High Level meeting in Strasbourg

I’m home again, and very positive about the meeting a few days ago. I’m writing this personal report a bit later, because I’m having a cold, and my nose and ears are blocked (not nice when flying). I needed to rest, so it took me a few days to complete this personal report.

Friday 4 November 2011, the High Level meeting on Evolving Standards for monitoring torture and ill-treatment in institutions for persons with disabilities took place in the Hilton Hotel in Strasbourg. There were about 20 people. I was the only participant representing a mental-health-user perspective, and I was representing ENUSP, the European network of Users and Survivors of Psychiatry (www.enusp.org) at this meeting. The other participants came from various organizations, such as :
- MDAC (Mental Disability Advocacy Centre) who was organizing the event,
- CPT (Committee on Prevention of Torture),
- SPT (Sub-committee on Prevention of Torture),
- CRPD Committee (expert committee on the Convention on the Rights of Persons with Disabilities),
- various universities (mainly from the UK).
- Also the European Commissioner on Human Rights, Mr. Thomas Hammarberg was there with his assistant.

The scope of the meeting was to discuss academic papers about CRPD-topics in relation to mental health care. It was a closed and confidential meeting, so we were asked not to quote any remarks in our reports, in order to have an open dialogue with all participants, where critical views can be challenged. But of course I can write about the presentations of the concept papers and about some points of discussion.

At 9 AM sharp the meeting started in the conference room at the bottom floor of the Hilton Hotel.
Oliver Lewis from MDAC gave an introduction and explained that in today’s meeting we would be discussing various rights from the CRPD (Convention on the Rights of Persons with Disabilities), such as the Right to live in the community (CRPD art. 19), the Right to be free from torture or cruel, inhuman or degrading treatment or punishment (CRPD art. 15), and we would have a focus on international inspection mechanisms.
The members of CAT (expert Committee Against Torture) couldn’t be present due to other meetings, but they were interested, and the same goes for the UN Special Rapporteur on Torture (Juan Mendez), on Disability (Shuaib Chalklen) and on the right to Health (Anand Grover). The Special Rapporteurs were busy with other activities, and it was noted that they are performing their tasks without any resources, as volunteers, which implies that they need to have another part-time paid job in order to pay their bills.

First, all of the participants presented themselves and mentioned what their expectations were, such as identifying key violations and practices that are not compliant with CRPD, making the paradigm shift, and of course increasing the quality of inspection.
It is a fact that there are 1,2 million people in Europe living in institutions, and living in an institution increases the risk to be subject of abuse. And although there are no good statistics, it is well known that a lot of human right violations occur inside institutions. These “invisible people” need to be protected from violations, and inspection and monitoring bodies play a role in that, and can push national governments to comply with the standards, which are evolving over time because the world is changing. The quality of National Preventive Mechanisms (domestic inspection bodies) varies enormously, and inhuman treatments in institutions continue to exist despite inspections and recommendations by CPT and SPT. This is very alarming, and all participants were committed to learn more about mental health practices, the CRPD, and to counter the violations and abuse.

The meeting was about legal monitoring and the newest UN standards, and I suddenly realized how important it was to be there, because developing concrete UN standards is incredibly important for all countries. I felt privileged to be there, but I also felt like there should have been more users involved. It was a pity that Gabor Gombos couldn’t come, that would have brought more balance, but nevertheless I felt really heard and I think I have contributed in a good way.

All presentation were on concept papers written by academics, so that means that all articles still had to be finalized, and were presented here for discussion. Everybody at this meeting came there to learn, which created a good open vibe for discussion.

