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Human Rights of People with Mental Disabilities

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Human Rights of People with Mental Disabilities Human rights of people with mental disabilities Neeraj Singh Gill A thesis in fulfilment of the requirements for the degree of Doctor of Public Health School of Public Health and Community Medicine University of New South Wales March 2020 1 Thesis/Dissertation Sheet Surname/Family Name : GILL Given Name/s : Neeraj Singh Abbreviation for degree as given in the University : DrPH calendar Faculty : Medicine School : School of Public Health and Community Medicine Thesis Title : Human rights of people with mental disabilities Abstract 350 words maximum This thesis explores the human rights of people with mental disabilities in regional Queensland, Australia, within the context of contemporary human rights frameworks adopted by the United Nations and the World Health Organization. The study was informed by a scoping literature review to synthesise the current knowledge in this field and identify gaps. It is a qualitative study using a ‘stellar approach’ characterised by superimposed triangulation of data sources and data-gathering methods. This involved semi-structured interviews with persons with mental disabilities and carers, a focus group with stakeholders and consultations with legal and psychiatric experts. The data were analysed iteratively, informed by post-modernist and critical realist frameworks. Abductive analysis – a combination of deductive and inductive analyses – was conducted. In the interest of reflexivity, a chapter on the positioning of the candidate as a situated researcher was included. This study found widespread violations of the human rights of people with mental disabilities. Involuntary/coercive psychiatric treatment; inadequate access to healthcare; and stigma and discrimination were found to be the most common violations of rights. While most participants, including service-users, agreed with the need to retain involuntary treatment provisions as the last resort, many participants highlighted the excessively restrictive ways in which involuntary treatment was enforced, violating their dignity. Poor access to healthcare, especially in rural and remote areas, was highlighted. Social exclusion through stigma, ‘the lonely road’, was the most distressing violation of rights. The study concluded that citizenship approaches, coupled with the capabilities approach to social justice may provide a philosophical basis for promotion of human rights of people with mental disabilities, which can then be practically implemented by addressing the social determinants of health and adopting the recovery paradigm in mental health. Specific strategies include: mental health promotion and prevention and access to early intervention; policy/legislative mechanisms to minimise coercion; the provision of voluntary, community- based, recovery-oriented services; and the social movement approach to promote the right to social inclusion and freedom from stigma/discrimination. Promotion of economic, social and cultural rights of people with mental disabilities would pave the way for protection of their civil and political rights. Declaration relating to disposition of project thesis/dissertation I hereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International (this is applicable to doctoral theses only). ………………………………………………… ……………………………………..……… ……….……………………...…….… Signature Witness Signature Date The University recognises that there may be exceptional circumstances requiring restrictions on copying or conditions on use. Requests for restriction for a period of up to 2 years must be made in writing. Requests for a longer period of restriction may be considered in exceptional circumstances and require the approval of the Dean of Graduate Research. FOR OFFICE USE Date of completion of requirements for ONLY Award: iii Originality statement I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project’s design and conception or in style, presentation and linguistic expression is acknowledged. Signed: Date: iv Copyright statement I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350-word abstract of my thesis in Dissertation Abstract International. I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation. Signed: Date: Authenticity statement I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format. Signed: Date: v Inclusion of publications statement UNSW is supportive of candidates publishing their research results during their candidature as detailed in the UNSW Thesis Examination Procedure. Publications can be used in their thesis in lieu of a Chapter if: The student contributed greater than 50% of the content in the publication and is the “primary author”, i.e. the student was responsible primarily for the planning, execution and preparation of the work for publication The student has approval to include the publication in their thesis in lieu of a chapter from their supervisor and Postgraduate Coordinator. The publication is not subject to any obligations or contractual agreements with a third party that would constrain its inclusion in the thesis Please indicate whether this thesis contains published material or not. This thesis contains no publications, either published or submitted for publication (if this box is checked, you may delete all the material on page 2) ☐ Some of the work described in this thesis has been published and it has been ☒ documented in the relevant Chapters with acknowledgement (if this box is checked, you may delete all the material on page 2) This thesis has publications (either published or submitted for publication) ☐ incorporated into it in lieu of a chapter and the details are presented below CANDIDATE’S DECLARATION I declare that: • I have complied with the Thesis Examination Procedure • where I have used a publication in lieu of a chapter, the listed publication(s) below meet(s) the requirements to be included in the thesis. Name Signature Date (dd/mm/yy) vi Related publications and presentations The following is a list of relevant publications and presentations arising from the writing of the thesis. Publications: Gill NS, Allan J, Clark B, Rosen A. Human rights implications of introducing a new mental health act – principles, challenges and opportunities. Australasian Psychiatry. 2020, Vol 28(2) 167 – 170 Gill NS. Human rights framework – an ethical imperative for psychiatry. Australian and New Zealand Journal of Psychiatry. 2019, Vol 53 (I) 8-10 Presentations: Human rights of people with mental disabilities – a stellar advance. N. Gill, A Withall, J. Travaglia, N. Zwar, A. Rosen. Poster presentation, World Congress of Psychiatry 2019. Lisbon, Portugal. 20-24 August 2019. UN CRPD and related legislation – consequences for psychiatry. Panel Discussion. World Congress of Psychiatry 2019. Lisbon, Portugal. 20-24 August 2019. Double whammy recolonization of marginalized populations by mental health services. Invited Speaker and Chair. The MHS Conference. Brisbane 27 August 2019 Human rights framework and mental health legislation: International perspective. Invited Speaker. Mid-term CME, Indian Association of Private Psychiatrists. Bangalore, India. 20-21 April 2019. Human rights framework of the UN CRPD 2006 and forensic provisions of Queensland Mental Health Act 2016. Forensic Mental Health and Human Rights Workshop. Invited Speaker. Hosted by: TC Beirne School of Law, The University of Queensland, Brisbane. 22 March 2019. A comparison of mental health legislation in three countries – Fiji, India and Australia. Symposium. 7th World Congress of Asian Psychiatry, Sydney. 22 February 2019. Challenges of Human Rights to Professions. Invited
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