Training Day 2: Gaps and bridges

Today, 13 March 2013, was the second day of our training on article 33 of the UN CRPD. Some members of the NPM and Ombudsman-office were supposed to join us, but they didn’t show up!! This disrupted our training-schedule and we had to re-organize the entire day, meaning that we had meetings during every break to decide on next steps in the training. It was a clear sign of a lack of interest on the side of the official monitoring framework. Not any member of the official monitoring mechanisms showed up, while we were supposed to have about 5 persons present from those organizations. It was painful to see how they failed on us and the UN.

The plan for today was to build bridges today between the NPM, the Ombudsman-office and persons with disabilities, but only persons with disabilities were present, so our objective of the day couldn’t be met. Also Kay wasn’t feeling well, so she returned to the hotel before we started the sessions.

It wasn’t actually a great start of the day, but nevertheless it was positive that some new participants joined the group (persons with disabilities and NGO’s). We started again with a short round where everybody introduced themselves and where they came from.

We decided to spend the morning session on further training of interviewing skills, because it is a very delicate thing to interview persons in an institution about their experiences including human rights violations without putting them at risk.

In small groups we went through the questions of the Ithaca toolkit, to assess if the questions were appropriate and how to formulate the guiding key questions in a practically useful way. I was hosting a group of Russian speakers, and there were only English and Romanian documents available, so all questions and discussions were interpreted, until everything was clear to everyone.

After the coffee break I gave a short introduction on forced treatments, and how care and force are the opposite of each other.
I illustrated that with a paper-folding-exercise.

Everybody got a piece of paper. The sheet of paper represents a person and his/her life. The full paper represents the full freedom of a person living in the community.
1. During a psychosocial disability the freedom is reduced for various reasons – it’s a disability (fold the paper in half).
2. When the person gets institutionalized, this imposes a further limitation on the freedom of the person (fold the paper again).
3. The result of institutionalization may be that contacts with family and friends are lost (fold it again).
4. The person may be getting forced medication, which again decreases the freedom of the person (fold it again)
5. The person could also be abused, ignored and stepped on, making the paper smudged and covered in dirt.

By now the paper is folded up to a very small format, and the person obviously has only a fragment of their life left, covered dirt.

However, care and support should help to unfold the person, and give back the original freedom. Care could support restoring family relations (fold the paper 1 step open), and support de-institutionalization (1 step open again) and enable participation in the community, such as work or education (fold it open once more) and overcoming the barriers of the disability to restore the full freedom (fold it open).

The person now has the full freedom back, but as you can see there are still folding-marks left on the paper, and the dirt is still on it. You can say sorry to the paper, treat it nicely, but that won’t fix it. The scars remain.
This process is often a reality for persons with disabilities.

It’s now clear, what the duty of mental health care is.

The rest of the morning we went through the themes of the Ithaca toolkit, and we focussed especially on issues around daily life (living conditions, activities, privacy and relations) and forced treatment (seclusion, restraint and medication) and forced institutionalization/deprivation of liberty.

During the lunch we had another meeting to decide on the afternoon programme. We were still hoping that the members of the NPM and Ombudsman-office would show up to join us, but in the mean time we organized a different programme.

It appeared that some of the participants were still not feeling skilled enough to do interviews with residents, so we decided to proceed by showing some role-play-interviews to the entire group, and in each scene we made another mistake which the group was asked to identify. This was a funny and very useful session, giving very practical examples of the do’s and don’ts.

Then after the afternoon-coffee-break, we had another meeting with the trainers, where we discussed how to do the visit, because we noticed some persons weren’t really comfortable or ready to go there (2 days preparation is really short for such a sensitive activity), and also due to the absence of NPM and Ombudspersons, there was a shortage of persons with monitoring experience for the site visit. We decided to split the group up for the next day. One group will go on the site visit to the psychiatric hospital for their first monitor-experience (observing and interviewing) together with Oliver and me. The other group will receive further training on skills and techniques in the classroom by Dodo and Kay.

The last session of the day was a parallel session for both groups. The visiting group of 11-12 persons prepared for the visit, and formed 2 smaller groups which will visit different wards in the institution tomorrow. Some practical issues were discussed, such as if the wheelchair-users can access the bus and the building, and how we will perform the actual visit (each group of 6 persons will break up in pairs or trios and rotate between observing, interviewing residents and interviewing staff).