The first presentation was about The importance of independent inspection of psychiatric and social care institutions, by Elina Steinerte from the UK. She did it over the telephone with a powerpoint-presentation on screen.
Elina told about the national practice in the UK, where the CQC (Care Quality Commission) is the national organisation for monitoring the quality of care, including the rights of those deprived of their liberty in care facilities.
The international bodies CPT and SPT also monitor the rights of persons deprived of their liberty, and are not only visiting prisons but also visiting psychiatric hospitals for monitoring torture and ill treatment for persons deprived of their liberty. But SPT and CPT both visit more prisons than psychiatric institutions. The CPT and SPT are legally allowed to visit places where “deprivation of liberty" occurs, and there are 3 crucial elements to define their scope: 1. A place that is under jurisdiction and control of the State party, 2. the person is not permitted to leave at will, and 3. where the person is deprived of liberty either by virtue of an order given by a public authority, at it’s instigation, consent or acquiescence.
Elina Steinerte plead that the actual scope excludes outpatient services, and that there is a lack of clear guidelines for monitoring human rights in mental health care facilities, while for prisons there are quite clear guidelines: the Standard Minimum Rules for the Treatment of Prisoners. To overcome this gap, particular expertise and mandate is required to asses mental health care. This could also avoid that in monitoring bodies, mental health care inspection takes second place under the criminal justice system. She said that in the future a newly operational committee on the CRPD could be an advantage for explaining the keys and the limits of the CRPD in practice, and provide guidance to better practices, and this operational expert committee could also stress the importance of the rights of the CRPD.
This caused some discussion, because there are already quite an amount of monitoring bodies, both national and international, who all need to cooperate and share their expertise. And besides that, the CRPD does not only apply to care facilities, but also beyond, such as in prisons. So there are also arguments to include the CRPD expertise into the CPT and SPT.
There was a lot to say for both approaches, and both options remained a point of discussion.

I said that in my opinion, legal frameworks alone are not enough for changing the practices, because the restraints in mental health care are done out of powerlessness and a lack of other knowledge, and as long as the carers are not empowered with other methods, these practices will continue to exist and will just get another name in order to escape the legal frames – that happens in NL too. So I think guidance on good practices is very much needed.

The second presentation was done by Oliver Lewis from MDAC, and he presented a concept paper from Rose Sibley and Kay Sheldon about service user involvement in monitoring. It was again about the national monitoring body CQC from the UK.
Oliver explained that participation is the lifeblood of the CRPD, and the CRPD slogan of WHO illustrates this: “nothing about us, without us”. States have responsibilities in consulting and including users in development and implementation of laws and policies (CRPD art 4.3), to realize independent monitoring (CRPD art. 16.3) and to include users in the monitoring process (CRPD art. 33.3).
A good practice can be found in the Care Quality Commission (CQC) in the UK. The CQC has included a user (Kay Sheldon) in their Board of Commissioners, who participates in quality monitoring, and joins in performing the visits and interviews at care facilities. Including a user in quality inspection has proven to have several advantages, such as stronger bridges between CQC and psychiatric or care facilities, with sharper findings and a better understanding, and more commitment and ownership to the findings. Also having a user included in the official inspection visits shows an empowering role model in reducing stigma in terms of learning and personal development.
Also, the CQC has formed a network of service users (SURP) on the internet in order to consult with a representative group of users to find general recommendations.

Questions were raised on: Where do you find and recruit such users? What skills and experience do they need to have? What do they need for support? How to include them in prison visits? And what about independence?
A remark was made on independence, illustrating that National Preventive Mechanisms (NPM’s) on Prisons are performed by prison officers, which is in a way a colleague of the service provider, and this can cause fear and resistance by users/prisoners, so currently “independence” is explained as an expert coming from same institutions. So in respect of the principle of independence there is room for including users. This doesn’t have to be a problem by following the regular independence guidelines (basically: not inspecting your own institution or own country).
For monitoring mechanisms it is important not to stop in trying new inclusion methods, but to carry the message forwards to governments.
And users (persons with disabilities) are recognized as experts. For example: when a person is blind, long silence or changing the house constantly can be ill-treatment, but a commission or mechanism may have no special knowledge on this suffering and may not recognize this, while a user often directly recognizes the differences, expressions and opinions. And involving a user can also be especially useful in recommendations for realizing reasonable accommodation.

Then after the tea break, Peter Bartlett gave a presentation on his concept paper; “A mental disorder of a kind or degree warranting confinement: examining justifications for psychiatric detention”. I had studied this article fully, and I wanted to make some remarks, but I can’t really summarize what was said, because of what happened during the discussion:
I raised my hand to say something on the point of “people who benefitted from detention” and “people who needed detention”, because in my opinion that doesn’t exist. Nobody needs or benefits from detention, except for the people who are not in detention, but the people detained aren’t benefitting, surrounded by walls and restraints. And also, most people aren’t grateful for forced treatments, especially when they know that there are alternatives - but many don’t know that, and therefore accept the hostile methods as a last “professional” resort. But there are alternatives.
I strongly emphasized the difference between care and coercion, saying mental health is personal feeling, and care should be helpful, supportive and meaningful, with attention for mental wellbeing. Trust and openness is needed for care. And forced interventions undermine wellbeing, trust and meaningful contact, and therefore force is not to be used in mental health care. Coercion and forced interventions have got nothing to do with mental health care, which is about wellbeing.
I asked them all: What is protection? What is worse than being chained and restrained, and confined? What is violence? What does mental health mean? And what does care mean? I assumed they understood what I meant. And I recommended that coercion and care should be separated, in order to enable care. Mental health care cannot be united with forced interventions.

