The expected CRPD compliance and transition from medical to social paradigm requires a new range of partnerships and new ways of formulating questions on inclusion. For example, as TCI shared in Galway in 2017, ‘consent’ is too restrictive, putting the onus on the person with psychosocial disability to choose between bad options – medication or institutionalization, both options often coming with conditions. ‘Choice’ is the broader value to aim towards, for example, a person may have an unmet housing need or a need for nutrition. Choice on an equal basis with others then is about bringing a person with psychosocial disability within the broader, nested development linked human rights as found in the CRPD. Article 25 of the CRPD is only one human right often reduced to a dungeon for persons with psychosocial disabiities. There are dozens of others which liberate us.
Part IV is about the liberating aspects of partnerships towards inclusion.
The Cross-Disability Movement
The CRPD created opportunities for collaboration and engagement with the cross disability movement. At the global level, there has been great progress with support from the disability movement especially from IDA. At the national level, it varies greatly as there are countries where there is:
- solid alliance with strong support by the cross-disability movement to the agenda of persons with psychosocial disabilities
- the cross-disability movement does not support actively but does not oppose advocacy of persons with psychosocial disabilities
- some countries where some members of the disability movement oppose are based on prejudice and the medical approach
It was agreed that engagement with the cross-disability movement is critical to create a new center of gravity of State action to support persons with psychosocial disabilities more in line with the CRPD and less centered on mental health intervention.
There is obviously many inter-sectionality related issues connecting mental health with disabilities, discrimination against women, Sexual Orientation and Gender Identity (SOGI) and race or ethnicity.
Once again CRPD provides a useful framework but there are some persistent issues. The CRPD Committee is the body that has the most intersectional approach to stigma and discrimination – this is necessary when looking at the LGBTQI+ community for instance. However, same sex desire is still seen as mental illness in many countries despite international standards. There is a lack of resource material regarding LGBTQI+, disabilities and mental health – both conceptual and practical at country level.
There is a lack of investment in capacity building of DPOs and Human Rights activists around knowledge of the CRPD and intersections with CEDAW, Convention on Elimination of Racial Discrimination and other treaties. For instance, alternatives evidenced as effective elsewhere (e.g. Open Dialogue) remains inaccessible and insensitive to the needs of communities marginalized along racial and ethnic lines. Shadow reports process are often non-consultative with marginalized communities and oblivious of some multiple discriminations.
This implies a need for further outreach to the diversity of gender equality movement and other social movements as well as linking with marginalized constituencies within persons with psychosocial disabilities such as indigenous peoples.
Human Rights Organizations
Considering the positive work of Human Rights Watch globally and interaction with human rights groups at the country level, further engagement seems to be a relevant investment. Such groups can bring light and credibility in denunciation of human rights violation and generate adhesion within their supporters. It can create a greater awareness of the true cost and little outcomes of mental health policies.
Some issues were raised on the “control” over the message and the leadership of advocacy. Many would be well intentioned and call for improvement of psychiatric institutions rather than closing them contributing to pseudo reform. Moreover, it is unlikely that they would embrace a broad inclusive agenda but rather focus on civil and political rights violations.
At the national level, the need to engage with National Human Rights Institutions and ombudsman offices as they can open up spaces for participation and new avenues for advocacy was highlighted.
Development Processes and Organizations
As the mental health momentum expands, development organizations are getting involved such as the World Bank, ILO or OECD and other think tanks such as ODI often in relation to Universal Health Coverage. On the other hand, there is an interest of disability section of development organizations to work with the most marginalized groups including persons with psychosocial disabilities. The issue is that often those organizations adopt the “progressive” yet non-CRPD compliant approach of mental health.
Those organizations are critical as they command significant resources and have strong influence. It is therefore vital to engage. They might not be too sensitive to human rights discourse, but more to social and economic inclusion. They would also be users of policy guidelines developed based on innovative, tested, and effective CRPD compliant practices.
It is also important to engage with the disability movement on the SDG processes at the national, regional and global levels.
There are also actors rebranding usual mental health practices with CRPD/recovery/inclusion language without much change in reality. Those are particularly harmful as they lead to false reforms which prevent actual shift of paradigm by neutralizing the opposition. Finally, there are mental health professionals who want to adopt the CRPD shift of paradigm to a “certain extent” which ultimately is not a shift of paradigm.
Mental Health Professionals
The discussions reflected a mixed picture both at a national and global level. There are mental health professional opening up to CRPD approach and inclusion in some case leading innovative approaches. But there are also mental health professionals who stick to traditional psychiatry, impose their views and occupy the policy space, blocking/crowding out self-advocates and innovators. There are also actors rebranding usual mental health practices with CRPD/recovery/inclusion language without much change in reality. Those are particularly harmful as they lead to false reforms which prevent actual shift of paradigm by neutralizing the opposition. Finally, there are mental health professionals who want to adopt the CRPD shift of paradigm to a “certain extent” which ultimately is not a shift of paradigm.
There is also some difference between higher and lower income countries. The key issue is to find an adequate entry point. From a Global North/European perspective, it is very challenging because the “recovery” agenda has often been co-opted or hijacked. There is hesitation on the merit of engagement. In the Global South, it seems like there is not much of a need to talk to psychiatrists because they are not there or it may be very disempowering due to the imbalance of power. However, there is also the importance to engage before the mental health systems expand and they gain even more power. Therefore, it is still important to speak to psychiatrists in general, to the Global Mental Health Movement and not just to the progressive psychiatrists.
It was acknowledged that some advocacy approaches alienate mental health professionals who feel directly threatened and in return do not engage. The issue is that there are few platforms or forums where different actors in mental health and psychosocial disability meet in a constructive way. The WHO “Quality Rights” training package provides an opportunity to build a progressive platform for dialogue.
It was also noted that while such engagement is important it should mobilize most energy as it is critical to engage with other actors in the human rights, intersectionality, development and disability streams.
Declaring that, the following report is an embargo of many months on this work which TCI Asia Pacific takes the responsibility to disseminate it widely. TCI Asia Pacific has supported the meetings financially and led the initiative in many other ways. We thank the many organizations that attended the meetings, IDA, and the co-facilitators, Alex Cote and Alberto Vasquez.