my presentation at CAT on the Netherlands

Today, Monday 13 May 2013, was the start of the CAT-sessions on the Netherlands.

The CAT-committee monitors the Convention Against Torture, and performs periodical reviews of state parties to the convention to see if torture and ill-treatment are happening in that particular State. This week the Netherlands is reviewed by the CAT-committee, and I made a submission on Torture and ill-treatment in mental health care in the Netherlands. (also see http://www2.ohchr.org/english/bodies/cat/cats50.htm )

This morning I arrived at 9 AM at Palais Wilson, a nice building of the United Nations where the CAT-sessions are taking place. It was a 10 minute straight walk from my hotel. Very convenient!

In the morning I met mr. Nicolaas Schrijver, a Dutch member of the Committee on Economic Social and Cultural Rights (CESCR). I informed him a tiny bit on the mental health care issues, but he wasn’t an expert on that and our time was limited, so I moved on to other subjects, such as the pilot projects on Family Group Conferencing to avoid coercion, and certain exclusive policies in certain shops, which relate more to economic, social and cultural rights. It was basically just a chat.

After that I stayed at the cafeteria at Palais Wilson, and prepared my oral presentation together with Victoria Lee from IDA (International Disability Alliance). And then we got company from the 2 interns of IDA (Aura and..) who made the copies of my submission and my summarizing hand-out. It was good company to have a stress-less preparation:)

Then at 12.00 the private session for NGO’s (non-governmental-organizations) on the Netherlands started. There were only 2 NGO’s present: me from my organization Mind Rights, and the Dutch lawyer-committee on human rights (Nederlands Juristen Committee voor de Mensenrechten – NJCM).

I have a lot of mixed feelings about the NJCM. The submission of this lawyer-committee on Human Rights didn’t address mental health care issues at all, which I think is an outright shame. And then last week I was shocked when I found out that the NJCM was supported by the mental health institution which treated me so bad (tortured me). They are also supported by a Human Rights Organization for and on behalf of doctors, nurses and paramedics. This clearly shows where the Human Rights-lawyers in the Netherlands stand.

NJCM presented their submission first. It was about migrant-detention, which is a real issue. However, I found the presentation of NJCM quite disturbing; They continuously called migrants “aliens”, and advocated for “shorter detention and a better detention regime” , while I think they should have advocated for release and no detention at all. When I told this to the NJCM delegates, they answered: “but we have to take into account what is achievable”… I am totally not a fan of this lawyer-committee, although the persons were friendly.
The submission of NJCM was quite lengthy and monotonous, and mainly about various procedures for immigration and migrant-detention, which brought up a lot of questions and the NJCM wasn’t able to provide answers directly. It didn’t really have a bite.

After that it was my turn to present my submission. I told about forced institutionalization in mental health hospitals, and how thousands of persons are subjected to forced treatments, including solitary confinement, physical restraints, forced medication and forced body cavity search. This is of course not leading to wellbeing or recovery.
I told about the recent projects to reduce coercion in mental health care in the Netherlands, There are 2 main streams in mental health care: one is the old medical model-perception, and the other is a social and human rights based approach. Now, the projects to reduce coercion are ended, and the medical model still dominates. These projects were led by the national mental health organisation, which is a state-funded organization with no meaningful consultation of users. This is contrary to the human rights based approach.
The violations in mental health care are not addressed by courts, lawyers or the government. There are only procedural safeguards. There is a lack of awareness and no understanding of the human rights based approach.
This also leads to problems in monitoring and a lack of access to justice. The lawyers are only there for the involuntary admission-procedures, and they sometimes pressure the person to consent to treatment, claiming that agreeing will make it less bad. There are basically no active lawyers for filing complaints about forced treatments. I also know that from my personal experiences. I asked so many lawyers, and even the ministry of justice, and I published blogs raising the question if there are any lawyers at all on this matter at all. Now, after 18 years my personal complaints are now looked at by the Special Rapporteur on Torture, prof. Juan Mendez.

I saw some shocked faces at that point. I continued.
In the Netherlands, forced psychiatric interventions are not perceived as a human right violation.

Thousands of kids have been placed in detention (child-prison), because their family-home was perceived “unsafe” and there is a waiting list for mental health care. The family and friends of these children are considered “not certified” to deal with these children, and therefore these children are placed in prison-settings, because the prison-officials are certified. This is of course not in the best interest of the child. This corresponds with the findings of the Committee on the Rights of the Child on the Netherlands in 2009, which found that the best interest of the child was not sufficiently codified in the Dutch laws). The government’s solution to this illegal detention of children was to rename the institutions.
In the Netherlands there is no alternative to institutional care, especially in more complex situations. Some parents took their kids out of the institution, because they couldn’t bear to see the suffering caused by restraints and institutionalization. These parents quit their job to be able to care for their kid, and they are lost. There is no help for them.
There are many deaths caused by forced interventions. A list of media-reports on deadly use of restraints and seclusion is included in the summarizing paper.

The last remark I made was about the reservation of the Netherlands upon signing the Convention on the Rights of Persons with Disabilities (CRPD). The Netherlands made a reservation to article 15: the right to be free from torture (!). That would mean that the state doesn’t consider Freedom from torture a fundamental human right for persons with disabilities in the Netherlands. That is completely outrageous!!!
Probably this exception has to do with the item on experimental medication. As already said, the medical model approach is still very dominant in the Netherlands.

