A couple of weeks ago a tribunal in the UK decided that Ian Brady – probably the country’s most famous living killer – should remain in a high-security psychiatric hospital, rather than being sent to a prison as he wanted. Brady’s lawyers argued that he did not have paranoid schizophrenia, and had never been mentally ill since he was jailed for life in 1966. The outcome of the case was that he has to stay in hospital – no surprise there. What I want to concentrate on in this blog post is a miniscule detail of the case.

Last week we launched our summer appeal, asking for your support to enable us to continue to challenge abuses in eastern Europe. Our appeal was launched the while we had several lawyers from Bulgaria, Czech Republic and Moldova in our office. With top anti-torture lawyer Phillippa Kaufman QC, we were training them on how to challenge ill-treatment through the courts. The training was funded through a $7,500 grant from the UN Voluntary Fund for Victims of Torture. This is significant in itself, because it demonstrates that this ‘mainstream’ human rights fund now fully recognises that people with disabilities can face discriminatory torture and ill-treatment.

In the Moldovan mental health system, voluntary means involuntary, consent means coercion, yes means no, and a safeguard means a rubber stamp. Reducing law into formalistic fiction creates an environment where healthcare staff mistreat patients to such an extent that some instances amount to torture. The new Moldovan government needs to abandon the focus on hospitals and instead ensure that law underpins autonomy, that budgets are oriented towards community-based supports, and that people with disabilities participate in monitoring human rights.

Psychiatry, religion and culture all assert considerable power over individuals. A human rights approach can rebalance this power. I want to address the question: should the law allow someone to consent to what she believes to be a cure, but what others consider to be “inhuman or degrading treatment” which is banned under international law?

Traditional and spiritual healers deliver the bulk of mental health ‘services’ in Nigeria, Africa’s most populous country. They profit from the populist belief that madness is caused by demonic possession. As a result people labelled as mad are hyper-stigmatised and families urgently want to rid the devil from their afflicted relative. Within this delusional belief system, beatings, lashings, burnings and rapes drive out the evil spirits. The colonial lunacy law provides precisely zero protections against arbitrary internment, chemical and physical restraints, and non-consensual electroshock in psychiatric hospitals. The tiny amount of psychiatrists are hospital-based and overstretched. Mental health services are largely absent from primary healthcare, save in some EU-funded pilot projects. Both the psychiatric and the traditional healing industries are unregulated, unmonitored and susceptible to corruption. Ill-treatment is carried out with impunity because perpetrators are never punished.