Then Peter Bartlett said to me that the paper wasn’t about care or forced treatment, but about detention, in prison, and there was another paper presentation about forced treatments. I was totally confused by this remark, because the title of his paper clearly said: “A mental disorder of a kind or degree warranting confinement: examining justifications for psychiatric detention”. I couldn’t see how this would be NOT related to involuntary confinement on a psychiatric ground (which in this meeting fell under the scope of detention and deprivation of liberty), so I stared at the title and I was quite paralyzed by this remark. I had studied the entire article, and this would imply that my entire interpretation of the article was wrong, or I just hadn’t enough knowledge of English words for this. So I felt very confused about this, and I dared not to say anything about this article anymore.
I think the article may have been very critical and challenging towards mainstream interpretations, but in my opinion it was staying within the limitations, and I felt like making the actual point there. In my opinion the article was not bad, and surely mentioning interesting legal points and ethical questions, but just a strong point on whether care and force can be united at all should be made.
I think it was an interesting article about questioning the concepts of dangerousness and its prediction methods, such as a person’s history (which doesn’t change over time) and questioning the role of court-decisions (rubber stamp policy), and challenging the concepts of disability-related, and symptom-related legislation (both discriminatory).
In my opinion the concept of forced care could also have been challenged, in order to give this article a more complete feeling.
But my discussion time on that part had already ended. I didn’t really like how this particular part of the discussion had ended, it took me some time to think about it. Afterwards I think the communication on this point should have been better (that is my opinion). I think we were not necessarily disagreeing, and maybe could have reached agreement. But the discussion wasn’t there anymore.
Anyway, afterwards I did get compliments of other participants for the remarks I made during the day. I still feel a bit weird about this part, but anyway, I’m glad I made my point against forced treatments, and that this view was shared by a lot of participants.

A remark was made about how to deal with persons on the street, when there is not enough ground to take them in, and there is not enough community based care. Or people with psychosocial disabilities massively ending up in prisons, where they get no care at all.
Someone mentioned CRPD article 14, which says that disability or symptoms can be no justification for deprivation of liberty, and this also means abandoning the stereotype gateways where it is not the sole reason (like mental health and dangerousness).
It was a point of discussion whether this scenario of article 14 of the CRPD would lead to a situation where the availability of community living and services becomes the exchange of detention, for a progressive realization of the right to liberty. While then, on the other hand there need to be guarantees and safeguards for those who are still deprived of their liberty, and there must be strong evidence to justify deprivation. But this all together may lead to the risk that the realization of human rights in care facilities becomes a social issue, depending on the availability of community care, which would mean that it’s harder to realize equal rights for all people in all places.
The role of CPT and SPT is to ensure that there is a defensible system in every State, an they do not define for States what they have to do, because how States perform their duties is a matter of culture and sovereignty.
But it is important to inform everyone that we have the CRPD, and the rights apply NOW, so this must be acted upon immediately by the States in order to comply.
There was no clear conclusion to this part.

Then the next presentation came from IDA (International Disability Alliance), represented by Facundo Chávez Penillas. He presented a draft discussion paper on “How inspectorates of places of detention can promote the right to live independently and be included in the community”. It was about de-institutionalization.
Facundo pointed out very clear that article 14 (right to liberty) and article 19 (living independently and be included in the community) are not in competition, and even related to monitoring. CRPD Article 14 says that confinement on the ground of a disability is illegal., but the role of inspectorates is larger, and also aims to avoid deprivation of liberty and avoid mistreatment. Now the goal must be de-institutionalization. So it’s important to push the CPT and its inspection mandates to a bigger and broader frame, and push States towards de-institutionalization.
It’s a question whether improving safeguards and improving conditions of detention, will lead to end detention and to end institutionalization. And maybe better equipped cells will defeat the fight against the existence of these institutions, and strengthen the wrong practices? So when advocating for safeguards it is important to think in a new dimension, and consider whether we want to keep the system or change the system. And considering the practical variety of work, maybe the CPT mandate would be appropriate to push for a new dimension in monitoring with the goal of de-institutionalization.
Then there also need to be coherence in jurisprudence in cooperation with other frameworks, national (NPM’s of which some are good, and some not) and international (like CRPD, CPT) and also with organizations like WHO, who study for example mental health laws and maybe good practices of human rights language may be found (although we know that most laws still allow deprivation of liberty and a new wave of laws is needed).
For CPT and SPT members it can also be hard to understand all aspects of the CRPD, and a training for better understanding might be useful. And maybe this training could then also be available for many different levels of practice, such as for countries in order to create new legislation, policies and practices, and for education to other monitoring mandates, to cooperate on the CRPD issues.

