Draft guidance on Mental Health, Human Rights, and Legislation published jointly by WHO and OHCHR
Contribution and comments from the Truth and Justice Collective for Nathalie
Draft guidance on Mental Health, Human Rights, and Legislation published jointly by WHO and OHCHR :
see here : https://www.ohchr.org/en/calls-for-input/calls-input/draft-guidance-mental-health-human-rights-legislation-who-ohchr
Text of the contribution : Contributions and comments
Institutional and political actors like what seems to reinforce and validate their narratives. Contrary and independent evaluations are met with grimaces.
The draft guidance on mental health developed jointly by the Office of the High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO), two United Nations bodies that are theoretically independent in their functioning and objectives, is part of a perspective of transforming mental health systems through processes of compliance with human rights principles, including the articles of the Convention on the Rights of Persons with Disabilities (CRPD), enriched by reports of their special reporters1. This convention is designed to protect the people who pass through its services and networks, including the psychiatric institution, which generates everything except care and recovery.
The intiative of these two international organizations is evident in this joint project2 , composed of three chapters, with an explanatory introduction containing three major questions and a language note on the notion of mental health and its derivatives, testifies to the beginning of an awareness that the problematic of mental health is in an epistemic and structural impasse. The 154 pages including the 8-page appendix and the 33-page bibliographic data in its initial linguistic version, carries in itself open windows for comments and contributions from state and non-state actors to comment and contribute to improving the project itself to make it more current.
- Chapter 1 provides a general overview of the challenges of mental health legislation and the need for reform consistent with a human rights framework;
- Chapter 2 highlights the key principles and issues that legislation should reflect and provides examples of different rights-based provisions; and,
- Chapter 3 provides guidance on how to ensure a rights-based process in the development, implementation and evaluation of mental health legislation.
The importance of the questions posed in the introduction
A careful reading of the introduction and an understanding of the scope of its meaning requires a necessary pause on the three questions posed.
The collective modestly takes it upon itself to legitimize its comments on thres actors cited in the set :
1) People with disabilities and their representative organizations
2) Professional associations/organizations representing psychiatry and related professions in the mental health sector;
3) Researchers and academics; and
Who is the guide for?
The collective focuses on the first question : Who is the guide and these presentations for, and which organizations are they for?
- United Nations bodies, entities and experts;
- Government officials;
- Actors working in humanitarian contexts;
- People with disabilities and their representative organizations
- Family members;
- Civil society organizations;
- Community-based organizations;
- Faith-based organizations;
- Professional associations/organizations representing psychiatry and related professions in the mental health sector;
- Professionals and advocates working in the legal and judicial systems;
- Researchers and academics; and
- Media representatives.
In the latter case, attention will be focused on Chapter 3, specifically on :
Education and public awareness and evaluation. Items:
3.5.3. Public Education and Awareness
3.6.1. Importance of evaluation
3.6.2. Systemic and regular review of legislation
3.6.3. Evaluation criteria and strategies
- People with disabilities and their representative organizations
- Professional associations/organizations representing psychiatry and allied professions in the mental health sector;
There is a real and strong idea that the system of representations of psychiatry and people categorized as disabled is deeply in structural and functional crisis. The failure of this system is amplified by the powerlessness of these actors to place themselves in the perspective of the persons concerned, and the extent of the bureaucratic and paternalistic functioning, especially in the psychiatric world and its aftermath. These actors use the idea of representation to the public authorities and the media not to make the needs and expectations of the people they claim to represent heard, but to put themselves in unbearable postures of the real interlocutors that the concerned people and their relatives ignore them and do not recognize them in fact, and when they ask them for help or an intervention however small it may be, they will be sent back in forms of verbal violence or in a mode of voluntary ignorance, implied by "We can't do anything". They are structured in associations with opaque functioning and far from respecting their own object and objectives of their organizations.
