Chapter

The Human Rights of People with Severe and Persistent Mental Illness

Alan Rosen, Tully Rosen and Patrick McGorry

in Mental Health and Human Rights

Published on behalf of Oxford University Press

Published in print June 2012 | ISBN: 9780199213962
Published online February 2013 | e-ISBN: 9780191754500 | DOI: http://dx.doi.org/10.1093/med/9780199213962.003.0019
The Human Rights of People with Severe and Persistent Mental Illness

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Alan Rosen, Tully Rosen, and Patrick McGorry, in reviewing the rights of people with serious and persistent mental illness, examine the significance and origins of the mental health and human rights advocacy movement, its political setting, and ‘reforms’ with different, even opposing agendas. Concerning the debate over involuntary treatment, tensions between rights are discerned: the right to autonomy (or to refuse treatment) encounters the right to treatment and/ or access to health care, and also encounters the right of others to health and safety. Selfdetermination, undergirded by the UN Principles (1991), includes participation in decisionmaking, civic life, and citizen roles, and should not be confused with ‘dying with one’s rights on’ – civic abandonment that opposes paternalism on the pendulum of injustice. The authors distinguish dominant from alternative paradigms: prevailing individualistic international approaches in mental health and rights are contrasted with collectivist, multifaceted models. Alternative formulations attempt to bridge medical and social domains, and include indigenous healing systems. To effect change, the authors engage with and affirm complex, layered understandings. Stakeholder miscommunications are reviewed. Systemic abuses and neglects of psychiatry occur in authoritarian regimes, but also with coercive treatments, including for forensic patients and those in police custody. Improvements include increasing media scrutiny and public information access, advances in early intervention, minimizing and regulating involuntary treatment, adopting user-focused definitions of recovery including quality of life, advance directives, shared decision-making, and collectivist as well as individualistic solutions. To enhance social inclusion, the authors advocate including all stakeholder groups in service participation, overturning laws that breach rights, and addressing power imbalances. Significantly, they outline and strongly advocate for the application of a comprehensive repertoire of many of these strategies, including interactive consultative methods, which if systematically applied within mental health services, could substantially reduce and obviate the need for much involuntary treatment and care.

Chapter.  12861 words. 

Subjects: Psychiatry

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