Replies of the Netherlands to CAT-committee

Today, Wednesday 15 May 2013, was a very busy day full of meetings again, with in the afternoon the session with the Replies of the Netherlands to the questions that were asked by the CAT-committee yesterday.
Todays session (CAT Replies of the Netherlands, 15 May 2013) can be found online in a few days at http://www.treatybodywebcast.org

Mari, Yoshi and I met in the lobby at 8.15, and then went to get coffee at Starbucks. Then Yoshi found out that his wallet was missing. He probably got pick-pocketed last night. Very sad, but despite this unpleasant start of the day, we managed to be at Palais Wilson at 9.00 AM. We went to the cafeteria for the personal meeting with Ms. Nora Sveaass, a member of the CAT-committee, who is really taking on the issue of forced psychiatric treatments. She has founded her own NGO: Health and Human Rights Info (http://www.hhri.org/ )
We had a very positive meeting. I briefly handed her the information which I had prepared for her, and then we talked about the Japanese situation of mental health care and torture and ill-treatment. Mari told some shocking things about psychiatric institutions in Japan, such as the use of correctional violence: every year some persons are beaten to death by nurses. In most of the cases this is not investigated.
Also, institutionalization is the only form of mental health care: about 97% of Japanese state budget for mental health care goes to institutions. There are 300.000 beds and 90% are private institutions. The number of psychiatric beds is incredibly high, and many thousands of persons are detained for longer than 20 years. The average stay is 5-10 years. There is huge understaffing, especially in long-stay wards for “chronically ill persons” , because these persons are not treated, only maintained….
Also persons in institutions “cannot be victims” , and crime inflicted upon them is not recognized. The only slightly positive thing is that by now, a few NGO’s are opening up to this topic, but the general public has no awareness. This raises a dramatic picture of enormous suffering in mental health care in Japan.
Ms. Nora Sveaass understood the issues very well, and that gave us the feeling of recognition. So it was a good meeting, and I think it will be fruitful.

Then at 11.00 we had a meeting with Peggy Brett at the CCPR Centre (Centre for Civil and Political Rights). This was near the UN Nations-building, which has the famous lines of country flags in front. The CCPR helps NGO’s to engage with the Human Rights Committee (HRC), and we got a handbook with guidelines for Non-Governmental Organisations (NGO’s) for participation in the reporting process to the HRC. We talked about upcoming country-reviews by the HRC: Japan will be reviewed next year. We talked about what strategic actions could be taken, like for example a coalition report with a joint position from more NGO’s.
The Human Rights Committee is also drafting a General Comment on article 9 of the ICCPR : the right to be Free from Arbitrary Detention. WNUSP has already provided comments to this process next year, and is currently drafting another response. The draft can be found online.
It was quite interesting, because Mari, Yoshi and I don’t have direct experiences with the Human Rights Committee and the ICCPR-country-reviews.
Every UN-treaty has it’s own committee, and they have all evolved in their own way. It is useful to learn more about the backgrounds in order to understand these mechanisms.

After this meeting we were very hungry, and we were lucky that our next meeting at 13.00 was in a cafeteria, at the University close to Palais Wilson. There we met Shantha Rau Barriga from Human Rights Watch. We had a very interesting dialogue on strategies for change in mental health care and awareness raising in general. The word “never” regarding forced treatments is hard to understand for lawyers and mental health professionals, because they think there may be exceptions. I explained that in the Netherlands we had found a shared goal in “aiming to ban coercion, by finding as much alternatives as possible”. This is something everyone can agree to, and we hope to eventually achieve the stage of “never” forced treatments.
I then also elaborated on alternatives, and how forced treatments are only making things worse, so it isn’t mental health treatment. It is torture and ill-treatment. Alternatives to forced treatments are not about fighting symptoms, but about relieving the cause of the distress. about inner life, a social approach, de-escalation and support, contact, wellbeing, recovery and so on. Care is a social thing.
It was very interesting to discuss this with Human Rights Watch, and this may get a follow-up.

Suddenly it was 14.45, and I rushed off to Palais Wilson again, which was next door.
After the smooth security check, I went inside, straight to the second floor, where the CAT-session on the Netherlands took place at 15.00.

The delegation representing the state of the Netherlands gave replies to the questions which were asked by the CAT-committee yesterday. Again, a lot was about migrant-detention, which I’m not going to summarize. I’m only reflecting on the issues said about mental health care.

Here below are the replies, as given by the delegation representing the state of the Netherlands.

First the delegation said the Netherlands has the intention to ratify the CRPD and the Optional Protocol of the CRPD is also being discussed (which enables amongst others an option to file individual complaints). The reservation at the time of signature remains unchanged: The reservation mainly relates to European Conventions and focuses on definitions of human being, medical experimentation, best interest of the child, and consent/will/autonomy of the person. It is unsure whether the reservations will be maintained at the time of ratification.

