rehabilitate chronic psychiatric patients” through outpatient review, continued psychosocial rehabilitation, home visits and “medication on wheels”. The most common reasons for admission are ‘schizophrenia’ occurring in almost one in every two persons followed by ‘bipolar mood disorder’ in roughly 30% of persons.

WHO Regional Office for the Western Pacific reports that many Pacific Island countries have suicide rates which are higher than the global average (WHO-WPRO, 2013). Break down of traditional family systems, out-migration, parenting issues, child abuse, suicidal thoughts, ideation and attempts among young people, obesity, alcohol and other substance use among the young, have become a major concern in the kingdom. However, psychosocial naming of people’s concerns, studies on psychosocial distress and any news about community based support systems are not available in the literature. 

Needed: full CRPD Compliance in mental health 

While professionals advocate for a ‘half way house’ for those transitioning from inpatient mental health care back to the community, the hospital unit has an open door policy whereby patients can drop in to seek respite and care on voluntary basis. However, coercion is practiced and numbers of involuntary commitment patients are recorded at 90%. The Mental Health Act also provides for compulsory community treatment orders but the objective cannot be met as regulatory system cannot match up. It is recognized that ‘institution based rehabilitation’ must be replaced by CBR. Funding for mental health and well being services is very low at only 1% of the Ministry of Health’s total expenditure, dramatically below WHO recommendations, mostly for medical treatments and improving infrastructure for practice of psychiatry. There are no ECT facilities in Tonga, closest being Fiji Islands, and so the moral questions faced by other commonwealth countries around the use and abuse of this controversial procedure, is not found here. 

Recommendations

The ‘advanced’ countries are today struggling with loss of communities, state control and over-institutionalization. In the global south, however, there are not so many ‘mental’ institutions, though thousands of unregulated social care institutions do exist. The ‘custodial’ mentality remains due to mental setbacks caused by colonialism in most post colonial countries in the Asia Pacific. Poor availability of community services, poor regulatory mechanisms, liberalising economies, have their impacts on communities and systems, with abuses happening in open communities. Mental health legislation, a product of colonialism, has been a recognized barrier worldwide, for the serious discrimination of persons with mental health problems and psychosocial disabilities. The Kingdom of Tonga, like many other lower/middle countries in the Asia Pacific, does not have medicolegal institutions, or special organizations built on principles of ‘custody’. This is a huge opportunity to build communities around Inclusion.

1. Inclusion in Development and Health care – Tonga has an impressive primary health-care system, good public health infrastructure, public health program features, comprehensive health care, urban development, civic administration, education, civic amenities, water, sanitation and waste disposal programs. Psychosocial perspective can be integrated into the already existing systems on development, including public health. Programs already in existence, offered in the kingdom, could be ‘upgraded’ to inclusion programs.

2. Preparing multiple stakeholders for Inclusion – service providers in Tonga work in the remotest parts of the Kingdom closer to families and communities. The church is found in all parts of the Tonga human habitats. They are all stakeholders who could be trained in inclusion of persons with mental health problems and psychosocial disabilities. The policies in development, as they are emerging, could already have a psychosocial well being and inclusion component. Then, at the local level, partnerships for inclusion and mental health can be forged through many development pathways.

3. Programming communities for Inclusion – family and kinship structures, community networks, culture are strong sentiments in the Kingdom, as evident from Langi-Maa conference. Basic modules of non formal care giving and support for persons with disabilities including mental health problems, can be offered for families and communities through the existing networks and systems. Local NGOs can be roped into the trainings. Training modules could be geared towards creation of support networks, family systems strengthening, community awareness and skills building, negotiation and arbitration techniques, peace building techniques, etc. 

4. Strengthening mental health systems towards Inclusion – Existing medically orientated mental health systems could be ‘upgraded’ towards CRPD compliance, with a more holistic view of the person and their social environment. Mental health law and policies can be reframed to be in alignment with the CRPD. Goals of psychosocial well being could be towards recovery and wellness promotion. The larger purpose of the mental health system would be to facilitate the inclusion of persons with psychosocial disabilities into communities. 

LANGI MA’A 2017 [4]

The visit to the Kingdom of Tonga was tied to TCI speaking engagements in the Symposium, “LANGI MA’A 2017: TONGA MENTAL HEALTH AND DISABILITIES SYMPOSIUM, organized at the TANOA INTERNATIONAL DATELINE HOTEL, NUKU’ALOFA, from October 9th to the 13th, 2017. 3 areas were identified as useful to the development of the sector in Tonga:

1. Brief overview of the CRPD

2. Inclusion of persons with Psychosocial disabilities

3. Programs development and available treatments/services compliant with the CRPD.

This was the very first mental health symposium in Tonga post independence and TCI Asia was proud to have participated [5].

TCI Asia visit to Tonga was supported by CBM-Australia in partnership with the Tonga mental health and disabilities Association [TMHDA, Nukualofa, Kingdom of Tonga]. TCI Asia is partner with the International Disability Alliance (IDA). IDA provides technical assistance and guidance to TCI Asia. 


References

[1] Kavita Nair, 2017, “Mental health systems in Tonga- A background paper” for TCI Asia Pacific. Bapu Trust, Pune. 

[2] https://blogs.worldbank.org/opendata/new-country-classifications-2016 

[3] Also, see http://www.loauuniversity.edu.to/index.php/en/taught-courses/183-mental-health-related-problem-in-tonga

[4] https://www.tmhdatonga.org/

[5] We thank CBM-A and Jillian Ferguson for great support to make our participation and our visit most meaningful

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Mental Health Europe Responds to the Lancet Commission Report

Mental Health Europe recently published a response to the Lancet Commission Report released on World Mental Health Day 2018. 

“…the report’s key recommendations still come from a biomedical starting point, and therefore fail to recognise fully both the psychosocial model of mental health and community services. Change would involve tackling the power of the national and global institutions that provide structural support for the medical model, which has presided over the escalating epidemic of mental ill health. MHE would emphasise the need to invest in psychosocial support respectful of local customs, practices and beliefs instead of biomedical interventions

Read more here.