Crisis of representations in the psychiatric universe and its mental health consequences
Whoever approaches an association or a non-state but subsidized organization in the mental health sector, discovers in time the voluntary passivity, the negligence, or even the maltreatment masked by the idea of accompaniment and listening. The trials of the periods of confinements to face the pandemic of the covid-19 have been revealing of the total resignation of these associations from their role and function, leaving people suffering from psychic crises and the lack of the necessary link and treatments in great difficulties, amplified by the organized fear around the pandemic and the deprivations of the fundamental liberties to move outside the authorized time.
The view of the collective
The anthropological determinants of the fundamental critique of mental health ideology
For the collective, the interoperability of mental health ideology in horizontal and vertical dimensions constitutes a major obstacle to any possibility of transforming the services that propagate it in its stigmatizing and discriminatory forms. The only way that could give a chance to put an end to this harmful propagation to the health of the society itself, is the courage to undertake intelligent and processual steps to liquidate these services, passing by the deinstallation of the set of dogmas that found the architecture of this devastating ideology, and opening another way for the repeal of the law and legislation on mental health, which has become obsolete, and which only amplifies the discrimination and dehumanization. Likewise, this cognitive enterprise also concerns the urgency of disintegrating and invalidating pseudo-scientific and corrupted research conducted without purpose and that gravitate around this ideology, maintaining it in circulation with its related tainted notions, source of moreover the contamination of the treated and evaluated persons in their complex cognitive functioning, even in the forms of their intelligence, of mental illness, ignoring the heaviness of the context and the socio-economic environment generating the degradations of the global health, amplified also by the processes of impoverishment and exclusion. And yet, an intrusion is visibly made by the ideologists of mental health by introducing a concept without epistemic foundation to make it pass as a new mental illness: the eco-anxiety, without knowing what they are talking about3, and when they talk about it, they shelter in an intolerable reductionism to qualify it as a personal problem4.
What characterizes these ideologues, who pass themselves off as professional researchers and practitioners, is the fact that they manifest themselves in an indescribable posture hidden in projects of recovery and accompaniment, highly paternalistic and normative. In fact, they do not know what the rules of their game are with the mental and psychological processes of the people subjected to mental health approaches and intervention systems. They organize the game with these processes by organizing themselves through mechanisms of medication and criminalization of processes and behaviours deemed not to conform to the dominant and imposed norms and by the institution itself. Moreover, any possibility of regulation all of these services in order to adapt them to new realities will never be able to respond to changes in perspective as long as this same regulation carries within itself conservative loops of existing meaning. Only a willingness to change the existing paradigm could satisfy the conditions of the exit of the structural and epistemic crisis that is rooted and deployed in the mental health system, amplified by the absence of objectives and purpose, and of the culture of evaluation and meaning in this system and its networks.
Why a fundamental critique of the notion of mental health?
Health is global.
It is an issue that involves all the actors of society, institutional and non-institutional, professional and non-professional,
From the outset, the notion of mental health generates stigmatizations overloaded with heavy meanings.
It is deeply rooted in the system of social and collective representations in the Western sphere5.
Changing this system of representations is problematic.
The role of the social sciences and humanities is timid, even insignificant in the process of transforming the system of social representations of the meanings attributed to the notion of mental health so that they are domesticated in a sense of normality.
By continuing to circulate the notion of mental health and the attributions of "mental illness" without epistemological hygiene, as mental disorders, schizophrenia, bipolar, depression, anxiety, eco-anxiety, etc., these sciences and their paradigm institutionalize by force the forms of abuse and disintegration of the identities of the targeted populations by codified preconditions in erroneous diagnoses and medical-psychiatric certificates, with the complicity of the big media.
Who is the guide for?
