Debate, article: How long will the well-intentioned guardian state continue legitimizing torture in psychiatry?
Sorry for poor quality of this Google translation:
NO-6657 Rindal, 31. January 2017
Letter to Professor Jan Ivar Røssberg, University Oslo
Copy: Robert Whitaker, Jaakko Seikkula, Humania STIFTELSEN, Medisinfrie Tilbud, Knowledge centre (Kunnskapssenteret), Experience expertise (Erfaringskompetanse), Health institute (Folkehelseinstituttet), Drug administration (Legemiddelverket)
I refer to the contribution of Jan Ivar Røssberg: «Psychiatric wards without medication: Why is it a bad idea?» conference at Litteraturhuset 8. February kl 17-21 about What is the scientific basis of treatment with or without neuroleptics? of the Humania STIFTELSEN.
As part of the realisation of "patients health service" the ministry of health gave the assignment for «Medication free treatment for psychiatric patients».
Norwegian psychiatric association has not taken position but some psychiatrists criticised the offer as unethical, without evidence an experiment and call it a "gigantic mistake" (see Health minister makes totally wrong choices).
Patients meet the following reality:
Many get not healthy even after many years medication
In fact patients with schizophrenia live 20 years shorter then other people. Nearly all are treated with antipsychotics. (see Responding to the Catastrophic Reduction of Psychiatric Patients’ Life Expectancy, a keynote at WPA XVII World Congress of Psychiatry Berlin 2017)
«Patients and health personnel have different opinions if medicine is necessary. One of the discussions between patients and health personnel is if medicine is necessary for treatment. Normally health personnel holds the opinion that a patient must use neuroleptics, but the patient does not want it.» (Experience expertise 2012:3. Force in Health care. Personnel and dissatisfied patients have different opinions)
Forced treatment can be experienced as trauma, retraumatisation and abuse. «Patient experiences show that forced treatment is experienced as strong traumatic abuse» (Health directorate: Kontroll av tvangsbruk i psykisk helsevern i 2015). The report of Sivilombudsmanns unit for prevention of torture, Kristiansand 7.-9. September 2015 says: “Most patients under forced medication had negative experience e. g. described as «terrible», «cruelly», and «torture».”
«Surveys (see Hammervold, 2009 and Wynn, 2004) show that ”patients experience of physical restrains is characterised of health systems power and patients vulnerability with feelings of powerlessness, loneliness, fear and retraumatisation” (Norvoll og Husum, 2011, s. 23). For those who have experienced abuse earlier, physical restrains may result in very negative consequences not the positive effect, health personnel expects.» (Experience expertise 2012:3. Force in Health care. Personnel and dissatisfied patients have different opinions)
Approx. two third of patients file complaints against forced treatment
There are few alternatives: basically the choice to take medicine voluntarily or forced medication
From a patients perspective questions are:
Patients are interested to become healthy which is best shown by «Number (of patients) Needed to Treat», value 1 meaning that all patients become healthy. Paulsrud committee concluded:
Chapter 9.2.1 Effect on acute psychotic symptoms: «Number of patients to be treated for one extra patient to become better (Number Needed to Treat), from 5 to 10».
Chapter 9.2.2 Effect of maintenance treatment: A meta-analysis of studies comparing effects of second generation antipsychotics and placebo, concludes that the danger of med at danger for relapse is reduced by approx 25 percent. That means that one can prevent one relapse for four patients that are treated for one or two years.»
Compulsory psychiatric care outside hospital (TUD) is used much. According to Zinkler, Martin: Risikobasierte Allgemeinpsychiatrie : Wirkungen und Nebenwirkungen.Recht & Psychiatrie Jg. 32, 2014, Nr. 2, S. 64-68 : Tab., Lit. (2014) 85 patients have to be treated to prevent one hospitalisation.
Are there other research results, which grantee that the law requirement of high probability of positive effect is reached?
