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Psychiatric Treatments and the United Nations 1985 Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment PDF
Bob Sapey, July 2013
Various psychiatric treatments including the use of neuroleptics without consent have been considered torture by the United Nations since 1986. This means that most mental health professionals are engaged in activities that could lead to their prosecution for torture.
I have written and spoken about this a few times, but have been aware that the background and documentation relating to this issue may not be familiar to many people. So I thought it might be helpful to write a blog as a guide to the key UN documents so that they can be used in teaching.
Each of the five documents listed in the references at the end can be found at the UN Commission on Human Rights website (www.ohchr.org) by searching for the document codes:
In 1985, 40 years after the end the Second World War and one year after The Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment had been adopted by the United Nations General Assembly, the UN Commission on Human Rights decided to appoint a special rapporteur to examine questions relevant to torture. The Commission wished to pay tribute to those who helped end the Second World War whilst also responding to their serious concerns ‘about the alarming number of reported cases of torture and other cruel, inhuman or degrading treatment of punishment taking place in various parts of the world’ (UNCHR, 1985). This appointment was initially for one year, but the role has been continuously renewed.
In 1986, Mr. Peter Kooijmans from the Netherlands submitted his report to the Commission (UNCHR, 1986). In this he set out the range of activities that constituted torture (paragraph 119). Torture can be both physical and psychological. Physical torture includes:
2. Extraction of nails and teeth
4. Electric shocks
5. Suspension by feet, hands, testicles
7. Exposure to excessive light or noise
8. Sexual aggression
9. Administration of drugs in detention or psychiatric institutions, including ‘neuroleptics, that cause trembling, shivering and contractions, but mainly make the subject apathetic and dull his intelligence’ (UNCHR, 1986:29).
10. Prolonged denial of rest or sleep
11. Prolonged denial of food
12. Prolonged denial of hygiene
13. Prolonged denial of medical aid
Psychological torture includes:
14. Total isolation and sensory deprivation
15. Being kept in constant uncertainty, in terms of space or time
16. Threats to kill or torture relatives
17. Being forced to help torture relatives
18. Total abandonment
19. Simulated executions
20. Disappearance of relatives
This list is of acts of torture, not other cruel, inhuman and degrading treatment and punishments also covered by the Convention.
The following year, Mr. Kooijman's report on the qeustion of torture was presented to the UN General Assembly. He dealt with the issue of psychiatric treatment in greater depth and the record of the session records that:
'Consequently, the Special Rapporteur of the Sub-Commission proposed the adoption of a draft body of principles, guidelines and guarantees for the protection of the mentally ill or persons suffering from mental disorder. They include the following: "difficulties of adaptation to certain moral, social, cultural or political values or religious beliefs shall not be a determining factor in diagnosing a mental illness or a mental disorder" (draft art. 5, para. 2); "certain therapies and treatments, such as psychosurgery and electroconvulsive treatment, shall never be applied without the patient's consent or the consent of his legal representative" (draft art. 9, para. 3); "medication shall be given to a patient only for therapeutic purposes and shall not be administered as a punishment or used for the purpose of restraint or for the convenience of the medical and nursing staff" (draft art. 10, para. 1); and "every patient shall have the right to refuse treatment" (draft art. 11, para. 1). (UNCHR, 1987, Para. 34)
In 2008, following the adoption by the UN of the Convention on the Rights of Persons with Disabilities in 2006, the special rapporteur to the Commission on Human Rights, Manfred Nowak reported to the Commission on the same questions of torture, but with a specific focus on disabled people and this was also presented to the UN General Assembly (UNCHR, 2008). In this report Manfred Nowak referred back to the work of Mr Kooijmans in stating:
'Inside institutions, as well as in the context of forced outpatient treatment, psychiatric medication, including neuroleptics and other mind-altering drugs, may be administered to persons with mental disabilities without their free and informed consent or against their will, under coercion, or as a form of punishment. The administration in detention and psychiatric institutions of drugs, including neuroleptics that cause trembling, shivering and contractions and make the subject apathetic and dull his or her intelligence, has been recognized as a form of torture'.
(UNCHR, 2008, para. 63)
He went on to refer to a case of Viana Acosta v. Uruguay in which
'...the Human Rights Committee concluded that the treatment of the complainant, which included psychiatric experiments and forced injection of tranquillizers against his will, constituted inhuman treatment'.
(UNCHR, 2008, para. 63)
He concludes this brief discussion by stating that,
'The Special Rapporteur notes that forced and non-consensual administration of psychiatric drugs, and in particular of neuroleptics, for the treatment of a mental condition needs to be closely scrutinized. Depending on the circumstances of the case, the suffering inflicted and the effects upon the individual’s health may constitute a form of torture or ill-treatment.' (UNCHR, 2008, para. 63)
Earlier this year the current special rapporteur, Juan E. Méndez’s recommendations in respect of persons with psychosocial disabilities to the Human Rights Council were put to the UN General Assembly.
The Special Rapporteur calls upon all States to:
a) Review the anti-torture framework in relation to persons with disabilities in line with the Convention on the Rights of Persons with Disabilities as authoritative guidance regarding their rights in the context of health-care;
b) Impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptics, the use of restraint and solitary confinement, for both long- and short-term application. The obligation to end forced psychiatric interventions based solely on grounds of disability is of immediate application and scarce financial resources cannot justify postponement of its implementation;
c) Replace forced treatment and commitment by services in the community. Such services must meet needs expressed by persons with disabilities and respect the autonomy, choices, dignity and privacy of the person concerned, with an emphasis on alternatives to the medical model of mental health, including peer support, awareness-raising and training of mental health-care and law enforcement personnel and others;
d) Revise the legal provisions that allow detention on mental health grounds or in mental health facilities, and any coercive interventions or treatments in the mental health setting without the free and informed consent by the person concerned. Legislation authorizing the institutionalization of persons with disabilities on the grounds of their disability without their free and informed consent must be abolished. (UNHRC, 2013, para. 89)
United Nations Commission on Human Rights (1985) Resolution 1985/33. Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. E/CN.4/RES/1985/33 [www.ohchr.org].
United Nations Commission on Human Rights (1986) Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment Report by the Special Rapporteur, Mr. P. Kooijmans, appointed pursuant to Commission on Human Rights resolution 1985/33. E/CN.4/1986/15 [www.ohchr.org].
United Nations Commission on Human Rights (1987) Question of the human rights of all persons subjected to any form of detention or imprisonment torture and other cruel, inhuman or degrading treatment or punishment. Report by the Special Rapporteur, Mr. P. Kooijmans, appointed pursuant to Commission on Human Rights resolution 1986/50. E/CN.4/1987/13 [www.ohchr.org].
United Nations Commission on Human Rights (2008) Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. A/63/175 [www.ohchr.org].
UNHRC (2013) Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez. A/HCR/22/53 [www.ohchr.org].
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