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New Report Compiles Global Evidence Base for Alternatives to Coercion by Piers Gooding

Author: Piers Gooding



A new report brings together evidence from around the world on preventing, reducing and ending coercion in mental health settings. The report, authored by Bernadette McSherry, Cath Roper, Flick Grey and myself, was commissioned by the Office of the High Commissioner for Human Rights to inform the work of the Special Rapporteur on the Rights of Persons with Disabilities, pursuant to the Human Rights Council.

The report seeks to compile leading practices from around the world on alternatives to coercion, as well as to identify gaps in the research.

Readers of this blog will know that the CRPD – the Convention on the Rights of Persons with Disabilities – challenges governments to improve access to voluntary supports for persons with psychosocial disabilities and to end coercive interventions. The United Nations Committee on the Rights of Persons with Disabilities has unequivocally directed governments to eliminate detention and forced treatment on healthcare grounds as it violates the CRPD.[1]

For decades prior to the CRPD user/survivor activists have sought to reduce, prevent and eliminate coercive practices. Coercion includes detention and non-consensual treatment, to the use of seclusion, physical force, the use of belts or straps to restrict movement, or pharmacological interventions to control behaviour.

We wanted to know whether coercive practices can be reduced, prevented and eliminated. Our review examined efforts in hospitals in high-income countries, to family homes in rural parts of low- and middle-income countries.

The review isn’t exhaustive, as it was confined to English-language resources. A larger review is needed to uncover empirical research and reports of promising practices, particularly in non-English-speaking regions. It is also likely that we missed important resources. The review could be updated periodically.

We included 169 studies and reports from many parts of the world. To our knowledge, no researchers have systematically analysed alternatives to coercion on this scale. Taken together, the material offers valuable insights into the state of alternatives to coercion.

The report is freely available and includes three handy tables at the end of the report. The first, summarises the formal, scholarly literature. The second, lists ‘grey literature’ – such as policy documents, materials released by disabled people’s organisations, and so on – as well as existing reviews of different practices, such as advance directives. The third appendix lists initiatives from around the world, including the work of TCI-Asia.

Given the emphasis in this blog, I will briefly summarise the findings concerning the Asia Pacific. There were very few English language resources on efforts to reduce and end coercion.

Studies from India, Indonesia and China appeared in the review but given the low number of studies, few generalisations can be made. There is a clear need t record good practices, including better understanding the concerns of persons with psychosocial disabilities and others concerned with coercion in mental health settings.

There were only two Indian studies: Shields and colleagues sought ‘client and carer’ views on psychiatric advance directives,[2] while Raveesh and colleagues examined the attitudes of psychiatrists and caregivers to the use of coercive practices. Participants in Raveesh’s study recommended ’empowering patients, improving hospital resources [and] staff training in verbal de-escalation techniques’.[3]They call for ‘standardized operating procedure[s] in the use of coercive measures’; this recommendation is not an alternative to coercion per se, though the authors argue that clear regulation would reduce coercion overall.[4] The counterargument is that such regulation may cement the use of coercion in day-to-day practice.

Three peer-reviewed studies were undertaken in Indonesia, all concerning the practice of ‘pasung’, that is, the shackling or restraint of persons with psychosocial disabilities in family homes and communities. Minas and Diatri, in their observational study on Samosir Island, argued that the ‘provision of basic community mental health services, where there were none before, enabled the majority of the people who had been restrained to receive psychiatric treatment and to be released from pasung’.[5] Puteh and colleagues similarly concluded that the ‘development of a community mental health system and the introduction of a health insurance system in Aceh (together with the national health insurance scheme for the poor) has enabled access to free hospital treatment for people

with severe mental disorders, including those who have been in pasung’.[6] They argue that it can inform ‘other low and middle-in- come countries where restraint and confinement of the mentally ill is receiving insufficient attention’.[7] Suryani and colleagues take a slightly different approach in applying a programme to address pasung; they sought to integrate more culturally-specific forms of support, which they describe as a ‘community-based, culturally sensitive … mental health model’ that assisted all 23 people subject to pasung to show ‘a remarkable recovery within 19 months of treatment’.[8]

In China, a study by Guan and colleagues was a largescale, national project, involving a nationwide two- stage follow-up study to measure the effectiveness and sustainability of the ‘unlocking and treatment’ intervention and its impact on the ‘well-being of patients’ families’.[9] Similar to the Indonesian studies, the unlocking process referred to an intervention to free people from deprivations of liberty in family homes or communal spaces (such as villages). 96% of participants were reportedly diagnosed with schizophrenia. Prior to unlocking, their total time locked ranged from two weeks to 28 years, with 32% having been locked multiple times. The authors reported that over 92% of participants remained free of restraints in 2012 and they argued that ‘[p]ractice-based evidence from our study suggests an important model for protecting the human rights of people with mental disorders and keeping them free of restraints […][via] accessible, community based mental health services with continuity of care’.[10] China’s ‘686’ Programme may be useful, therefore, for informing efforts in low-resource settings where community locking of persons with psychosocial disabilities is practiced. However, it does not appear that any of the research in the Asia Pacific – at least to our knowledge – included persons with psychosocial disabilities themselves on the research team, unlike some of the research in Western Europe and North America. More research may also be needed to determine whether the reduction of ‘informal’ coercion in countries like Indonesia and China, may have led to an increase in ‘formal’ coercion, through health services.

Caution is necessary on this front, given TCI-Asia has warned of a growth of psychiatric institutions in Asia, as well as laws which authorise non-consensual psychiatric interventions.[11] In a submission to the CRPD Committee, TCI-Asia warn that ‘even though mental health legislations do not exist in many [Asian] countries, and some have [only] recently adopted new coercive mental health laws, mental institutions are coming up quite fast, resulting in the escalation of barriers to inclusion’.[12] It may be useful for organisations representing persons with psychosocial disabilities to influence research that captures effective alternatives to coercion.

In the Pacific, there is evidence of efforts to address coercion in the mental health context.[13] The Pacific Disability Forum Sustainable Development Goals/CRPD Monitoring Report 2018, for example, notes that ‘[s]ome resources are still used to fund services in education and mental health that are not aimed at inclusion and participation and should be reallocated towards inclusive programs’. However, the report also highlights positive measures, such as the Kingdom of Tonga’s first National Disability Inclusive Health Plan 2016-2020, which is designed to strengthen access to health care, rehabilitation and mental health services for people with disabilities in Tonga.[14] However, the extent to which such formal services are genuinely rights-based, recovery-oriented and trauma-informed – and which avoid coercion – is unclear.