After Paulsrud committees report in 2011 the Council of Evidence-based Psychiatry was founded 2014 with focus «recovery» and new research on long-time effects:
The Council of Evidence-based Psychiatry has given us new knowledge about effects of psychiatric drugs. Recently the Norwegian Psychological Magazin (Tidsskrift for Norsk Psykologforening, Vol 52, nummer 2, 2015, side 126-131) has published an interview with Robert Whitaker. Harrow (4.2, 4.5) showed that the long term recovery rate increases from 5% to 50% after 15 years removing continuous antipsychotic longtime medication. «Relapse after withdrawal of antipsychotic medication is (also) an effect of withdrawal not (just) an effect of sickness (psychosis).» Professor Peter C. Gøtzsche Director of the Nordic Cochrane Centre is publishing books, newspaper articles and gives interviews available also for social media informing about harm done by antipsychotic medication (4.3, 4.4).
Wunderinks randomised studies confirm these results (4.7). «Open dialogue» therapy method uses minimal medication and can reach 80% «revovery» (improvement which allows to come back to family and job) (4.7).
How see critics long term effects and these studies?
5 UN committees (5) have criticised that Norway has violated its human rights commitments because of the highest use of forces treatment in Europe. The Special Rapporteur on Torture Juan E Méndez said 4. March 2013: "States should impose an absolute ban on all forced and non-consensual medical interventions...»
Is there scientific documentation that positive effects of forced medication are so obvious that the «absolute ban» of the Special Rapporteur on Torture is superseded?
Why continues forced medication for patients telling that force medication is experienced «terrible», «cruelly», and «torture».”?
15 years with intentions and programs to reduce forced treatment failed. What can be done? There are experiences of forced treatment banned: Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience. What is the reaction of critics of medication free treatment?
Attachment: Experience expertise 2012:3 (Erfaringskompetanse.no 2012:3). Force in Health care. Personnel and dissatisfied patients have different opinions (Tvang i psykisk helsevern. Ansatte og misfornøyde brukeres ulike oppfatninger): http://www.erfaringskompetanse.no/wp-content/uploads/2015/08/Tvang-i-psykisk-helsevern.pdf
UN committees the UN Special Rapporteur on Torture strongly support the patients perspective. Real world experience shows that it is possible to abolish forced treatment. Survivors arguments are supported by the CRPD Committees answer.
5 UN committees (5), Human Rights Commissioner of the Council of Europe, Mental Disability Advocacy Center (MDAC), Ombud against discrimination (LDO), Directorate of Health, Disability organisation support reduction and removal of coercion.
Committee on Economic, Social and Cultural Rights recommends 2013. " 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"
Committee against Torture 13 December 2012 CAT/C/NOR/CO/6-7:
(T)he State party should provide systematic, thorough and practical training in the application of the Istanbul Protocol (Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment) to all relevant health personnel.
The UN Committee against Torture (CAT/C/NOR/QPR/8) asks Norway 2015 preparing Norway’s report for 2016:
(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... ”
In General Comment 1 premise 42 the CRPD-committee states about force in psychiatry:
“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).”
Page 5 of the speech of Special Rapporteur on Torture Juan E Méndez in 22. meeting of the "Human Rights Council" 4. March 2013: "States should impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs, for both long- and short- term application. The obligation to end forced psychiatric interventions based on grounds of disability is of immediate application and scarce financial resources cannot justify postponement of its implementation."
Report A/HRC/22/53 of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment of 1. February 2013, Section 32: "For example, the mandate has held that the discriminatory character of forced psychiatric interventions, when committed against persons with psychosocial disabilities, satisfies both intent and purpose required under the article 1 of the Convention against Torture, notwithstanding claims of “good intentions” by medical professionals (ibid., paras. 47, 48)". Section 82.: "The prohibition of torture is one of the few absolute and non-derogable human rights, a matter of jus cogens, a peremptory norm of customary international law."
“Dignity must prevail” – An appeal to do away with non-consensual psychiatric treatment World Mental Health Day – Saturday 10 October 2015 «The concept of ‘medical necessity’ behind non-consensual placement and treatment falls short of scientific evidence and sound criteria.»
«Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience»1 shows that considerable improvements are possible. The rate of inpatients under coercive medication fall under 0.5 %. In Norway approx. 10% of inpatients where under coercive medication (SINTEF 2012)2
The survivors of psychiatry “Bundesverband Psychiatrie-BPE-Germany” asked the UN CRPD committee 19. February 2015: «Please condemn Germany as a human rights criminal. Norway uses approx. 20 times more forced medication compared to Germany. UN CRPD Committee gave concluding observations about the Federal Republic of Germany. Quotes from the States Report of the UN CRPD Committee CRPD/C/DEU/CO/1 on 17/04/2015: 3
«30. The Committee recommends that the State party take all the immediate necessary legislative, administrative and judicial measures to:
(a) Amend legislation to prohibit involuntary placement and promote alternative measures that are in keeping with articles 14, 19 and 22 of the Convention;»
“33. The Committee is deeply concerned
that the State party does not recognize the use
of physical and chemical restraints, solitary confinement and other harmful practices as acts of torture.”
Documentation of harm of antipsykotic medication and human rights issues:
4.1. Council of Evidence-based Psychiatry:http://cepuk.org/, http://cepuk.org/unrecognised-facts/long-lasting-negative-effects/
4.2. Psykofarmaka på kort og lang sikt: Tidsskrift for Norsk
Psykologforening, Vol 52, nummer 2, 2015, side 126-131:
4.3. PETER C. GØTZSCHE, professor, dr.med., Rigshospitalet: KRONIKEN
5. AUG. 2015 summarises in newspaper Politikken: Tvang i psykiatrien bør forbydes:
4.4. PETER C. GØTZSCHE, professor, dr.med., Rigshospitalet i Politikken:
'Deadly Psychiatry and Organised Denial' (2015):
4.5. The public mental health system is creating a huge class of chronic
mental patients through forcing them to take ineffective, yet extremely
harmful drugs. http://psychrights.org/Research/Digest/NLPs/neuroleptics.htm
4.6. Effective Non-Neuroleptic Treatment
4.7 Harrow + Wunderink + Open Dialogue = An Evidence-based Mandate for A New Standard of Care:
4.8. Psych-Drugs Harm - One: Robert Whitaker - A History - September 16, 2015 – CPH
4.9. Jung, E., Wiesjahn, M., Wendt, H., Bock, T., Rief, W. and Lincoln, T.M., 2016. «Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study»
Letter to Norwegian Authorities: Norway violates it's human rights obligation to reduce and remove coercion in psychiatry: http://home.broadpark.no/~wkeim/files/UN_coercion.html
16. July 2015: Shadow report: What can be done about NORWAY ranking highest in Europe in use of coercion in psychiatry including human rights breach forced drugging?http://home.broadpark.no/~wkeim/files/150716mdac.html
16. June 2015: Letter to Prime minister Erna Solberg of Norway to respect human rights of people with disabilities and remove coercion in psychiatry http://home.broadpark.no/~wkeim/files/150614pm.html
Legemiddelverket oppfordres å slutte å legitimere helseskadelig langtidsmedisinering med antipsykotika: http://home.broadpark.no/~wkeim/files/150916helsedir.html
Kjetil Lund: 23.JUN.2016 : At all tvangsmedisinering må forbys, slik også FN-komiteen under Konvensjonen om funksjonshemmedes rettigheter og andre FN-organer går inn for, er et nødvendig neste skritt. http://www.aftenposten.no/meninger/debatt/Psykiatri-Uhyggelig-klokkertro-pa-tvangsmedisinering--Ketil-Lund-580997b.html Replikk.
Martin Zinkler: Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience: http://www.mdpi.com/2075-471X/5/1/15/htm
2Døgnpasienter i psykisk helsevern for voksne (PHV) 20. november 2012, SINTEF. https://www.sintef.no/contentassets/f98d2810156e4dd6b8b7aa1da8174334/endeligrapport_sintef-a26086_2.pdf