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   Anupriya Wijayaweera

   student (logged in via email @yahoo.com.au)

   Dear Ms. McSherry,

   Since you are a person with extensive legal training, I think the focus needs to shift from an outsider perspective of
   (i) "How do we actually help these poor people who are actually diagnosed as mentally ill by our expert psychiatrists?"

   to the insider perpective of the following-
   (a) Is the diagnoses itself valid? given that the diagnoses is extremely subjective and should not be left to psychiatrists alone-psychiatrists are implicitly claming expertise in sciology,culture…

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   Dear Ms. McSherry,

   Since you are a person with extensive legal training, I think the focus needs to shift from an outsider perspective of
   (i) "How do we actually help these poor people who are actually diagnosed as mentally ill by our expert psychiatrists?"

   to the insider perpective of the following-
   (a) Is the diagnoses itself valid? given that the diagnoses is extremely subjective and should not be left to psychiatrists alone-psychiatrists are implicitly claming expertise in sciology,culture etc simply because there is no objective valid biological criteria for diagnoses-its merely an interview
   (b)what legal measures can be taken to improve this diagnostic process?

   I will not even go into the other issues from the diagnosis onwards- execpt to say you have missed the key issue-is the diagnosis valid? For example- is it really justified for between10% to 15% of American school going children to be put on ADHD drugs.
   Please begin at the beginning-is there actually a valid mental illness in the first place -or is big pharmaceuticals widening disease parameters in conjunction with psychiatric opinion leaders as it does with other physical illnesses-"mental illness" being most vulnerable to such stretching simply because there is no reasonable objective critria to point out that there is such mental illness.
   The law,which has unfairly placed the public at the mercy of psychiatrists with no training in the law, should be helping out in bringing relief to such people who are labelled as ill by psychiatrists-at the beginning of the journey through the mental health legal system-not in the middle or at the end.The complaints of false diagnoses are numerous-surely there is some truth to some of these complaints if you look at the law of averages

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      jim morris

      (logged in via email @yahoo.com)

      Soon after my daughter graduated medicine I got into a conversation with a community health worker who seemed to think I had done a good job as a single father.
      I responded by telling her that my daughter had achieved her goal through her own hard work and determination but how disgusted I was with the feminist mafia who had made living in poverty ten times more difficult by maintaining the fiction that all men are advantaged and deserving of punishment for the oppression of women during recorded…

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      Soon after my daughter graduated medicine I got into a conversation with a community health worker who seemed to think I had done a good job as a single father.
      I responded by telling her that my daughter had achieved her goal through her own hard work and determination but how disgusted I was with the feminist mafia who had made living in poverty ten times more difficult by maintaining the fiction that all men are advantaged and deserving of punishment for the oppression of women during recorded history instead of adapting their sexist ideology to recognise the fact that many men are also struggling.
      That 'outburst' was misconstrued as being antiwomen and somehow I was deemed to be in need of 'help' whether I liked it or not. Next thing I knew I was being compulsorily taken for 'assessment' complete with police car and ambulance. Of course I was judged to be sane and rational by a psychiatrist but being taken away by police accompanied by an ambulance in front of the neighbours caused me to lose my accomodation and led me to be homeless for 2 months.
      Seven months later I am still waiting for an explanation or an apology but I guess I should be grateful that they didn't get a chance to fill me with medication. I learnt two things from that experience: feminists don't like to be confronted with the fact of their hypocrisy, and if you don't have money you don't have any rights or legal recourse. Stalin is long dead. Long live stalinism.

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   Sandra Betts

   Physiotherapist, OHS&E Mgr, & Civil Celebrant (logged in via email @netspace.net.au)

   There are problems with the involuntary assignment of people to mental health institutions. Specifically, a person can be signed in as 'a danger to themselves or the public' based on an unproved allegation. A police officer can sign them over to 'care' based on what is told to them, which may not be confirmed as true. If the same person was charged with a crime or misdemeanour offence they have a right of reply and the charge must be proved in some way. When a person is signed involuntarily into…

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   There are problems with the involuntary assignment of people to mental health institutions. Specifically, a person can be signed in as 'a danger to themselves or the public' based on an unproved allegation. A police officer can sign them over to 'care' based on what is told to them, which may not be confirmed as true. If the same person was charged with a crime or misdemeanour offence they have a right of reply and the charge must be proved in some way. When a person is signed involuntarily into an institution there is no such requirement of proof. The person detained can be there for some lengthy periods before being released by a Magistrate. They usually do not know their rights or how to access them. their money, handbag, even clothes can be taken from them. They are forced to take medication which is prescribed upon initial assumptions made, not necessarily a thorough diagnosis. Large quantities of interactive medications can be prescribed. And there is little means of redress. If a medication regime causes side-effects of short or long lasting duration, they will not be able to afford to take the matter to court for damages due to new illnesses caused unless (and I quote Slater & Gordon lawyers Sydney) they "have the resources of a Rupert Murdoch". And to quote a lawyer from Melbourne "They can basically kill you (with their prescription regime) and you'd have no ground to stand on under mental health law". So, for Flick Grey, here is a comment from an expert-by-experience for you.