More research is needed to identify positive actions being taken in Pacific Island countries and New Zealand (and indeed, Australia) to reduce, prevent and end coercive practices in the mental health context, including among indigenous communities.

On this latter point, it is noteworthy that the Family Group Conference approach, which has become prominent in Dutch efforts to reduce coercive psychiatric interventions, was developed from Maori approaches to family law disputes.  In New Zealand, a handful of crisis respite services are Māori-led, or incorporate Māori cultural practices. Awhi Rito, for example, provides crisis respite for mothers and their babies.

Outside of the Asia Pacific, the research challenged certain assumptions in typical mental health services, such as the notion that psychiatric wards need to be locked. This assumption is based on a belief that locked doors prevent people from absconding, attempting suicide or dying by suicide.

However, German researchers examined around 350,000 admissions to 21 hospitals over a 15-year period & found “insufficient evidence that treatment on locked wards can effectively prevent these outcomes”. In fact, their research suggested the opposite. Open wards were associated with a decreased probability of suicide attempts, absconding with return, and absconding without return, though open wards did not appear to affect rates of death by suicide.

In Germany, according to Zinkler, some hospitals (mostly in small towns and rural areas) have almost completely abolished compulsory psychiatric treatment, with no corresponding increase in other types of coercion or violent behaviour.

These are just a few examples from the report. Although the literature was diverse and relates to a whole range of practices which makes it hard to standardise solutions, there is good evidence to support a range of initiatives in community organising, policy, law and practice.

Reassuringly, it seemed that whenever governments, service providers or community advocates made concerted efforts to reduce, prevent and end coercive practices, they largely succeeded.

Perhaps another important lessons for advocates, activists and allies of people with psychosocial disabilities in the Asia Pacific is that good practices are likely to be happening already, but that it can be important to record these practices, including documenting any successes (or failures).

There have not been any jurisdictions that have implemented all the positive measures to reduce coercive practices in family homes, social and housing services, hospitals and community services. Perhaps a future study could what would happen if multiple initiatives, in family homes, crisis respite houses, hospitals and elsewhere, were introduced together with the explicit of reducing and eliminating coercion from responses to psychosocial disability.


Dr. Piers Gooding is a socio-legal researcher at the Melbourne Social Equity Institute, at the University of Melbourne.

He is on Twitter at @P_Gooding



References

[1] Committee on the Rights of Persons with Disabilities, General Comment No 1: Article 12: Equal Recognition Before the Law, 11th sess, UN Doc CRPD/C/GC/1 (19 May 2014) and CRPD Committee, Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities: The Right to Liberty and Security of Persons with Disabilities, 14th sess (September 2015)

[2] Shields et al, above n 57.

[3] Raveesh et al, above n 220, s221.

[4] Ibid.

[5] Minas and Diatri, above n 8.

[6] Ibrahim Puteh, M Marthoenis and Harry Minas, ‘Aceh Free Pasung: Releas­ing the Mentally III from Physical Restraint’ (2011) 5 International Journal of Mental Health Systems 10, 10.

[7] Ibid.

[8] Luh Ketut Suryani, Cokorda Bagus Jaya Lesmana and Niko Tiliopoulos, ‘Treating the Untreated: Applying a Community-Based, Culturally Sensitive Psychiatric Intervention to Confined and Physically Restrained Mentally III Individuals in Bali, Indonesia’ (2011) 261(Suppl 2) European Archives of Psychiatry and Clinical Neurosciences 140, s143.

[9] Guan et al, above n 56.

[10] Ibid.

[11] Transforming Communities for Inclusion -Asia, Submission to the UNCRPD Monitoring Committee, Day of Generai Discussion, Article 19 ; see also .

[12] Ibid.

[13] See, eg, Pacific Disability Forum, Pacific Disability Forum SDG-CRPD Mon­itoring Report 2018, 15 ; Bhargavi Davar, ‘From ‘User Survivor’ to ‘Person with Psychosocial Disability’: Why We Are ‘TCI Asia” (blog) 

[14] Pacific Disability Forum, above n 407.SHARE

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#WhatWENeed Taiwan

#WhatWENeed in Taiwan

1. De-colonization of the mental health sector

Taiwan was the first independent, Asian, democratic republic. However, it has had a complex history of colonialism, invasions and occupations by different nationalities (Dutch, Spanish, Chinese, Japanese, etc.). “Taiwan’s culture and cultural legacy has been largely shaped by the processes of imperialism and colonization as the structural and psychological effects of successive colonial projects have been integral to developing Taiwan’s self-image and the evolution of both official and unofficial Taiwanese culture”(1). History goes that the British refused a proposal to occupy Taiwan. So, the country escaped having pre-human rights lunacy laws. 

2. Full CRPD compliance and inclusion within disability frameworks

Taiwan government sought to voluntarily engage with the CRPD monitoring process. They appointed an Independent Review Committee comprising of CRPD Committee members and other independent experts to review CRPD compliance. Refer to the report here.

People with Disabilities Rights Protection Act was made in 2007, where people with psychosocial disabilities are indeed included. In Taiwan, 1,125,113 people are registered as having disabilities. Of these, 10% have been diagnosed as having mental disabilities. However, the estimation is from a medical psychiatric perspective, not from the perspective of disabilities. From 2014 there is a law to implement the CRPD – Act to Implement the Convention on the Rights of Persons with Disabilities(身心障礙者權利公約施行法), the goal of which is to comply with CRPD. In 2014, it is officially the domestic law in Taiwan.

A new Mental Health Act was introduced only in 1990. Writers on the history of mental health legislation in Taiwan are clear that this law was not made to protect the human rights of persons with psychosocial disabilities. As typically found in the region these days, it was not lawyers which made the law, but private psychiatrists: “The government commissioned a private mental institution to develop a draft of the Mental Health Act, with the purpose of protecting the public and reducing the dangers from psychiatric patients” (2). The MHAct leans heavily towards protectionism, guardianship and involuntary commitment. 