Someone said that CRPD article 14 isn’t very strong in legal language, because it says that persons with disabilities can not be detained “unlawfully or arbitrarily”. But most national laws allow for forced treatments and confinement, so then it isn’t unlawfully or arbitrarily. This makes the paradigm shift hard to explain or to defend in legal terms, because CRPD article 14 is a doubtful phrase, which is hard to position and develop on. CRPD article 14 is not challenging the current laws and policies explicitly, nor stimulating a paradigm shift. It can be interpreted as justifying any social and legally accepted treatment. There are no laws yet on de-institutionalization, and most countries see deprivation of liberty as necessary. But the right to liberty can not just rely on social acceptability of a country, so this phrase needs to be strengthened.
Someone else added that monitors also have an option to challenge detention grounds, by addressing that admission in a facility can be a violation of CRPD article 3 (general principles) directly.

Everyone agreed that there need to be strong guarantees for ending the current large-scaled deprivation of liberty which is associated with disability, and which is particularly bad in the East of Europe. Also eliminating stigma is needed, like countering the presumed dangerousness and presumed incapacities, which are significantly harming persons with psychosocial and intellectual disabilities, who are lacking any legal capacity, and being subjected to detention with no chances, no safeguards and no defence.
It had been a rich discussion.


Then it was time for the lunch break, which was a buffet of the Hilton Hotel.
In the hallways I talked to several people. I also visited several psychiatric hospitals around the world (just like CPT and SPT do), so there was a lot to talk about. We all know what “very bad” means, and inhumane conditions in mental health care still occur in every country.

I talked to several people about the recent insights I gained in South Africa last couple of weeks. Like for example, the correspondence in human rights violations by an approach to cast out demons or to cast out illnesses; both ways can be extremely hostile for the users (chains, cells, restraints, denial and abandonment), and both ways are aimed to cast out or destruct an element of the person. The social, holistic approach differs from that, because it isn’t aiming to destruct personal aspects, but rather aims to find a way to deal with it. For users the difference between those approaches is huge.
Of course I also talked about the recent scandal of the man who died in a seclusion cell in psychiatry in the Netherlands, which I had heard of by internet on my way to Strasbourg. The fact that the family had gotten money on condition to keep it quiet made it even worse. The man had tragically died last year, after denial of medical care: the medical hospital didn’t want to take the man in, and then he was found dead in an isolation cell with several broken ribs and blood in his lungs. The parliament now demands for investigation of the case, and investigation of the national monitoring body for mental health care. And I also told about my own story, which also includes denial of medical care, and I told about the lack of access to justice, which goes for about all users. And I emphasized that the Netherlands is even a so called “advanced and developed country”, we all know that there are many worse places, especially in the East. At some places you never get out, and circumstances can be so incredibly horrible, with poverty, violence (hostility) and abuse.

Right after the lunch break, we started with a 10 minute video from Chile, which illustrated how horrible circumstances can be with poverty, violence and abuse. It was a shocking video, and has had a lot of impact in Chile in changing the way people looked at those institutions.
Someone mentioned that showing bad practices alone isn’t helping, because there is a huge need to see good practices, in order to have some guidance and speed up the change.
But anyway this video has had a positive effect in Chile, when broadcasted and shocking the country. So it was still a positive contribution for that situation.

Then we had another telephone-presentation, by Nell Munro on “When does involuntary treatment in a psychiatric or social care institution become ill-treatment?” for purposes of human rights monitoring bodies. We didn’t receive her concept paper, but she had made a powerpoint-presentation which was shown.
She explained that the differences between voluntary treatment and involuntary treatment were problematic for research, because they are not easily distinctive, with the varying degrees of coercive voluntariness, and how to include the doctor’s view versus patient’s view, or how to address the “threat of force” inside an institution, or proof a lack of consent. So this couldn’t be the scope of her research.
Also, the distinction between standard conditions for detention, and treatment are hard to describe, because in many situations as we know, the detention conditions ARE the treatment, and the treatments features are often just varying conditions of the environment. This is illustrated by the fact that many complaints are also both about conditions and treatment. So this scope was also not suitable for her research.
The third possible distinction to analyse was the distinction between acceptable treatment, and ill-treatment. We know that both extremes exist, and that most practices can be placed in the middle of these two, in a grey area.
The key features to identify ill-treatment come from human right instruments. And some main key features to identify acceptable treatment are: consent, acceptance to users, acceptance to minimum standards, and eventually acceptance to “gold standards”.
The techniques to distinguish acceptable treatment from ill-treatment, should be found in: talking to users and being proactive on their complaints, and also, involving users in processes of monitoring and delivery. Techniques to challenge and raise standards are: asking feedback on existing standards, and asking users about good aspects of care.
It is important to challenge the minimum standards by raising awareness and use the service users’ views as “soft evidence” to change the behaviour.

