[Norsk]

Norway violates it's human rights obligation to reduce and remove coercion in psychiatry

To: Ministry of Health and Care Services (ref. 2014/4257), Prime Minister of Norway (ref. 2015/815), Directorate of Health (ref: 2012/9562), Ministry of Children, Equality and Social Inclusion (ref. 2015/2134, ref. 2013/4343), Ministry of Foreign Affairs (ref. 2014/6998, ref. 11/05400), Ministry of Justice, President of parliament Storting

Compared with other European countries, Norway ranks the highest when it comes to the use of compulsory” treatment according to Mental Health Act (1). «The truth is that Norway has a long tradition of extensive use of compulsory admissions and has been a world leader in use of this kind of force in ‘psychiatry’.» (5)

Norway has ratified UN Conventions Covenant on Civil and Political Rights (CCPR), Convention against Torture (CAT), International Covenant on Economic, Social and Cultural Rights (CESCR), Convention on the Rights of Persons with Disabilities (CRPD) as 130. state and is therefore obliged to respect these human rights conventions. These Conventions touch coercion in psychiatry.

Norway writes reports and UN committees give concluding observations and if necessary follow-ups to assure compliance.

The Human Rights Committee (CCPR), Committee on Economic, Social and Cultural Rights (CESCR), Committee against Torture (CAT), Committee on the Rights of Persons with Disabilities (CRPD) and Universal Periodic Review have criticised Norway because of coercion in psychiatry.


Convention

Year/ document

Excerpts of contents

International Covenant on Civil and Political Rights (CCPR)

2011 CCPR/C/NOR/CO/6

"The State party should take concrete steps to put an end to the unjustified use of coercive force and restraint of psychiatric patients... Furthermore, the State party should strengthen its monitoring and reporting system of mental health - care institutions so as to prevent abuses” (2).

Convention against Torture (CAT)

2012 CAT/C/NOR/CO/6-7

The Committee “ remains concerned at the widespread use of restraints and other coercive methods in psychiatric institutions, as well as at the lack of available statistical data, including on the administration of electroconvulsive treatment (ECT)... The Committee is concerned that the provisions of the Mental Health Care Act, allowing for compulsory admission and treatment on the basis of either the “treatment criterion” or the “danger criterion”, leave the possibility for wide discretionary decisions to such an extent that it might lead to arbitrary and unwarranted practice(arts. 2 and 16).” (2).

International Covenant on Economic, Social and Cultural Rights (CESCR)

2013 E/C.12/NOR/CO/5

The Committee “recommends that the State party amend the Mental Health Act to introduce stricter procedural requirements to ensure that persons with psychosocial disabilities have adequate legal protection against the use of coercion. It also recommends that the State party incorporate into the law the abolition of the use of restraint and the enforced administration of intrusive and irreversible treatments such as neuroleptic drugs and electroconvulsive therapy” (2). Forced medication and use of restraint must stopp (3).

Universal Periodic Review

07.07.2014 A/HRC/27/3

27. New Zealand encouraged Norway to move to full implementation of CRPD, particularly regarding the use of coercion in mental health care

131.167 Ensure that criteria for compulsory treatment and detention in legislation and in practice are non-discriminatory and focused on safety, and remove any criteria referring to disability or “serious mental disorder”

International Covenant on Civil and Political Rights, follow-up from 2011 (3)

01.12.2014

The Committee requires (“information not yet provided”): «(a) the impact of the national strategy to end the unjustified use of coercive force and restrain of psychiatric patients»

Follow up 6. August 2015: “The Committee regrets that the State party has not implemented the Committee's recommendation to end the unjustified use of coercive force and restraint of psychiatric patients.”

Convention on the Rights of Persons with Disabilities (CRPD)

2. June 2015 CRPD/C/NOR/1

Norway has send a draft of its report to consult civil society. The state claims that laws satisfy CRPD. My contribution shows that this is wrong: «Helsedepartementets 9-årige kamp mot menneskerettigheter for personer med nedsatt psykososial funksjonsevne: Menneskerettsbrudd tvangsmedisinering, tvungen elektrosjokk og beltelegging må forbys med lov»

Committee against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, List of issues CAT/C/NOR/QPR/8

Due 2016

Please indicate:

(a) “Whether the use of restraints and the enforced administration of intrusive and irreversible treatments such as neuroleptic drugs and electroconvulsive therapy has been abolished in law...

(b) Ensuring that every competent patient, whether voluntary or involuntary, is fully informed about the treatment to be prescribed and given the opportunity to refuse treatment or any other medical intervention...

(c) Whether the Mental Health Act has been amended to introduce stricter procedural requirements to ensure adequate legal protection against the use of coercion for persons with psycho-social disabilities and whether there has been a decrease in the use of restraints and other coercive methods in psychiatric institutions during the period under consideration.”

In General Comment 1 premiss 42 the CRPD-Committee states:

As has been stated by the Committee in several concluding observations, forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the rights to personal integrity (art. 17); freedom from torture (art. 15); and freedom from violence, exploitation and abuse (art. 16).”
The United Nations Special Rapporteurs on the rights of persons with disabilities, Catalina Devandas-Aguilar, and on the right to health, Dainius Pûras, today called on States to eradicate all forms of non-consensual psychiatric treatment.

Speaking ahead of the World Mental Health Day (8 October 2015), the independent experts urged Governments to put an end to arbitrary detention, forced institutionalisation and forced treatment, in order to ensure that persons with developmental and psychosocial disabilities are treated with dignity and their human rights respected.