Researchers and academics and,
In spite of the high quality publications in the university research environment in the different recognized scientific disciplines, sociology, psychology, cognitive sciences, language sciences and in the whole sphere of human sciences, we have to note the paradigmatic crisis in the functioning of the research that is articulated to the mental health problematic. This crisis is amplified by a great disinterest in fundamental research for the sake of immediate economic profitability, in order to turn to applied research, at the open borders with companies and industries that finance them within the framework of what is called partnership. This form of research in this system of partnership largely affects the independence and freedom of the researcher, presented and defended from research-innovation and recovery. While the spirit of independence and the nature of the objectives in basic research remain independent of temporal and economic constraints.
The reductionist logics that thrive in the disciplinary research community deserve to be emphasized as they strongly impede a holistic understanding of the subject matter of research in the mental health universe.
Mental health: an unidentified and ill-defined object
Whether it is treated as an object of study and research, the notion of mental health is automatically contaminated by social, clinical, legal and legislative prerequisites, amplified by the impotence of its identification as an object. The notion is overloaded with semantic attributions with heavy and disastrous consequences, not liberated or lightened from social, cultural and political meanings to inscribe it in a processual way in a language so that it is something that does not exist or as something that is similar to the health of society, economy and politics.
There is an urgent need for researchers in all fields of mental health to become aware of the fundamental error6 in the circulation of the notion of mental health and its attributes in their current forms and that it is of great scientific and human value to evolve the language of research in a perspective of rupture with that which pathologizes and maintains normative categorizations imposed by the institution and by the social and cultural order.
There is also the heavy disappointment of seeing articles from French-speaking academic sources and meetings and colloquia inundated with speeches and written performances that are compartmentalized and locked into insipid thought boxes, symptomatic of the impotence of freeing oneself from the overvalued reductionist paradigm, the bio-medical paradigm, to the detriment of anthropological and ecological determinants.
3.5.3. Education and public awareness
If every society is endowed in its cognitive structures with a complex set of social representations, more or less fixed and diffuse, concerning a set of objects with vague contours and sources of questions and meanings on the determination and orientation of their conduct, it would be risky to undertake modifications of these representations by brutal and violent mechanisms. The inscription of the notion of mental health and its derivatives in systems of social and mental representations in the sense defined by Moscovici7 is of a structuring heavily affected by negative attributes and dehumanizing meanings, amplified by narratives and media reports that pass through the big media, written, audio and visual and through the whole system and technology of communication.
It is necessary to notice forms of primitive resistance to the possibilities of modification of this system of representations as long as the media actors continue untiringly to propagate all the dehumanizing attributes treated with danger8.
Nevertheless, the pedagogical and educational necessity to introduce the learning and the knowledge of the text of the Convention of the Rights of Persons with Disabilities in the school and higher education system would be one of the major conditions in the structural change of the erroneous social representations on the world of the disability and especially in the psychosocial universe and what is understood by the mental health. Still, should we anticipate that the campaign to education and awareness on mental health could create the opposite of what is desired and expected?
"I generally think that mental health awareness is about describing mental illness as something it is not, like being the same as a broken limb; or just describing depression and no other mental health problems," a writer diagnosed with bipolar disorder9.
It is also of great importance to include in the processes of creating awareness and education public about the understanding of the anthropological determinants of mental health, the idea of destigmatizing needs, and treating or addressing them within the overall framework of comprehensive health needs without the prior intention of medication.
"Destigmatization of mental health needs is always incredibly necessary, especially when done in a culturally appropriate way. However, I don't think they are a substitute for real policy solutions. Furthermore, I find that news campaigns that do not push for policy solutions do not effectively address structural barriers to care. "10
10 The processes and procedures of public education and awareness about mental illness and mental health need to be addressed in an interactive participatory strategy that recognizes that every person is affected regardless of status and identity, and that socio-economic and ecological determinants are highly influential on overall health.
3.6.1 Importance of evaluation
3.6.2. Systemic and regular review of legislation
3.6.3. Evaluation criteria and strategies
Although the presentation of evaluation in this draft published by OHCHR and WHO focuses on the processes and procedures involved in the evaluation of the impacts and intended effects of a law or legislation concerning mental health, there are black holes that need to be filled in order to position oneself in what one wants to hear about evaluation.