The IRC recommended that “the State expedite the review of its terminology and approach in laws, policies and practices to enable the paradigm shift that recognizes persons with disabilities as full holders of all human rights and fundamental freedoms, and provide a timeline for completing such review”.

3. Discard the medical model in favour of the social model of disability

Both these legislations lack focus on community resources, and put too much emphasis on Disability Cards, institutions and the medical model. The number of psychiatrist to persons is 1:17000, which is higher than other Asian countries. Persons who have a psychosocial disability find it hard to get a disability card from the government resources. The disability assessment system uses discriminatory medical language, such as “mildly disabled”, “moderately disabled” and “severely disabled” in assessing persons with disabilities. In 2017, among those with chronic mental illness, 54.8% were moderately disabled, 28.5 % were mildly disabled, 15.9% were severely disabled, and 1.6% were extremely disabled. The most common cause of disability was chronic illness (71.1%). According to the “Report on the Living Conditions and Needs of Persons with Disabilities in 2016: Questionnaire Survey of Major Family Caregivers”, the incidence of “chronic mental disorders” was 37% from 18 to 30 years old, and the median age of occurrence of disorders was 28 years old. The proportion of “unmarried” people with “chronic mental disorders” was 47%, the proportion of “no children raising children” was 53.47%. The average number of years of family members caring for those with “mental illness” was 17.13 years, while the average number of years of care for intellectual disability was 23.49. These figures are quite high, and there is concern about how they were arrived at. The government has schemes for independent living, but excludes persons with mental disabilities. 

4. Abolish Guardianship

There is no separate guardianship law. However, the Civil Code of Taiwan provides the order of commencement of guardianship and the order of commencement of assistance. An adult’s guardian shall be selected by a court ex officio. The said order would not be implemented until the adult loses his/her capability of communication. Under the circumstance, the definition of a ward’s “independence” cannot be met perfectly. The government has noted the gap. Therefore, in January 2015, the Ministry of Justice invited the social welfare groups, including Parents’ Association for Persons with Intellectual Disabilities, Taiwan, scholars and experts to discuss the “Voluntary Custody System”, which allows the person with disability to determine his/her guardian, so that the a person’s dignity and interest may be respected. Given this, Ministry of Justice will complete the draft of amendments to the laws for establishment of the voluntary custody system, and submit the same to Executive Yuan for examination as soon as possible. The Ministry of Justice will also proceed to record and research the motion about the capability of a person subject to the order of commencement of guardianship separately.

The guardianship refers to the circumstances in which the commencement of guardianship and assistance by the court. For the number of persons who have been commenced of guardianship and assistance by the courts (juvenile and family) from 2014 to 2016. As for the number of persons with intellectual and mental disorders that were not in guardianship, since it involves the national statistics of disability population, there is no reliable data available. The number of persons who have been commenced of guardianship and assistance by the courts from 2014 to 2016.

(Unit:People)

2014 had 3609 commencement of guardianship cases and 260 commencement of assistance cases. 2015 had 3799 commencement of guardianship cases and 263 commencement of assistance. 2016 had 4081 commencement of guardianship cases and 266 commencement of assistance. There has been a steady rise in the guardianships for persons with psychosocial disabilities. 

As can be seen, there is a big gap in legal compliance in guardianship and CRPD compliance. The IRC has recommended that “the State amend all relevant laws, policies, and procedures and that a system of supported decision-making be put into place that is compliant with the UN CRPD Committee’s General Comment No. 1, including the provision of adequate resourcing for such a new system”.

5. Traditional healing

Taiwan has diverse cultures of Chinese, indigenous/aboriginal populations and cultural practices. Mahayana Buddhism has been practiced in Taiwan since centuries, however, the Chinese prohibited practices of Buddhism, which resurfaced only in 1978. Traditional Chinese medicine (such as: Acupuncture) is available widely in Taiwan but “healing psychological problems” is not often its main target. Chinese medicine is based on energy systems – chi and the yin and yang. Doctors working Chinese medicine consider adjusting the body’s energy as the primary goal. But it can help healing. Taichi, qigong, herbal medicine, yoga are also methods of healing. There are also temples that hold rituals for people having experience of a mental crisis. Traditional medicine is covered under the public health insurance scheme.

6. Community support systems

The IRC in 2017 have remarked repeatedly on the derogatory language commonly used in Taiwan, stigmatising persons with disabilities in general, and persons with psychosocial disabilities, who have internalized the identity as “mental patients”. Families are the main form of support in long term care, and it is internalized by the persons with psychosocial disabilities as “burden of care”. The government does not support them in any way. While policy is presently forced to think about “de-institutionalization”, there is no provision for de-institutionalizing, by setting up community support systems. The mental health system is not adequately prepared for this, by integrating resources from other sectors notably labour, social services, general health care. The quality of care for community mainstreaming and inclusion needs to be enhanced, and the health care payment and evaluation provisions need to be revised to avoid the re-institutionalization.

There is a proposal to create smaller institutions (50 beds or less), but this is still based on the penal model of involuntary commitment. Stigma is high, making “mental patients” resistant and afraid to seek medical treatment. As provided in the People with Disabilities Rights Protection Act, the valid term of a disability certificate is 5 years. The persons with disabilities in a community will take the government’s assessment at least once per 5 years, and the government will organize a professional team to confirm their needs and provide supportive care services for individuals and families. In addition, all levels of governments shall conduct need assessment on the living situation, health care, special education, employment and training, transportation and welfare and shall publish and announce the results of such research at least once per 5 years. In the performance evaluation indicators of social welfare, each local government shall make implementation plans and prepare and execute the budget in accordance with the assessment result. 

The government has a budget of more than 20 million per year for persons with disability to live in the community, and only those who are identified as severely disabled can apply for the maximum number of hours – 60 hours per month – equivalent to only 2 hours a day.However, because the indicator for disability includes ADL and IADL, most people with mental disability are not eligible.

