The dissemination of the Special Rapporteur Dr. Danius Puras\’ report has been a moment of joy and appreciation for the Seher: Comprehensive Urban Community Mental Health and Inclusion Program team. As a community mental health program working towards an outcome of full inclusion of persons with psychosocial disabilities, it was a moment of great validation, but also a moment for reflection. We have been involved in services for more than 20 years and it was a proud moment for us to see its fruits and receive recognition at the global level, through a special mention of the Seher program in this report.
The Seher team would like to congratulate Dr. Dainius Puras for the courage he has demonstrated by dismantling the very foundations of psychiatry\’s ethics, history and power. Dr. Puras has been instrumental in calling for radical change in conventional beliefs and practices within mental health at large and psychiatry in particular, from a global, structural and historical framework. In this report he takes a revolutionary stand by refusing to imagine mental health without human rights. This is a stand we endorse. We acknowledge that the report would carve the path for a human rights based community mental health, where inclusion and human rights are at the core of every action.
Dr. Puras lays the foundation for a future by challenging the history of psychiatry and its deep connection to colonization. The structure of such colonization has changed, but the foundations continue to be the same: the hegemony of the west is maintained by discarding local knowledge, local traditions and local healing systems. The report acknowledges that the tools for mental health are created in a different culture and then transported into different communities as gospels of truth, thus setting up neo colonial relations and structures.
We agree with Dr. Puras in questioning the obsoleteness and failure of the biomedical model in addressing psychosocial disability as a social justice issue. We reiterate his challenge to the expertise and power of psychiatrists, research and knowledge developed from this association and the deep rooted pharmaceutical nexus that has maintained this system. This has led to invalidating peoples\’ lived experiences, context and personal narratives in asserting and enjoying life on an equal basis with others.
These backgrounds force us to question consent, the violence of mental health systems and of the custodial brutality that have become normative parts of the mental health systems, found in no other health system. There is no system to challenge the treatment and care that is given to the person, the duration of the stay at the institution, consent for medication, hospitalization, ECT, physical and chemical restraints. The person experiences violence and stigmatization in multiple ways within a dominant and powerful medical system. This level of coercion is only inflicted upon a dehumanized subject, when a subject is rendered a full object, raising a crucial question, “What happens to the person in this ‘transaction’?\”
These pondering questions become critically important as we reflect on our work in response to the report.Do our approaches to psycho-social health facilitate the social, political and civil rights that is available to all persons? Do our notions of care recognize the exclusion of rights of persons with disabilities in a way that is structural and systemic to practices of ‘care’?
In our experience, feeling well is way beyond ‘erasure of symptoms’,‘symptom management’ or judgment about a person\’s ‘functionality’. We have seen how‘normalcy constructed within this frame becomes the basis for discrimination and further exclusion of persons with psycho-social disabilities. In this way, the mental health system and its gatekeepers place barriers to all aspects of a person\’s life. Within this system a person is constantly struggling with being ‘allowed’ choice. Access to disability support does not depend solely on a ‘medical’ or ‘psychiatric diagnosis’. We need an imagination of mental health without and outside mental institutions and the mental health care system. We need systems that recognize persons with disabilities and includes them in all policies and programs. We need to develop systems and structures that facilitate the full inclusion of persons with psychosocial disabilities within communities.
We reaffirm and assert the need for an inclusive multidimensional approach outside of the psychiatry paradigm. As an organization working from the Disability Inclusive Development framework, our service programs are geared towards the inclusion of persons with psychosocial disabilities into communities. We endorse the rights of persons with disabilities in all matters related to their life, without having to pass through the medical gateway. Our services are rooted within non institutional, community based and rights based foundations. These open up opportunities for growth and development. In that, we appreciate the call by Dr Puras to end the outdated colonial practices of segregation and coercion.
We base our trust in the report and we move forward with the hope that alternative voices that have challenged the mental health system are taking a central position through the declaration of this report. However, we also hope that the dissemination of this report would challenge global bodies such as the World Health Organization (WHO) to introspect its role in endorsements of essential drug lists and stand alone mental health laws, reflecting a pre-CRPD medical discourse.
It has been a 20 years journey for the Bapu Trust and we see the fruits of this journey when we read the report. We see the spirit of the Bapu Trust and several other such initiatives worldwide running through the pages. But, we also need to reflect and notice that in the end the report is speaking from within the discipline of health, calling for the highest standards of health and mental health by psychiatrists and other gatekeepers within the medical paradigm. At Bapu Trust, we look at pathways to inclusion and inclusive development by looking at barriers to accessing rights at the intersection of three doors: the mental health door (which is the smallest), the development door (which is in the middle) and the human rights door (the biggest.) Our value system guides us to enter from the human rights and development doors. This broadens the scope of engagement and calls for a need for intersectoral collaboration and work on each goal under the Sustainable Development Goals (SDG’s). However, it seems the report reiterates health as the primary door through which to enter mental health.
We are hopeful that this report, among other concerted works, has set the pace and direction for achieving the highest standards of living dignified lives. It sets the vision for giving and receiving support; and manifesting enabling environments for all persons with psychosocial disabilities everywhere.
About the authors:
As we write this, the news of a 13 year old boy diagnosed with autism was shot by a police officer in Salt Lake City as he was perceived as a threat to others (9 September, 2020)