25 March 2014

World psychiatry and accountability for human rights violations

In the first of this trilogy of blog posts on torture in healthcare I criticised leading psychiatrists’ calls for a hierarchy of human rights for people with ‘mental disorders’. I discussed how psychiatry needs to accept the right to community living with supports as part of reshaping the public mental health landscape in the second post. In this final part I argue that the psychiatric community must be prepared to recognise human rights abuses among its professionals and propose the use of restorative justice principles to deal with the problem.

The series is based on a chapter I wrote in ‘Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture’s 2013 Thematic Report’. You can read my chapter here, from page 247.

The World Psychiatric Association’s former president Mario Maj acknowledges that people with mental health problems, “have been and are neglected or abused in public mental hospitals and in a range of private institutions, and sometimes also in community facilities or in their home.”[1] The use of the passive voice introduces fuzziness in causation: who did what and why? The statement “Some psychiatrists cause harm to people” is as uncontroversial as “Some police officers cause harm to people.

There are two ways in which the Movement for Global Mental Health could make progress on accountability.

First, as Amartya Sen says, “Silence is a powerful enemy of social justice.”[2] The Movement should speak out against human rights violations. It needs to start naming these abuses as torture where that word is justified.

If the World Psychiatric Association is not willing to demand that psychiatric associations regulate and discipline their members properly, those representing the more progressive Movement should step up to the mark. Any democratic society needs doctors to behave ethically and lawfully. Mechanisms to enforce standards need to be effective and they need to be used.

The Movement could call for state-paid independent advocacy to prevent abuses and represent people when abuses take place. The Movement could work with bar associations to ensure that people with mental heath diagnoses can access justice on an equal basis with others. 

Second, the Movement could usefully borrow from restorative justice some guiding principles on how to establish a process of accountability that focuses on the harm done and engages those most involved. The process should give survivors of psychiatric injustice an opportunity to tell their stories, be listened to, and be asked about what needs to be done to prevent future human rights violations. This could be carried out within a framework of values that “include the need to heal the hurts that have been felt.”[3]

Words can be more powerful than pills. Used in a smart way, words can demonstrate human rights readiness.

Many psychiatrists do wonderful work and are human rights champions. But there are others who have harmed people and acquiesced in human rights abuses. They have enjoyed immunity from punishment and prosecution, shielded by unjust laws and malfunctioning redress mechanisms.

Recognition of wrongs is introspective and painful, but the wrongs carried out in the name of medicine demand such humility and thought, whatever the level of awkwardness may be.


[1] Mario Maj, The Rights of People With Mental Disorders: WPA Perspective, 378 The Lancet 1534-1535 (2011).

[2] Amartya Sen, The Idea of Justice (2009).

[3] John Braithwaite, Restorative Justice and Responsive Regulation vii (2002).