The core spirit of the CRPD is that the obstacles are not caused by the physical and mental defects of the physically and mentally disabled, but by the external environment, stereotypes, discriminatory attitudes, or interactions that will hinder the physical, mental, and physical participation of the disabled. There is still a long way to go for community-based care for “mental patients” in Taiwan. On the one hand, it is necessary to invest in the establishment of a sufficiently mobile community care team. On the one hand, it is necessary to create a friendly and acceptable community environment, with laws and resources in place, and cross-team cooperation such as health, social, labor and police so that mental patients can be more effective. The medical care and self-reliance can reduce the burden on family members and reduce the problem of social security. Mental patients are not terrible, terrible is the public misunderstanding and stigma. Only when everyone works together can the community-based care of mental patients succeed.

There are unmet needs of many community mental patients, including physical and mental symptoms, as well as the need for money, social welfare, and social relationships. In addition, it is very important to note that self-stigma has become an obstacle to the recovery of community mental patients. This is similar to the poll conducted by the Taiwan Psychiatric Association last year. 37% of “mental patients” are afraid to tell others that they have mental illness, and 41% of “mental patients” feel that others cannot accept that they are using psychiatry. In addition to the self-stigma of community “mental patients”, the problem of social stigma of mental illness is also very serious. A 2017 survey found that 46% of people with “mental illness” were rejected or discriminated against during their duties and many believed that people with “mental illness” were at risk. Recovered people are still not accepted by the community or by the employers. The linkage needed between disability assessment and entitlements is not made so there is no social protection. There are a few clubhouses and very few peer support systems. Most resources are clinical/medical based. If one does not have professional licenses such as social worker or therapist, etc, she or he doesn’t have many resources (e.g. budget) to build up a community based support system, for example, peer support systems. Persons with psychosocial disabilities are finding it very hard to build up a self-run, independent support system.

The IRC has strongly recommended “That the State amend all relevant laws and policies, including the Mental Health Act, so that involuntary detention on the basis of disability is prohibited, and that a system of procedural safeguards, including immediate access to legal assistance, be put into place, including ensuring the free and informed consent of the individual; and (b)That the State uphold the freedom to make one’s own choices as a principle in article 3 (a) of the CRPD and recommends an absolute ban on the deprivation of liberty on the basis of actual or perceived impairment”.

7. Full CRPD Compliance

The current legislations do not meet the standards set by the CRPD. The IRC has commented on full participation of persons with disabilities and DPOs in developing laws and policies, and specific recommendations on all CRPD provisions. Towards assisting persons with disabilities in inclusion and adapting to communities, the government provides in Articles 26, Article 30, Article 32, Article 37, Article 47 of the Regulations of Personal Care Services for persons with disabilities, various community-based services – including life reconstruction, residence in communities, community-based day-care, community drop in facilities for operation at daytime, etc. With regard to the content of these services, besides providing daily living skill training, inter-personal relationships and social skill training, the government also plans to carry out campaigns to promote participation in life and adaption to communities simultaneously to assist persons with disabilities in actively participating in community activities, to enhance their interaction with families and communities and to enhance community engagement.

All local governments have been actively planning and establishing community-based day-care, residence-in-communities and family care service centers. As of the second quarter of 2017, there were 159 community facilities for operation at daytime, 114 community-based day-care service centers, 94 residence-in-communities service centers, and 129 family care service centers, which served 5,326 persons. Moreover, to assist persons with disabilities in living in the communities independently and choosing the living places that are suitable to them and participate in society equally under the preconditions that they can make their own decisions, choices and be self-reliant and that opportunities are equal for them, the government promotes supportive services for independent living of persons with disabilities and had served 14,402 persons by the second quarter of 2017.

In order to achieve the goal of “caring psychiatric patients in the community” and enhance the quality of psychiatric rehabilitation services, as well as to assist the psychiatric patients with better condition in returning to their community, in 2014, DPOs requested the department of public health in every municipality or county (city) to limit the total quantity of bed (50 beds or less) on the application of new establishment or service expansion proposed by mental institutions. As of the end of 2016, up to 84.24% of such institutions have adjusted their service scale to 50 beds or less successfully. This practice will be taken into consideration when amending the relevant regulations for such institutions in the future, to gradually reduce the patients’ number from staying at large rehabilitation centers or institutions. Rather, we aim to provide the persons with a wide range of community service choices to facilitate them adjusting and living within the community. However care is seen as within a medical model still and independent living is yet to become a reality for persons living with mental illness. CRPD compliance and social model is needed.

© Prepared for TCI Asia Pacific (2018) by TAMI and TGQRAA, Taiwan, for the Bali Plenary meeting, August, 2018. 

About the organizations:

TAMI – The Alliance for the Mentally Ill of R.O.C., Taiwan(TAMI) is a non-government, nonprofit, grassroots, self-help organization of consumers, families, and friends of people with mental illnesses. Founded in 1997, TAMI currently has 29 group members from local organizations of 20 counties in Taiwan with more than 4,000 members who have made great efforts to provide services to people with psychosocial disabilities, working on the national and local levels in support and advocacy of mental health. TAMI has emphasized on support to persons with serious mental disorders and their families; advocacy for nondiscriminatory and equitable policies and treatments for brain disorders; also education to eliminate the pervasive stigma surrounding severe mental illness. TAMI works in co operation with professionals to change mentality; remove social and other barriers; addressing poverty, and enabling social support systems through employment; managing medicines, using psychotherapies, and social skilling; mainstreaming within communities; improving self determination of persons with psychosocial disabilities especially through providing transitional employment from asylums and social development; peer support trainings; personal life storying; building hope. 

TGQRAA: We are building local peer support systems, amending 〈Mental Health Act〉, helping other organizations building peer support discourses.


References

1. Wikipedia, https://en.wikipedia.org/wiki/Culture_of_Taiwan, accessed on 26-10-2018


2. Wei-Tse Hsu, M.D., M.S.1 , Hui-Ching Wu, Ph.D.2 , Frank Huang-Chih Chou, M.D., M.S., Ph.D.1 A History of Mental Health Laws in Taiwan * Taiwanese Journal of Psychiatry (Taipei) Vol. 31 No. 3 2017 195-203.

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#WhatWENeed Japan

Excerpts from TCI Asia Pacific Action in Japan


Osaka  – 22-23 November 2017

#WhatWENeed is peer support as community development, not “mental health care”

Excerpts from “TCI Asia Action in Japan”[1] [2]


One of the objectives of TCI AP’s Japan exchange were:

  • To bring a small group of peer support practitioners from TCI Asia membership and to have focused discussions on the importance of peer support in Asia.
  • It was also hoped that there will be a lively exchange with the Japanese government, and other key policy stakeholders, on the importance of peer support in Japan.  Being a high income economy, TCI Asia Pacific also learnt a lot about the highly institutionalized setting of mental health care.