A comment was made on the fact that the CPT is on purpose not giving concrete standards, because this is a duty of the State, and minimum standards might be turned into maximum standards. And the need to keep on stimulating continuous improvement was again emphasized.

The next speaker was Anna Lawson, she really gave a clear explanation of her concept paper on Reasonable accommodation and the avoidance of ill-treatment in places of detention; the role of monitoring and inspection.
The term “reasonable accommodation” originates from the principles of non-discrimination and equality, and is based on the fact that having a disability should not imply disadvantages or lesser chances. Reasonable accommodation is about particular needs for equal participation in life, and some aspects are for example communication in sign language, or wheelchair access, or flexible working times.
In places where people are kept against their will, like prisons and also psychiatry and care homes, the state is responsible for providing reasonable accommodation on an equal basis with others, otherwise it can be classified as discrimination and a violation of the equality-principle. States have responsibility for people in all detention situations that they are treated equally. That means that sometimes adjustments have to be made, to accommodate persons with disabilities on an equal basis, without a disadvantage based on a disability. In this way diversity is recognized in an equal and reasonable way.
Reasonable accommodation also applies to private and public sectors, and diversity of places is also recognized by the phrase on “not imposing a disproportionate or undue burden, where needed in a particular case” , which means that expected adjustments in particular countries can differ, and a small private company can differ from a multinational or state-run corporation.

Reasonable accommodation is very closely related to accessibility. For example: when the world is “built for non-disabled persons only”, then constant adjustments have to be made for accommodating a persons with a disability. While when accessibility is realized, there is less need for providing reasonable accommodation in particular cases.
Failing to provide reasonable accommodation can be classified as discrimination.
Anna used very clear examples of how the lack of sound or constantly moving the furniture, can be more horrible to a blind person, and sometimes even be torture or ill treatment. Or how it can be horrible for a person with autism not to be able to sit in the same place every day.
She concluded that it is needed to combine the strings of good practices that exist, and make a clear set of standards and principles, with a positive language, in order to realize accessibility and reasonable accommodation for persons with disabilities, which also includes persons with psychosocial or mental problems.

Her presentation was very powerful and clear, and afterwards there were nice comments on her concept paper, such as compliments on the concrete examples she used to illustrate what reasonable accommodation means, which is very helpful.

Then it was time for another coffee break, which we all craved. It was a very full programme, and also, telephone-presentations are harder than face to face-presentations, especially when you are not a native English speaker. So everyone had been concentrating really hard, and we needed this break.

After the extended afternoon coffee break, Charles O’Mahony gave a short presentation on the link between legal capacity and detention, and implications for the CPT Standards.
He explained that the medical model leaves no room for choice, because “the doctor will decide whether a treatment is needed” and users have to become an expert to argument on this. But the medical model in psychiatry, and guardianship and substitute decision making are outdated.
The social model requires interactive decisions, where rights, will and preferences are included. Whether a person can or can not communicate directly, there is an obligation of support. So there must be made efforts to support persons in exercising legal capacity.
Partial guardianship takes on a functional approach, and can be less restrictive, but this still isn’t the same as full legal capacity and getting support.

Legal capacity is a gatekeeper-right, because having legal capacity is the basis of all other rights. Without having legal capacity recognized, it is for example impossible to live independently in the community (CRPD art. 19), and without the chance to live independently, there is also no process of learning on how to do so, and what support would be needed for living independently.
Also forced treatments are an infringement of the obligations under article 12 (legal capacity).
It is good to see that the “best-interest-principle” has no place in the CRPD. The best interest principle is only mentioned in treaties for children and not for adults. But still many steps have to be taken before full legal capacity for people with mental or intellectual disabilities is realized.