Evaluation and the Meaning of Evaluation
Towards the appropriation of the Evaluation Culture
Evaluation as an approach: Evaluation is an overview
Evaluation as a step : It is the examination of a system that pursues objectives. Evaluation starts with the objectives to be achieved
This contribution is part of a framework of personal reflection nourished by quality references on the culture of evaluation as an approach and process, inherently associated with the posture of evaluating without constraint of the heaviness of the sponsors. Nevertheless, the reintroduction of the process into the evaluation process is a sine qua non for the ecological dimension to be the very essence of what is meant by the culture of evaluation in the design and implementation of the draft guidance on mental health, jointly published by the OHCHR and the WHO, leaving open windows for enriching, developing and improving it.
According to Bonniol (1997)11 , evaluation is not a play on words in a syntactic structure or system to make the opposite seem the same and the false seem true. Evaluation is first of all an issue, which by its implications creates new issues for a simple explanatory reason: it has to do with meaning because it initially has something to do with value, it is value itself.
The object of the evaluation
Its object is not what is observed in the sensible. Its real object is in the black boxes. The intelligence of evaluation or an intelligent evaluation is that which succeeds in managing heterogeneity as the object of evaluation in its complexity because it is itself a complex system dependent on complex thought, as opposed to control which is a matter of simple, analytical thought whose major function consists in bringing it into conformity with a pre-established reference framework.
Control censors meaning
Evaluation creates meaning
It is clear that there are confusions and disturbances of a methodological and conceptual nature in the mixture of two different logics:
1) Control logic
2) Logic of evaluation
The distinction between these two logics is an inescapable requirement in order to agree on what evaluation means.
In the first case, the logic of control consists in bringing a system (mental health or psychiatric institution and its users) into conformity with a pre-established system of norms, supported by a law in force and reinforced by internal regulations.
The function of control
The purpose of control in the mental health system is to homogenize people through the mechanism of a codified and sustained language in order to inscribe and situate them in the same abstract normative reference. It is a logic of suffocation and categorization. Control is a matter of simple thought.
In the second case, the logic of evaluation is complex thinking, it is not reduced to measurement techniques and the identification of the gap between results and objectives. It is an overview that creates meaning.
The function of Evaluation
It is fundamentally accepted in all approaches and steps in evaluation that Daniel Sttuflebeam's (1971)12 famous basic definition, "Evaluate is not to prove but to improve," was a catalyst for the proliferation of conceptions with practical implications that broke with the logic of control. Here, the radical demarcation from the concept of control is of an epistemological order and of a vision well exposed in the scientific and intellectual productions of high quality.
To evaluate is to distinguish
To evaluate is to distinguish a unit in the psychosocial, educational, economic, sanitary situation, etc. Then it is to identify the meaning that is recognized in this unit13.
Why is the meaning of evaluation meets resistance in mental health services?
Nothing is easier than to immediately perceive the confusion between control and evaluation, and the assimilation of the latter to the control paradigm.
The fear of evaluation in its original sense can only be explained by the power of Top-Down logics that do not admit a feedback that generates questioning and interrogations. In the same way, trust is banished in the questioning of the citizen attending mental health services. "The problem is that the French culture of crisis is fundamentally outdated. We are immersed in a kind of royal culture that banishes questioning, the unexpected openness and trust towards the citizen. We work within solidly fenced-in fields, sheltered We work within solidly defined fields, protected by demarcation lines that block cooperation and initiatives - but are the breeding ground for crises. "14
It is clear that the mental health system is viscerally impervious to the admission of even the slightest criticism of its foundations and objectives. As soon as the crisis begins to hit, these actors have already catapulted themselves into the stratosphere of irrationality. Moreover, all health services, whether public or private, are directly controlled by heavy bureaucratic structures, which protocolize relations with patients, whatever the degree and nature of their health needs, in the name of a so-called health democracy, which is only a set of procedures and management techniques to satisfy profitability and economy objectives. These are Regional Health Agencies.