Peer support movement in the way practised in the West has been there for at least 2 decades, as far as we know, in Asia (e.g. Hong Kong, Japan). Some leading user/survivor figures at the time, for e.g. Mary O’Hagan, supported the trainings and mentorship of DPOs in the countries[3]

Open Dialogue was also popular. Such community development methods were growing at a fast pace, with lead taken by organizations and by persons with psychosocial disabilities, particularly the Japan Group of Mentally Disabled People (JGMDP, Osaka).

In Osaka[4], we learnt that peer support for ‘Recovery’ (within the mental health system) and peer support for ‘Inclusion’ (as a part of community development) were two different pathways of actions.  The former is done within the medical paradigm;  the latter is within the disability / social inclusion paradigm.   

The Japan Health Department presented their study on the experiences of peer workers within their highly institutionalized mental health system. A high percentage of mental institutions in Japan are private and they have the typical warehousing design of colonial hospitals with a very high conduct of involuntary admissions. Hospital stay is very high in Japan, 275 days per person on an average. The Government is concerned, but hasn’t known how to work in communities. So they provided for special cadres of “peer supporters” who work in such highly institutionalized medical settings. Around 2000 peer supporters exist within the system.

While the stated objective of Peer Support in this framework was “living independently in communities” the program did not have the desired effect. Community care is not making good progress from the view of the health department – readmission, revolving door phenomena, all continue to exist in Japan. The Ministry of Health did a survey on peer support utilization from 64 local municipalities. Participants had high experience as peer supporters with a 10.6 years average.

The definition of ‘peer supporter’ is not very uniform or even clear. Peer supporter activities – awareness and psycho-education, escort services for activities outside of hospital, running support groups, home visits assistance very much underpaid, with between 2.5 – 30 hours a week. Peer staff support medical consultations especially on medicine compliance. They provide decision making support within the medical system. They expected that their co workers will understand their disability, respect them as human beings, be recognized for their special skills, appreciate their professionalism and enjoy equal treatment. They also expected that their peer support work will be recognized. However, peer support work was not recognized and was undervalued within the system. 

The way peer support is being used in countries like Japan, Hong Kong raises the question of whether the expected outcome strengthening mental health treatment, or is it to strengthen the supports in the community. Peer supporters- are they to work more like personal assistants to the person with the disability, or more like a psychiatric nurse?

Within high income Asian countries, the role of the peer supporters are largely within the medical, often institution based, system. In Thailand, peer supporters can be exhorted to share confidential information by psychiatrists.  There was sharing of experiences about widespread ‘co-optation’ when peer supporters work within the system. There was a strong opinion that a peer supporter should give news about side effects of medication to the person with disability, whether they want to hear it or not.

Low and middle income country experience of peer support is more from the location of Disability Inclusive Development (Indonesia, Pakistan, India, Sri Lanka), within communities, informal support and going beyond medical role, towards access to a variety of support systems for enabling living in communities. There is more DPO led actions in these countries. In India, however, the situation is fast changing, with psychiatrists leading peer support efforts. It raises the question whether it is peer support at all.
In nearly all countries, using arts and performances, turning to nature / agriculture and running, football and sporting were included as part of self care and recovery; and as community development activities. Some countries enjoyed funding support from social welfare for some of these activities. In Japan, the use of rhythm and drumming to explore possibilities of dialogic communication was useful, and it was considered as the ‘Asian’ way by JNGMDP.

The question of ‘who pays’ for peer support services has a variety of responses in Asia.  Peer supporters staff are paid in places, but not peer supporters.  Its a part time or full job for some people. Others are working closer with community families, etc. where it may also be voluntary, stipend based, informal work, etc.

Peer support is a felt training need for all over the region. Different small and big groups of persons with psychosocial disabilities are practising it. However, locally adapted, culturally appropriate peer support models, in compliance with the CRPD need to be developed, for sustaining the movement and expanding it through the region.  There is a crying need for a regional training program, and having peer partnerships throughout Asia.
Japan National Group of Mentally Disabled Group (JNGMDG) is a Japan based organisation led by users survivors of psychiatry fighting against Japanese Ministry of Health and Welfare, mental hospitals, psychiatrists and discrimination against persons with psychosocial disabilities.  To contact them reach out to: scp_kirihara@yahoo.co.jp 


References

[1]  JNGMDP & TCI Asia (2017).  “TCI Asia Action in Japan: Peer Support”. Report of a Country Mission Visit to Japan, Ibaraki, Osaka, November  22-23,  2017.  Japan National Group of Mentally Disabled People (JNGMDP) in collaboration with TCI Asia,  Research Center of Ars Vivendi of Ritsumeikan University, and NPO Corporation Aru.  Report by TCI Asia, 2017.

[2]  Thanks to, the team of JNGMDP, for visioning, planning, mobilizing resources, leadership, cordial and generous hospitality; Core team of JNGMDP for the gracious partnership; Ito, Kasumi, JNGMDP for tireless admin, translation, organizing and local support work;  Shivani Gupta, for overall co-ordination and backend support.

[3] Anthony C. Stratford, Matt Halpin, Keely Phillips, Frances Skerritt, Anne Beales, Vincent Cheng, Magdel Hammond, Mary O’Hagan, Catherine Loreto, Kim Tiengtom, Benon Kobe, Steve Harrington, Dan Fisher & Larry Davidson (2017): “The growth of peer support: an international charter”. Journal of Mental Health.  To link to this article: http://dx.doi.org/10.1080/09638237.2017.1340593

[4]  TCI members and international participants who travelled to the meeting were, Indonesia (3); SriLanka (1);  Pakistan (1);  South Korea (1);  Thailand (2); Taiwan (3);  HongKong (2); China (2); India (1);  Japan (9 key members from different provinces).   In all, 66 people participated in the peer exchange. Importantly, there was provincial representation from Japan in the meetings. JNGMDP organized simultaneous translation services for the 23rd meeting. For the meeting on the 23rd, around 89 persons participated from all allied sectors. The Workshop attracted around 50 participants.