Then it was time for the conclusions. It had been a rich discussion, but not many conclusions could be drafted, because there was still a lot that needed to be examined further. The concept papers will be revised, and all participants were positive about doing such a meeting more often, because it had been very informative for everyone.

In the closing remarks there was still some questioning about people with disabilities and special needs who are on the streets, who are often ending up in prison when they are not taken care of.
I said that, based on my experiences and knowledge, criminal acts are not a part of the disease, but a social response. The situation of those persons on the streets is way more complex than just having mental problems, a disability or special needs, but they often face stigma, exclusion, discrimination, violence, abuse and poverty, and are left at the bottom of society. Also they often face a system that violates their human rights, which is all together not really an invitation to comply with the world. So most criminal acts may as well be a result of the situation where these people are in.

One more remark was made on the fact that children, babies and young people in detention places should get a voice. And more user participation would be welcome.
Also it is time to reach a critical mass and transform all the famous statements into results. The discussion should move away from talking about risks, up to discussing on how good practices of legal capacity and reasonable accommodations can be realized.

After the programme of the conference, and after the conclusions, I was asked to give a 5-minute presentation on the Eindhoven Model, which now has the name: the Open Mind-support meeting. I had given out the mini-posters and leaflets, which I still had from my presentation in Cape Town at the World Congress of the World Federation for Mental Health a few weeks ago, and stressed that there were alternatives to forced treatments.

One alternative model for avoiding coercion and forced treatments is the Open Mind-support meeting, which is based on Family Group Conferencing. This is a constructive dialogue with the user and the persons close to the user, where everyone can suggest options, and the user has a veto in all decisions.
First I explained the making of this model, which is based on my conclusions, drafted from my own 200 pages of extended feedback during the consultation process at the Ministry of Justice and the Ministry of Health on the new draft law on “Obliged Care”. The ministries had “no time to discuss” and so I started to draft my own conclusions, and made a wishlist of desirable features. Then I found out that the concept of Family Group Conferencing would fit these needs, and this entire process has now led to my own project, called: the Open Mind-support meeting.
Then I briefly explained my recommendations for avoiding forced treatments and coercion, based on almost 10 years of experience in activism against coercion and forced treatments. I emphasised again that there is a strong need to separate care from coercion. Care should be helpful to the user, and coercion leads to more struggle. Conditions for real care are trust, contact, communication, supportiveness and hospitality. And this can only be done by “the right person(s)”, because it is about feelings of trust and safety and understanding. So finding the right person(s) is essential.
The Open Mind-support meeting facilitates a process for having a constructive dialogue, with friends, family and whoever the user invites. They can suggest options and the user has a veto in all decisions. The persons close in a user’s life often know a lot more than a distant psychiatrist knows, and they can suggest a lot of alternatives that would suit the real needs of the main person. An open mind is needed for all participants in order to find constructive solutions that reach agreement. And once again, the user has a veto in all decisions in the entire process.
This process of open minded supportive dialogues can be facilitated by an independent coordinator, who takes care of the process in the same way as it is done in regular Family Group Conferencing, and that is what we offer users in Eindhoven in our project of the Open Mind-support meeting.
Legally, citizens have the right to make their own plan first, and everyone deserves chances. So it would be a first obligation (in terms of the least restrictive intervention), to facilitate a process to avoid coercive treatments and to empower the user in making an own “how-to-be-treated-plan” instead of taking away their own control and their legal capacity. And besides that, a social approach is needed for recovery.
So the Open Mind-support meeting is a social model for supported decision making, by which a user can be empowered and supported in carrying out their own preferences.

I got quite a lot of compliments afterwards, and quite some persons came to ask for my business card. I was very happy that I had gotten this opportunity to tell about the Open Mind-support model and explain my view on good practices.

It had been a very interesting meeting, and right after the meeting we had a nice dinner with the participants at a cosy restaurant. I was sitting with CPT and SPT members and had a nice evening.
After the dinner I was really tired, and I seemed to have caught a cold, so I wasn’t feeling well. When I reached my Hilton-room, it was already past mid night so I decided to go to bed right away, and save my writings for later. And after travelling home and a good rest, I have now finalized this extended personal report.

It was a good meeting, it felt constructive. And I really liked participating on this topic of monitoring. So all the travelling issues and even getting a cold have been worth it. It was good to be there and to contribute from the user perspective, and I felt privileged to represent ENUSP, and proud to be there. I did my best.

And again, as usual, we had no time to really enjoy Strasbourg as tourists. But that wasn’t the goal of the trip either. I am satisfied in the way it is. I will be a tourist later.