About forced treatments in institutions was said:

The applicable guidelines inform that coercion is a measure of last resort. Since 2006
action was taken to diminish coercion. Between 2006-2013, the government allocated 5.5 million annually to projects to reduce coercion and many alternatives and good practices are identified. In 2010 a joint declaration was signed enforcing the intention to reduce coercion.
The efforts still increase. The new draft law on mandatory care will be submitted to the Parliament. This new law aims to focus on treatment and not on hospitalisation and allows for treatment at home. The new law aims to strengthen the legal position of persons with "mental disabilities" and allow them to express their personal preferences of treatment and those of their family. The less invasive treatment is a priority.

(we know this is smooth talk, the law is opening up to more options of forced treatments, and projects to reduce coercion have ended without significant results of reducing coercion)

A lot of other issues were covered as well, (also rather smoothing) and the delegation had also provided a written non-public document with answers and data.

This altogether didn’t answer all of the questions the CAT-committee had raised, so in the next round of clarifying questions several members of the CAT-committee raised questions again.

Mr. Bruni asked if in recent years anybody had been sentenced for torture or ill-treatment in the Netherlands, and if he could get some examples of cases of ill-treatment and torture and how these have been compensated. (we know there probably aren’t any recognized cases…)

Mme Belmir asked if human rights are taken into account when making new policies. (the delegation said yes of course…)

Ms. Sveaass raised questions about the forensic care/ TBS-system.

She said her questions had focussed on TBS, and she is also interested in comments on that. The TBS system was originally for persons deemed irresponsible for their actions but this form of care has developed into a harsh form of punishment, as echoed by CPT, which mentions a "further tightening of TBS policy".
But psychiatric services and MH care is more than TBS. There is a high number of psychiatric hospitals and many beds. In research it shows that Belgium and Netherlands come up with these very high numbers.
The mentioned "applicable guidelines", do they refer to the health-plan from 2006?
It says clearly that solitary confinement should not take place and to trade in beds to community services. Has there been any reduction in hospital numbers to exchange this to social services and community based care services?
There is nothing wrong with hospitals themselves, but it is wrong when hospitals house healthcare practices which amount to torture and cruel inhuman or degrading treatment.
And she would like to have more information on the high number of restraint and seclusion, based on info from state party itself. And information given in replies on death in restraints. These issues are so serious that cannot just be handled by a general policy of "reduction".
She asked whether NPM’s visit these hospitals, and reiterated questions on the case of Brandon – What happened? Has there been any investigation? any results?
A professor for care in intellectual disability stated that: in every institution there are at least 10-15 persons who face this ‘Brandon’ situation- what action is being taken?

I had goose bumps and tears in my eyes, when I heard her speaking so firmly. I have been longing for this for so long. The recognition of these practices being wrong, and even torture and ill-treatment. It was overwhelming me in a way. It really moved my heart.

Mme Belmir also raised questions again on TBS, monitoring and possible appeals or excesses.
And Mr. Grossman asked about the role of consent in psychiatric treatments.

The replies given by the state-delegation of the Netherlands:
The TBS system has been portrayed by media as part of punishment, but it is aimed at resocialisation and starts after the sentence has been exhausted. So after 4-5 years of prison, the person will then get treatment to prevent recidivism. The logic behind this is that at the moment that person is released, he/she is able to reintegrate into the society.
There has been recidivism, for example rapists, and afterwards there was a public demand of making sure that will not be a danger to society.
The public sentiment is that we need to be sure that there will not be a danger

Everyone in the Netherlands was shocked by the case of Brandon, and this has lead to a lot of changes, regarding technical answers, we can provide the information before tomorrow afternoon.

About complaints in the TBS system - yes, there is an individual complaints committee, if the complaint is not adjudicated, the persons can appeal to council for administration of justice and protection of juveniles.

On the high number of beds in psychiatry – the CAT-committee will get answers by tomorrow.

The session had lasted almost 3 hours (from 15.00 to 18.00). And afterwards I had some mixed feelings. It was obvious that the state-delegation tried to give “the right answers” to the CAT-committee. I sometimes felt quite upset by what was said by the state-delegates. But I was really moved by the questions that Ms. Sveaass had raised. I almost became emotional. This is recognition. It means so much. I’m still moved.

At the end of the session I happened to have contact with the Dutch delegation, who approached me. I asked if I could have the non-public document with information provided to the CAT-committee. They considered it briefly, and then they said: “why not, but you cannot make it public”. I agreed to that. So now I do have a copy of the information provided. And I have a card of the head of the delegation, so I will also ask for the additional information they will provide on Brandon and psychiatric beds and so on.

Then at 18.30 there was a reception at the N’v’Y Hotel, to celebrate the 25th anniversary of the CAT Committee. This was organized by OMCT (World Organization Against Torture). Mari, Yoshi and I were invited on behalf of WNUSP. We met a lot of interesting persons in a nice atmosphere. I liked it.
By the time we left it was 9 PM. I had been busy for 12 hours, (Mari and Yoshi had a break during the Dutch Reply-session). Now it’s about 1,30 in the night, and tomorrow we will have a day full of meetings, starting at 9 AM again.

It’s a very special experience to be here. I really hope this will make a difference for mental health care, in the Netherlands, and by CAT-jurisprudence, all over the world. It’s time to dream again.