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Peruvian law abolishes guardianship and recognises full legal capacity

On 4 September 2018, the Peruvian Government published Legislative Decree No. 1384 that recognizes and regulates the legal capacity of persons with disabilities. The reform was adopted by the Executive following the delegation of legislative powers granted by the Congress via Law No. 30823.

The legislative decree adopted, which holds the same status of a law, reforms the Civil Code, the Civil Procedural Code and the Notary Act. It recognizes the full legal capacity of all persons with disabilities, abolishes guardianship for persons with disabilities, removes restrictions on their legal capacity (e.g. to marry or to make a will), and introduces different regimes for supported decision-making. Legislative Decree No. 1384 also recognized the right to reasonable and procedural accommodation in courts and notary offices.

Restrictions to legal capacity remain for persons with addictions (“the habitual drunkards” and “the drug addicts”), “bad administrators”, “prodigals”, people criminally convicted, and people in a coma who do not have a designated support (although in this last case, the judge will explore support measures). This was a setback for civil society but historically those forms of guardianship (now curatorship) have had little use for a number of reasons: persons with addictions are not usually put under guardianship because mental health legislation permits their involuntary treatment; and to be declared a “bad administrator” or a “prodigal” (archaic legal provisions) a person has to “squander” more than half of their assets or significantly affect their future heirs.

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#WhatWENeed Hong Kong

We Need Full CRPD Compliance in Law and Policy Reforms

Author: Disabilities CV

Disabilities CV is a new disability rights initiative in Hong Kong committed to promoting self-advocacy among people with psycho-social disabilities, reforming mental health law and policy, and supporting a rights-based approach to public policy development, social inclusion and anti-discrimination. They are currently working with PILnet and Hong Kong local law firms on comparative legal research on the right to informed consent on mental health treatment and the right and mechanisms to appeal involuntary mental health treatment in a few jurisdictions around the world.

2018 is a historical year of implementation of the Convention on the Rights of Persons with Disabilities (CRPD) in Hong Kong. HKSAR submitted the 2nd periodic review on CRPD implementation in September 2018. Also, there are significant frameworks of law and policy reviews regarding disability issues have been achieving in process.

However, various reviews, such as those of the Rehabilitation Program Plan (RPP) and the Mental Health Ordinance, happen at the same time, without an independent monitoring mechanism for implementing consistent reviews. Behind inconsistent reviews is inequality discourse:
Under the Mental Health Ordinance, a person with ‘mental disorder’ or ‘mental handicap’ could counted be mentally incapacitated (MIP) by guardianship, reflects that legal capacity of the persons with psycho-social disability and intellectual disability has been restricted especially. It is because The Mental Health Ordinance restricts the legal capacity of persons with disabilities, predicating on grounds of mental capacity. This is the violation of article 12 of CRPD.

Prosecution for a suspected case of sexual abuse by a care home manager was dropped as the MIP victim was not ready to testify in court. Measures to facilitate MIPs to testify were introduced in 1993 and outdated.
The Committee on the Rights of Persons with Disabilities has called upon HKSAR to provide necessary psychological treatment based on free and informed consent of the persons and counseling at its concluding observations in 2012. However, the Government still refuses to repeal compulsory psychiatric treatment orders. Mental Health Review Report 2017 , which is the government report without CRPD principles completely, contrary to CRPD, it still suggests “revisiting the applicability of community treatment order when necessary”. As Disabilities CV is one of steering committee members of Hong Kong UPR coalition, we prepared and submitted the Submission and Fact sheets with other coalition members.
We need full CRPD Compliance in law and policy reforms!

HKSAR should amend the Mental Health Ordinance to (i) recognise that all persons have legal capacity; (ii)recognise the need of support for decision making instead ocategorizing persons in such need as mentally incapacitated persons;and (iii) allow for third party advocates to assist, in accordance with the CRPD, within one year.

HKSAR should introduce a clear statutory definition of ‘informed consent’, ensuring psychological treatment is only provided where necessary, based on free and informed consent, within one year.

The Fact Sheets and Submission prepared by members of the Hong Kong Coalition can be downloaded at:

Two Fact sheets of Disability Rights issues:

i. http://www.justicecentre.org.hk/framework/uploads/2018/03/HKUPR-Coalition-Fact-Sheet-Disability-Rights-Legal-Capacity-Police-Powers-and-Institutionalisation.pdf

ii. http://www.justicecentre.org.hk/framework/uploads/2018/03/HKUPR-Coalition-Fact-Sheet-Disability-Rights-Education-Employment-Access-to-Information.pdf

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Special Rapporteur Catalina Devandas response to the Lancet Commission on Global Mental Health on the Rights of Persons with Disabilities

Catalina Devandas 
Special Rapporteur on the Rights of Persons with Disabilities

In her response to the Lancet Commission on Global Mental Health that was released yesterday, Ms Devandas puts forward very clear message, that the report “fails to understand the potential of the CRPD to reframe, transform and enhance the global response to mental health in light of the rights of persons with disabilities.”

She highlights the Commission suggesting a disconnect between “advocates of the CRPD” and “people working on the ground in LMIC”, which she says implies “that the human right-based discourse does not respond to the real needs of persons with disabilities in developing countries.

She also expresses her concern over the Commission endorsing the mental health legislation that a number of countries have adopted or are in the process of adopting as being CRPD compliant. 

Read full article here.

We invite you to share your response to the document at tciasia.secretariat@gmail.com

The Lancet Report of the Commission on Global Mental Health is available on:

Html link – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31612-X/fulltext

PDF link – https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)31612-X.pdf

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#WhatWENeed Myanmar

#WhatWENeed in MyanmarFull CRPD Compliance on the inclusion of persons with psychosocial disabilities

Myanmar obtained Independence from Britain in 1948. Even though a former British colony, Myanmar has chosen not to be a part of the Commonwealth nations. There are strong feelings about having been colonized, that foreign rule has isolated the country for 50 years from international contact and growth, and left it desolate of self determination and resources. Myanmar, geographically, is divided by its 3 rivers.