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   Tina Minkowitz

   Attorney (logged in via email @earthlink.net)

   I'd like to point out specifically that the Committee on the Rights of Persons with Disabilities, the body authorized to interpret the Convention, has called for repeal rather than reform of the mental health law authorizing involuntary confinement, in its first concluding observations on the report of Tunisia. The Committee said:

   "The Committee recommends that the State party repeal legislative provisions which allow for the deprivation of liberty on the basis of disability, including a psychosocial…

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   I'd like to point out specifically that the Committee on the Rights of Persons with Disabilities, the body authorized to interpret the Convention, has called for repeal rather than reform of the mental health law authorizing involuntary confinement, in its first concluding observations on the report of Tunisia. The Committee said:

   "The Committee recommends that the State party repeal legislative provisions which allow for the deprivation of liberty on the basis of disability, including a psychosocial or intellectual disability." (U.N. Doc. CPRD/C/TUN/CO/1)

   The UN Office of the High Commissioner for Human Rights has been even more explicit; their call for repeal of mental health laws emphasizes that it includes laws on involuntary confinement for "care and treatment" or for preventive detention/public safety "when linked in legislation to an apparent or diagnosed mental illness."

   OHCHR said:
   "Legislation authorizing the institutionalization of persons with disabilities on the grounds of their disability without their free and informed consent must be abolished. This must include the repeal of provisions authorizing institutionalization of persons with disabilities for their care and treatment without their free and informed consent, as well as provisions authorizing the preventive detention of persons with disabilities on grounds such as the likelihood of them posing a danger to themselves or others, in all cases in which such grounds of care, treatment and public security are linked in legislation to an apparent or diagnosed mental illness. This should not be interpreted to say that persons with disabilities cannot be lawfully subject to detention for care and treatment or to preventive detention, but that the legal grounds upon which restriction of liberty is determined must be de-linked from the disability and neutrally defined so as to apply to all persons on an equal basis." (U.N. Doc. A/HRC/10/48, paragraph 49, see also paragraph 48 & paras 43-47 on legal capacity.)

   Note that there is no mental health law that could fit the criteria for neutral definition that is set out in the last sentence, because the detention under a mental health law is always defined as being linked to the disability. (I would also suggest that if a law is neutrally defined but in practice applied so as to replicate the function of a mental health law, it would not pass muster under the discrimination standard of the CRPD as defined in Articles 2 and 5).

   The article of the CRPD which the Committee and OHCHR were interpreting, is Article 14 on liberty, specifically a provision in paragraph 1(b) as follows:

   "[States Parties shall ensure] that the existence of a disability shall in no case justify a deprivation of liberty."

   For more information see my article in the book Rethinking Mental Health Laws, edited by Bernadette McSherry and Penny Weller, and see also materials at www.chrusp.org.

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   Flick Grey

   (University of Melbourne)

   Thanks for raising this issue - all too often rights have fallen off the mental health agenda, in the rush to "help those poor people."

   However, while access to respectful services is critically important, we also must discuss people's right to refuse treatment. Your article is somewhat ambiguous about the human rights implications for involuntary treatment. You write about "legal safeguards for the treatment of involuntary patients" but many in the international community are arguing that involuntary…

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   Thanks for raising this issue - all too often rights have fallen off the mental health agenda, in the rush to "help those poor people."

   However, while access to respectful services is critically important, we also must discuss people's right to refuse treatment. Your article is somewhat ambiguous about the human rights implications for involuntary treatment. You write about "legal safeguards for the treatment of involuntary patients" but many in the international community are arguing that involuntary treatment is itself a human rights issue (albeit currently legal under the Victorian Mental Health Act, and controversial under the UN Convention on the Rights of Persons with Disability).

   My final point is that these conversations must be critically informed by people with lived experience of service usage, service exclusion and involuntary treatment. The relative absence of experts-by-experience in these conversations is a loss, both to the quality of the conversations and to the human rights agenda more broadly.

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   John Mendoza

   (Adjunct Associate Professor at University of Sydney)

   Thank you Bernadette for raising the issue of law reform in relation to mental health. It has not featured in the recent public advocacy for investment in services. While there are a number of jurisdictions who have recently undertaken or are undertaking reviews of MH law, there has been a lack of national coordination or harmonisation. Regrettably Nicola Roxon showed no interest in addressing this. Discrimination of people with a mental illness is routine not just in relation to access to health…

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   Thank you Bernadette for raising the issue of law reform in relation to mental health. It has not featured in the recent public advocacy for investment in services. While there are a number of jurisdictions who have recently undertaken or are undertaking reviews of MH law, there has been a lack of national coordination or harmonisation. Regrettably Nicola Roxon showed no interest in addressing this. Discrimination of people with a mental illness is routine not just in relation to access to health services or the quality of services but in access to services the rest of the population takes for granted. this is a key reason for the social isolation and poverty of people with a mental illness. Like Indigenous Australians those with mental illness have significantly reduced life expectancy, lower incomes, higher rates of incarceration and so on. State run health services seclude and physically restrain people with mental illnesses daily and yet there is no public accounting for these avoidable and unnecessary actions. The best estimates indicate at least 30 cases of seclusion and restraint everyday in Australia. And in almost every state/territory there are still people kept in institutions for decades because there are no services for them in the community. In my state of Qld there are nearly 300 such cases. We hear and see nothing of these shameful practices. We need a lot more investment in mental health to close the gap in services; we need national law reform and we need a national mental health commission with real powers to bring light to and end these deplorable circumstances.

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   David Webb

   (logged in via Facebook)

   Human rights are not just about our rights in the delivery of services. The primary source of discrimination in mental health (usually and inappropriately called 'stigma') is laws that make second class citizens of people labelled as 'mentally ill'. The CRPD is about very much more than service delivery, Bernadette, so it is disingenuous of you to be silent here on the most critical human rights issues in mental health - our citizenship rights. Indeed your unstated assumptions here are deceptive and discriminatory against all people who experience psychosocial disabilities. I would write a longer response but this forum only allows contributions from people with a 'edu' email address (regardless of my own PhD) - a rather peculiar "conversation" to my mind.