As far as decided, I will take a group to the children’s ward and the Intensive Care Unit, and Oliver will visit the forensic ward and the general psychiatric ward. We spent some extra time on how we will introduce ourselves, because it’s important not to create a wrong impression of our visit, or a dangerous situation regarding repercussions towards the persons in the institution.

I’m pretty excited and a little bit nervous to go on the visit and host a group. It will probably be tough what we get to see. And also I have never led a monitoring group before, so it will be new for me, and I hope I will be able to do it well. We will have to see how it works out. I’m slightly nervous, but I know I shouldn’t stress out, and it’s probably best to just be very aware, flexible and just try and see. We will learn a lot, that’s for sure.

After this very long day we all split up, and I had dinner alone in the restaurant downstairs at the hotel. I had Penne Vodka :) and when I tried to take a picture of this unique dish, a man asked me if he should take a picture of me with my food. I agreed. Then this man appeared to be a Dutch man working for UNICEF and Red Cross, and we talked all evening about activism and NGO-work. It was very interesting to discuss the absence of the NPM and Ombudspersons, and the Moldovan political context.

We discussed why the monitoring mechanisms were absent, and whether we had enough local support. We may have been naïve in organizing this. Change takes a long time and it cannot be brought upon people, it takes a process of awareness and readiness. We talked a lot about my activities in the Netherlands, where after 10 years of my protests against force, there now finally has come substantive awareness that force is not a solution but a problem. But still, the isolation cells and restraints exist. It goes very slow. The man gave another example of the Red Cross willing to build houses in Brazil (fully funded and given to them), but the Brazil authorities still needed to check whether this was suitable for them, and it took 6 months to come to an agreement before the Red Cross could provide the houses for free. So even such a practical simple thing as donating houses after a disaster takes rather a long time, before it gets adopted by the local context.
We came to the preliminary conclusion that we may have chosen a too high profile for our training here: coming up with UN demands and a fully organized plan for them. It wasn’t their own process in their own tempo. Somehow we imposed this process on them and dictate how to do it, and that may not fit into the local context, and scare them, and cause counter-pressure (resistance), especially regarding the history of this country. It’s a plausible theory for me.

I do believe that real sustainable change comes from within, from awareness and not from rules or force. I think people will find ways around rules if they are not intrinsically motivated to follow a certain line. People generally don’t like being pushed by force or rules. I don’t believe in forced change. It’s similar to the way that forced treatments don’t work to improve mental wellbeing, and only limit some behavioural symptoms and replacing it by other problems – forced change will only stop certain symptoms, but there is a serious risk that another (new) form of the old view may pop up. (substitutions). It is really hard to change the deeper misconceptions and prejudices, and to create real awareness, and I strongly believe in the bottom up strategy, by moving the hearts of people instead of moving the rules.

I guess we probably should have invested more in connecting to the local context, and finding local support. We may have been naïve in hearing the monitoring mechanisms say “yes we will come”, without realizing what they feel about it. They may not have liked the idea at all, and may feel like they are pushed to do something they don’t believe in.

I don’t know for sure, I have only been here in Moldova for 3 days, and I’m not a local expert or the organizer, I’m just an invited presenter coming from the outside. But I tend to agree with the Dutch man, who pointed me at my own words, my own strategy and my own activism style which starts with moving the hearts of people. It was a very nice eye-opening chat I had with this man, and I feel like I should be more critical on such activities any next time, because I do really believe in grass roots change.

This doesn’t mean I’m against the UN Convention on the Rights of Persons with Disabilities, because I think it can be a tool for certain actions (like in courts and law-making), but I don’t think a set of rules is THE tool to change the world, and certainly not at the practical level. Real change takes much more than that. In my opinion it also takes moving the hearts of people to achieve a real paradigm shift.

And of course we intended to move hearts and build connections in our training. But I guess we wanted too much in too little time, with too little attention for the local context and current perceptions. I guess the NPM and Ombudspersons were not ready for this step, but I cannot be sure, because we didn’t speak with the NPM or Ombudspersons anymore, so their absence remains a kind of mystery.

Anyway, I have a theory and it’s plausible for me. I guess this is enough philosophy for today. I will now go to sleep, because tomorrow will be a very special day, and I will need my energy for that.