The collective proposes:
Instead of :
Mental disorders: put uncontrolled cognitive processes - Instability of cognitions / mental functioning.
People with disabilities : People with special needs states.
Mental health: states of cognition / states of mind/
Mental Illness: Cognitive difficulties - undefined or unidentified cognitive or mental states
The collective really perceives and on the basis of these experiences that the real actors who are able to produce evaluations with original spatio-temporal meanings are the persons concerned who pass through the psychiatric services and its mental health aftemath15. Unfortunately, the institutional actors are not yet prepared to recognize the contribution of those concerned. The scope of the draft of the orientation on mental health elaborated jointly by the OHCHR and the WHO, by valuing contributory comments, could in its realization, contribute to value their contributions, visibly perceived and identified in their codified testimonies and put on line on communication networks without constraints and independently of the influences and pressures of the institutions and of some bureaucratic associations. It would be a step of justice and reparation to the forms of injustice and mistreatment that have been inflicted on them, committed in the practices of infantilization, deprivation of fundamental freedoms and their multiple identity, reduced to a dehumanizing designation of mentally disorders people and dangerous behaviors and conducts.
The collective thanks all the members of the OHCHR and WHO who left windows open for contributors to leave their comments and help enrich the draft.
- Orientation – Project – Guidance -Comment - Contribution - Right - Language - Epistemology – Transformation – Evaluation – Control – System – Representation – Paradigm – Research – Actor – Awareness – Education – Ecology – Deinstallation – Language - Legislation
1. Convention relative aux Droits des Personnes Handicapées des Nations-Unies. https://www.ohchr.org/fr/instruments-mechanisms/instruments/convention-rights-persons-disabilities
2. Call for inputs: Draft guidance on Mental Health, Human Rights, and Legislation published jointly by WHO and OHCHR. (2022). https://www.ohchr.org/en/calls-for-input/calls-input/draft-guidance-mental-health-human-rights-legislation-who-ohchr
3. Eco-anxiété : analyse d’une angoisse contemporaine. (02/11/2021). https://www.jean-jaures.org/publication/eco-anxiete-analyse-dune-angoisse-contemporaine/
4. Déprimé par la crise climatique ? Voici comment soigner l’éco-anxiété. (04/12/2019). https://reporterre.net/Deprime-par-la-crise-climatique-Voici-comment-soigner-l-eco-anxiete
5. Jodelet, D. (1989). Folies et représentations sociales. Paris, PUF.
6. Lee Ross, The intuitive psychologist and his shortcomings: Distortions in the attribution process, New York, Academic Press, 1977
7. Moscovi. S. (1961/197. La Psychanalyse, son image et son public. PUF.
8. Comment la presse parle-t-elle de la schizophrénie ? (2021). https://sms.hypotheses.org/26292
9. Colette Shade. The Problem With Mental Health Awareness. (25/01/2021). (Consulté 28/08/2022). https://www.thenation.com/article/society/mental-health-awareness/
10. Colette Shade. The Problem With Mental Health Awareness. (25/01/2021). (Consulté 28/08/2022). https://www.thenation.com/article/society/mental-health-awareness/
11. Bonniol.J.J. (1997). Les modèles de l'évaluation : textes fondateurs. Bruxelles. De Boeck université.
12. Daniel L. Stufflebeam. (1971). Educational Evaluation & Decision Making. F. E. Peacock Publishers.
13. Ralph Linton (1945). The Cultural Background of Personality, New-York, D. Appleton. Trad. Le Fondement culturel de la personnalité, Paris : Dunod, 1977.
14. Rapport de la mission d'évaluation et d'expertise de la veille sanitaire en France (2006).
15. Quand les patients notent l’hôpital. (30/07/2015).