“We are forced to be compliant, broken down, life and energy sucked from our essence. They create sedated, manageable people not fit to function”
– Saeed Dezfouli
Justice Action supports the Committee on the Rights of Persons with Disabilities campaign on the Absolute Prohibition of Forced Treatment and Involuntary Commitment. The launch of the campaign on March 29, 2016, will coincide with opening day of CRPD 15th session being held at the United Nations in Geneva.
Justice Action has highlighted this issue over many years through our work with Kerry O’Malley & Saeed Dazfouli. Forced medication undermines the CRPD (especially Articles 12, 14, 15, 17, 19, 25(d), 28), General Comment No. 1 on Article 12, and Guidelines on Article 14. Justice Action supports the CRPD Committee’s approach, which can be summed up as a paradigm shift from procedural safeguards (out-dated paradigm in mental health laws) to absolute prohibition (new paradigm in CRPD).
The United Nation’s (UN) Convention on the Rights of Persons with Disabilities (CRPD) represented a breakthrough in the development of human rights law, reaffirming the basic and inalienable human rights outlined in the Universal Declaration of Human Rights (UDHR) extend to all individuals. It provides persons with disabilities, such as mental illness, a range of fundamental rights and guarantees in all aspects of their life, including the principles of non-discrimination, autonomy, inclusion, and freedom to make their own choices. The continued forced medication of mental health consumers should be abolished as it undermines the inalienable rights outlined in the CRPD and causes physical and psychological harm to individuals.
Article 12 of the CRPD, reaffirms equal recognition before the law for all individuals and their right to access support to exercise their legal capacity. This right is often denied for people with disabilities, and replaced by substitute decision-making regimes including mental health laws and tribunals. This has resulted in individuals being deprived of their fundamental rights as outlined in the CRPD, including the right to give consent to medical treatment, the right to liberty and security, and the right to freedom from torture or inhumane punishment.
Justice Action supports the CRPD Committee’s approach to forced medication, which is a paradigm shift from procedural safeguards to absolute prohibition, to ensure the basic and inalienable rights of mental health consumers are protected.
CRPD: Forced Medication
The importance of informed consent is outlined in Article 25(d) of the CRPD and General Comment No. 1 on Article 12 (at 41). It requires all health and medical professionals to obtain free and informed consent before administering any treatment to any individual. Despite the Australian Government stating that no individual in Australia is subjected to medical/scientific experimentation without free and informed consent, this right is denied to some mental health consumers through forcible medication. A report published by Justice Action in 2015, entitled Mental Health Accountability and Chemical Restraint: Research and Recommendations, highlighted the importance of mental health consumers having a choice in the provision of their treatment to ensure greater patient involvement. The report highlighted the unequal bargaining power that currently underpins the relationship between the medical practitioner and consumer. By disagreeing with physicians and refusing treatment, “consumers run the risk of being clinically judged by psychiatrists as possessing a lack of insight.” Appallingly, this can be used as a justification for additional coercive treatment and can even result in denied release. Consequently, consumers remain fearful of opposing involuntary treatment due to the negative ramifications.
The UN General Assembly’s Report of the Working Group on Arbitrary Detention similarly advocates for the abolition of forced medication. It instructs judges to apply absolute prohibition of “involuntary committal or internment on the grounds of the existence of an impairment or perceived impairment” (Principle 20, Guideline 20). The report outlines the state’s responsibility to protect people with disabilities from violence, abuse, and ill treatment, and reaffirms the importance of informed consent when administering medical treatment to mental health consumers.
Furthermore, the forcible medication of individuals is abusive and a cruel, inhumane treatment, with individuals deprived of their right to security and liberty. These concepts are also addressed in the CRPD (Articles 14-17). Justice Action works with numerous individuals who are forcibly medicated, and the experiences of these individuals highlight the inhumane and abusive nature of such practices. Saeed Dezfouli is one such forensic patient who has been subjected to forced medication since 2002, often being restrained seven nurses when being injected. On describing his experiences Saeed has stated; “We are forced to be compliant, broken down, life and energy sucked from our essence. They create sedated, manageable people not fit to function.” These experiences highlight the cruel and inhumane treatment and abuse that occurs during forcible medication, its violation of the CRPD (Articles 14-17), and the need for the absolute prohibition of such practices.
Harm Caused by Forced Medication
The use of forced medication if often justified as a response to the personal harm a mental health consumer may inflict of himself/herself. However, consideration is not given to the damaging consequences of forcible medication.
Treatments for mental health consumers often result in a variety of negative physiological side effects. Forcibly medicated individuals are unable to refuse treatment and are thus subject to these side effects. For example, the anti-psychotic medication Clozapine is an effective anti-schizophrenic, however it can cause side effects including weight-gain, drooling, constipation, muscle stiffness, sedation, tremors, and hyperglycaemia (high blood sugar levels). These side effects can lead to other health problems including diabetes and obesity, further increasing the harm experienced by forcibly medicated mental health consumers. Justice Action has received a large number of complaints regarding the physical side effects caused by medication they are forced to take. Speaking to Justice Action of her experiences under a Community Treatment Order, Kerry O’Malley stated the medication she was forced to take caused bleeding and a significant lack of energy.
Justice Action also published a report analysing studies relating to forced medication to determine its effects on personal harm. Studies demonstrated that forcibly medicating patients was connected with psychological discomfort, anger, panic, and sadness in patients, significantly impacting their personal well-being. A Scandinavian study by Kaltiala-Reino, Laippala, & Salokangas also noted the negative psychological effects of forced medication, stating "coercive treatment arouses negative feelings in the patient, creates negative expectations about the outcome of treatment, and fails to result in a trusting relationship between the patient and the professionals" (p. 318). In other studies, violent or non-compliant patients were subjected to seclusion techniques as punishment. This resulted in patient’s humiliation and social alienation, further impacting their psychological and social well-being.
The use of chemical restraints (sedatives) in forcible medication practices can have disabling effects that mimic symptoms of mental illnesses, leading to medical officers to reaffirm their diagnosis and continued forced medication. The repeated and long term forced medication also causes the individual to become submissive to the coercion and accepting of the practice as an unavoidable part of life. This increases the risk the individual will not be a meaningful contributor to society upon release, but a chronic mental health patient. This side effect is a direct violation of the Article 26 of the CRPD – the right to rehabilitation and habilitation. As mentioned, the practice of forced medication does not provide mental health consumers with the ability to be rehabilitated and return to the community as a functioning individual.
Forced medication seriously offends both international and domestic law. Mental health patients possess the same fundamental human rights as all other individuals. Article 12 of CRPD reinforces that all persons with disabilities are equal before the law. Despite this, the aforementioned evidence highlights the denial of legal capacity to persons with disabilities by undermining their fundamental right to liberty. As such, there is an urgent need for change in the administration of treatment for mental health consumers, as they are unjustly impacted by the broad discretionary power allowing physicians to force vulnerable patients to take medication, as they deem appropriate. Coercive medication removes choice, freedom and patient involvement within the mental health system, leaving open the potential for abuse of trust by physicians. Justice Action supports an absolute prohibition on forced medication. The abolition of this practice would instil greater agency upon consumers, significantly reduce the opportunity for physicians to exploit vulnerable patients, and drastically improve the well-being and outcomes for mental health consumers.