- See more at: http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=16583&LangID=E#sthash.03nsrBRU.dpuf

2013 the Mental Disability Advocacy Center called on Norway to withdraw reservations and Norwegian Equality and Anti-discrimination Ombudsman 19. December 2013 concludes that Norway violates human rights.
In addition the Human Rights Commissioner of the Council of Europe criticised Norway and demanded to reduce drastically coercion in psychiatry. In some countries you can protect yourself against coercion with an advance medical directive.
For 15 years Norway tried to reduce coercion, but the result was an increase with one third.
NORWAY MUST FULLY RESPECT RIGHTS OF PEOPLE WITH DISABILITIES, says the Council of Europe Commissioner for Human Rights, Nils Muižnieks (4)
Does it help to write to the Norwegian Prime Minister or is it necessary to start a campaign?
The Norwegian press does not inform about these problems and none of my letters to the editor were published.
The Human Rights Commissioner, Council of Europe and Mental Disability Advocacy Center have been informed that it is useless to write to Norwegian authorities about their human right obligations.
WSOs declaration during «27th Human Rights Council 18 September 2014» is still actual: «We note with concern that the Norwegian Government has no plans to make changes in legislation with regard to mental health detention and forced treatment» (6).
The UN Working Group on Arbitrary Detention, the UN Special Rapporteur on the Rights of Persons with Disabilities and the UN Special Rapporteur on the right to Health have made 30. January 2017 public an Urgent Appeal to Norway to discontinue forced treatment and hospitalization (7).
The appeal is based on the International Covenant on Civil and Political Rights (CCPR), the Convention against Torture (CAT), the International Covenant on Economic, Social and Cultural Rights (CESCR) and the Convention on the Rights of Persons with Disabilities (CRPD). These provisions impose an immediate obligation om the States to immediately discontinue these practices of forced treatment/hospitalization and reform laws allowing for deprivation of liberty and forced treatment on the basis of disabilities by replacing these practices with services in that meet needs expressed by persons with disabilities and respect the autonomy, choices, dignity and privacy. While awaiting a reply, we urge that all necessary interim measures to be taken to halt the alleged violations and prevent there re-occurance...
Compliance with the Convention Against Torture: Testing Nordic Exceptionalism” analyses COs on four Nordic and four comparator states over two decades, looking specifically at two issues: the definition of torture in law and detention conditions. Our findings suggest that the Committee increasingly subjects Nordic states to scrutiny, revealing differences between these states, particular causes for concern and, sometimes, frustration at refusal to heed recurring calls for reform.
Norway has ignored its human rights obligations for many years. Is the Norwegian state cruel, inhuman and allows degrading treatment?
This situation is unacceptable for a country such as Norway, which has a global reputation promoting and protecting human rights.
Walter Keim, Rindal (Norway)
10. July 2015

Copy: Equality and Anti-discrimination Ombudsman (LDO), national supervision of the Convention on the Rights of Persons with Disabilities (CRPD), Mental Disability Advocacy Center (MDAC), Norwegian Federation of Organizations of Disabled People (FFO)
References:
  1. Compulsory Mental Health Care in Norway: A Study of the Interface between the Law and Psychiatry. Rigmor Randi Diseth cand.jur. (2013) https://www.duo.uio.no/bitstream/handle/10852/35828/dravhandling-diseth.pdf
  2. Reporting status for Norway for all Conventions: http://tbinternet.ohchr.org/_layouts/TreatyBodyExternal/Countries.aspx?CountryCode=NOR&Lang=EN
  3. LDO (Equality and Anti-discrimination Ombudsman) 19. des 2013: Norway violates human rights (“Norge bryter menneskerettighetene”):  http://www.ldo.no/no/ombudet/Aktuelt/Nyheter/Arkiv/Featured-news/Norge-bryter-menneskerettighetene/
  4. NORWAY MUST FULLY RESPECT RIGHTS OF PEOPLE WITH DISABILITIES, SAYS the Council of Europe Commissioner for Human Rights, Nils Muižnieks: http://www.mdac.info/en/news/norway-must-fully-respect-rights-people-disabilities-says-muiznieks
  5. Arnulf Kolstad, Haldis Hjort, Einar Kringlen. Letters to the Editor on Norwegian psychiatry. History of Psychiatry, SAGE Publications (UK and US), 2005, 16 (2), pp.247-256. <10.1177/0957154X05054860>. <hal-00570827> https://hal.archives-ouvertes.fr/hal-00570827
  6. WSOs declaration 27. September 2014: http://www.upr-info.org/sites/default/files/document/norway/session_19_-_april_2014/wnusp_oral_statement_norway_2014.pdf
  7. 30. Janury 2017: UN Working Group on Arbitrary Detention, Special Rapporteur on Rights of Persons with Disabilities, Special Rapporteur on Health issue Urgent Appeal to Norway on forced treatment/hospitalization (ref. UA Norway 1/2017): https://spcommreports.ohchr.org/TMResultsBase/DownLoadPublicCommunicationFile?gId=22955



PS: The Mental Disability Advocacy Center suggests to write a letter based on the Commissioner for Human Rights report to the Norwegian Prime Minister. Support this petition with your signature :



Dear Prime Minister/ Your Excellency,

I am writing to express my concern regarding ongoing violations of rights that people with disabilities in Norway. Following the visit in your country of Nils Muižnieks, the Commissioner for Human Rights of the Council of Europe, I understand that such violations are still common.
It has been brought to my attention by the Mental Disability Advocacy Center that thousands of people with disabilities are denied the right to make decisions in their lives, even in such personal matters as marriage, adoption, abortion, sterilisation, medical treatment, and the acquisition of a passport. Thousands of others are forcibly detained, subjected to forced treatment, isolated and restrained.
This situation is unacceptable for a country such as Norway, which has a global reputation promoting and protecting human rights.
I support the call for Norway to withdraw its reservations to the UN Convention on the Rights of Persons with Disabilities .

With high consideration,





[Patients rights]