There was only 1 question addressed to me, which was about my summarizing paper, which states that forced institutionalization can last short-term (days, weeks) or long-term (months, years) and even can last a life time.
The question was about detention for life in mental health institutions: What is that based on? And are there any numbers on how many persons are detained for a life time in institutions?
I then explained that the forced institutionalization can be prolonged when there is no improvement of the situation, so this can last forever. There is no absolute end-date nor a procedure to end forced institutionalization after a certain amount of time. Unfortunately there are no numbers on how many persons are actually detained in mental health institutions for a life-time.

Mr. Bruni, who is a CAT-member and one of the rapporteurs on the Netherlands (who will write the report) said he will ask questions on forced psychiatric interventions and forced institutionalization to the delegates of the Netherlands tomorrow!!
That was exactly what we aimed for!

So I feel very good about my presentation to the CAT-committee today.
Tomorrow, Tuesday 14 May 2013 at 10.00 AM, the CAT-commitee will ask it’s questions to the State-representatives of the Netherlands. This will be broadcasted live online at http://www.treatybodywebcast.org/
I hope the questions asked by the CAT-committee will be good. I will be present at the session, but I’m not allowed to intervene, only listening (but I can talk to the CAT-members afterwards and stimulate their understanding of the issues). I hope it turns out well.

In the afternoon I was supposed to have an individual meeting with Mme Belmir from the CAT-committee (she is the other rapporteur on the Netherlands), but this is rescheduled to tomorrow morning.

So then Vicky and I went to sit outside in the nice sunshine, and prepared for the plenary session which took place at 15.00 with the CAT-committee and NGO’s in general. This session was about possible improvements of the CAT-approach (procedures and so on).
I read out a written intervention of the World Network of Users and Survivors of Psychiatry (WNUSP) – attached below.

After this session, Vicky and I went to sit outside in the sun again, and prepared a suggestion for a question which the CAT-committee could ask tomorrow to the delegates of the Netherlands.

It’s exciting. I’m really curious to what happens now. There weren’t much questions on my submission, and so far I have had only supportive feedback: “shocking, good report, substantive” and so on. I have a lot of hope for tomorrow.

Tomorrow at 10.00 AM, the CAT-commitee will be asking questions to the State-representatives of the Netherlands in a 2-hour session, which will be broadcasted live online at http://www.treatybodywebcast.org/

I will be there to listen carefully.
But now I’m first going to dream about it :)



The World Network of Users and Survivors of Psychiatry (WNUSP) is an international organisation representing and advocating for the human rights of users and survivors of psychiatry and people with psychosocial disabilities.

We welcome the attention being paid by the Committee to human rights violations committed in the mental health context in the consideration of the reports of States Parties and in Concluding Observations.

We appreciate the valuable recommendations the Committee has made with regard to ending the use of electroshock (ECT) and other treatments that may contravene the Convention; as well as on developing alternatives to psychiatric institutionalization; and on ensuring that mental health services are based on the free and informed consent of the person concerned.

However, we are concerned that the Committee couples these valuable recommendations with others that assume the continuation of involuntary confinement and treatment in psychiatric institutions, as a general practice or as a permissible “last resort” measure in exceptional cases. This is inconsistent with the standards contained in the Convention on the Rights of Persons with Disabilities (CRPD) and the standards of the Special Rapporteur on Torture in his latest report on torture in healthcare.

To date, your Committee has, for the most part, adopted an approach calling for legal or procedural standards, rather than outright abolition of institutional confinement and compulsory treatment, prohibition of these practices by law, and repeal of the laws that currently allow them to be practiced with impunity.

In one recent instance, the Committee referred to the Mental Illness Principles of 1991 as a guide for the revision of legislation in the area of mental health; however, the MI Principles express a standard which is contrary to that contained in the CRPD and can no longer be considered viable as an articulation of the human rights of persons with psychosocial disabilities.

In some other instances, the Committee called for immediate release of all those “forcibly placed in psychiatric institutions for reasons other than medical”. Rather than carve out an exception allowing involuntary hospitalization for medical reasons, the Committee should apply the same standards to persons with and without disabilities, and call for release of all those placed against their will in psychiatric institutions, and for measures to ensure no one is placed in such institutions involuntarily for any reason.

Speaking on behalf of users and survivors, such approaches limit the scope of human rights protection afforded to us. The Committee’s concern for legal safeguards in the process of forcible detention and treatment does not address the real issue- the fact that the forced detention and treatment themselves constitute human rights violations. If one person is locked up in psychiatry, that person's rights are still being violated.

The fact that laws exist that treat us as second class citizens, that target us for detention on grounds we have very little ability to challenge, and that the rest of the population is not subjected to - that is a violation of human rights itself. And when such laws facilitate torture and ill-treatment there is nothing else to recommend but their abolition. The Special Rapporteur on Torture acknowledged this and called for the absolute ban of forced psychiatric interventions recognizing that they always constitute at least inhuman and degrading treatment if not torture.

There is no case in which forced treatment and detention in psychiatry can be justified, and the continuation of laws that allow forced detention and treatment with procedural safeguards amounts to government approval of torture and ill-treatment, contrary to the obligation under CAT to take all effective measures to prevent acts of torture and ill-treatment.

Further, legal and procedural safeguards do nothing to alleviate the powerlessness felt by individuals subjected to forced psychiatric interventions.

We would like to encourage the Committee to continue its attention to coercive psychiatric practices and to move beyond the notion of legal safeguards to proactively uphold the rights of persons with psychosocial disabilities on an equal basis with others. We look forward to continued cooperation with the Committee on how to address these issues and remain at your disposal should you have any questions.