Administratively, like other Commonwealth nations, it has retained its administrative structure on central and federal basis. Years of the peace struggles, the ‘divide and rule’ policies of the British, and complex political alliances before and after the War towards independence, has impacted the nation; and its continuing internal strife, especially impacting ethnic peoples. The United Nations (UN) describes the situation in Myanmar as ‘a complex combination of vulnerability to natural disasters, food and nutrition insecurity, armed conflict, inter-communal tensions, statelessness, displacement, trafficking and migration’. This is yet another country of the erstwhile British colonies, that faces serious post colonial aftermath.

#WhatMyanmarNeeds:

1.  Our full and effective inclusion in national laws and policies.

Disability legislation for people in need is still an ongoing process of advocacy, rights and provisions.  Implementation of signed and ratified (UNCRPD) is still a challenge.  No  policy or legislation exists, that is in compliance  with  UNCRPD.Mental health is not fully integrated into Development services, or disability inclusion.

2.  Our right to live independently and be included in communities.

Myanmar, as expected from an erstwhile British colony, has the Lunacy Act of 1912. As expected, also, it has 2 old mental asylums warehousing people by the hundreds, in the traditional colonial way. Especially, more than 300 people  with  Psychosocial  disabilities in the mental  hospital  in  Yangon are institutionalized life-long.  Due to historical, legal, social and other barriers, they don’t get  the right  support  through  de-institutionalization, psychosocial  services and processes adapted to life in communities. Recent events of human rights violations   in Myanmar has been seen by globalizing mental health as an “opportunity” for expansion [1] of mental health services, especially, psychiatric and psychotherapeutic services.

3.  Full CRPD Compliance in  policy and legislation.

Current legal frameworks for persons with psychosocial disabilities is not in compliance with CRPD. It focuses on involuntary institutionalization and the medical model.The Lunacy Act is a colonial legislation, with provisions of deprivation of liberty of someone who is a ‘lunatic’ or an ‘idiot’. There is a view that this law must be made more contemporary.[2] In other British postcolonial societies, this has meant changing the legal concepts, but not the penal framework.

Guardianship

Guardianship law exists under the Lunacy legislation. Currently, according to the Lunacy act (1912) , the  mental  hospital (psychiatric  Board) has  the  guardianship  to  keep  more than 300   person with psychosocial  disability  as being  institutionalized  life-long. Currently, old  existing laws and  policies, as found in all erstwhile British colonies, discriminate the persons with psycho-social  disabilities on grounds of legal incapacity and put them under guardianship.

4. Community support systems

There is no provision for living independently or for community living:Families continue to take care of their loved ones in need.  The communities also engage in socialisation especially through traditional practices. Gaps include:

(1) lack of accessible community based  mental  health  support systems especially in remote, poor  areas

(2)  lack of the right  support  systems in terms of psychosocial  recovery and  rehabilitation, which is favoured by traditional society like Myanmar

(3) lack of trainings and skilled resources in psychosocial services

(4) lack of law and policy which safeguards the person centered  approach, and  finally

(5) rights and provisions in compliance with legislation on CRPD.

5. Public financing for Inclusion:

The state  doesn’t allocate  separate  budget  for persons with psychosocial    disabilities although  it provides  the (health)  budget for the 2 mental  hospitals. Some programs are  being operated  on some  extent of  psychosocial  part. But  persons of high support need with psychosocial disabilities are still outcast. The state does not allocate budget for independent living and inclusion. There is a lack of awareness and gaps in the implementation of psychosocial recovery and inclusion within the current system.

6. To foster community empowerment for care sharing

The huge gap in psychosocial  services  and the structure to  support  the needy  population  is necessary  to  build up the  community. Civil society groups are working and advocating for reform. There needs to be  more awareness about recovery and inclusion cross sectorally. We need more allies and persons for advocacy. CRPD must guide law, policy, trainings, especially knowledge resources and implementation manuals. 

(1)  mental health awareness and the importance  of psychosocial  wellbeing.

(2)  Community  based, trauma informed, psychotherapeutic  care  system across the country

(3)  Legal  and policy safeguards for the rights of person with psychosocial disabilities

(4) Disability inclusive community  and social  inclusion(5) Integrated multi-sectoral approach   in  psychosocial  support.   

7. To continue traditional healing practices that are CRPD compliant and serving communities:

Myanmar  is  one  of  South East Asian countries, has  traditional  ways  of  healing.  The first is  going  to  astrologers, taking their  advice and  doing  some  treatments  to feel safe and  combat  the  impending misfortunes. The second  is  Buddhist  traditional meditations,  which  is  provided  by  the  monasteries.  The sense of “collectiveness”  at the  meditation  center is  helpful   practice for  people to engage in  their cultural practices of healing and finding peace. Being  in the traditional space, is also an inspiration  for the  group to feel together.  Being  isolated  from  modernization  is  related  with the  still  strong  traditions of doing religious ritual practices, and a regularity of visits at the religious sites, pagoda, church, mosque. It is considered a good deed to adopt such practices. The ethical setting of different religions help  people  to  bring spiritual  confidence  and  esteem .  There  are  specific rituals  of  Burmese  and  Ethnic  people  across  the  country, related with  cultural and  belief systems (eg. Belief  in  full moon ,water festival, faith in the supernatural) play  in  healing path too. There  are  some games , dances of  the Burmese  and  Ethnics, and also folk  dance and  music  are  associated   with  individual autonomy, pursuit  of  happiness of   individual  and  feelings of collectiveness.

(Prepared for TCI Asia Pacific, Bali Plenary August 2018)Myanmar Christian Blind Federation  

We are working for sustainable psychosocial support, care, networking  for persons with psychosocial disabilities; Community based mental health and holistic care; Advocacy for progressive mental health care in community; Advocacy for implementation of UNCRPD elements in mental health care; policy development; de-institutionalization; and, Decentralization.   Our advocacy is for independent living and inclusion in communities, for persons with psychosocial disabilities.              


[1] A. J. NguyenC. LeeM. Schojan, and P. Bolton  (2018). “Mental health interventions in Myanmar: a review of the academic and gray literature”. Global mental health, 5e-8, February 19. doi:  10.1017/gmh.2017.30 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827419/

[2] https://www.mmtimes.com/news/government-urged-draft-mental-health-care-policy.html