MDAC, diritto di voto e Commissione di Venezia


La Commissione di Venezia ha adottato la propria Dichiarazione Interpretativa alla sua 84esima
Sessione plenaria del 15-16 ottobre 2010 con un contenuto chiaramente discriminatorio
secondo il quale:

Nessuna persona con disabilità può essere escluso dal diritto di voto attivo o passivo
per l'elezione sulla base della sua incapacità fisica e/o mentale, a meno che
la privazione del diritto di voto e di essere eletti non sia imposto da una
decisione individuale di una corte di giustizia, a causa della comprovata disabilità mentale.

Il 25 febbraio 2011, l' MDAC ha presentato una lettera ed ha chiesto alla
Commissione di Venezia di esporre la propria politica sui diritti di voto delle persone con disabilità
in linea con il diritto internazionale esistente.

Portando tre pagine di argomentazioni e pareri legali, l' MDAC ha indicato il motivo per cui la Commissione di Venezia dovrebbe rivedere la sua Dichiarazione Interpretativa, presentando la legge, la politica e le asserzioni del Consiglio Europeo che sostengono l' idea che, il diritto di voto e di eleggibilità è applicato a tutti senza discriminazione, compresi a coloro che presentano qualche disabilità intellettiva e psico-sociali (di salute mentale). Il parere legale ha sottolineato che la maggior parte degli Stati membri del Consiglio Europeo hanno ratificato o firmato la Convenzione ONU sui diritti delle persone con disabilità (CRPD). La Convenzione è stata ratificata anche dall'Unione Europea. L'articolo 29 della Convenzione prevede  il diritto alla partecipazione politica, incluso il diritto di voto e di eleggibilità, per tutti gli adulti con disabilità, senza eccezioni.

Nel mese di aprile 2011, abbiamo ricevuto una risposta da parte della Commissione di Venezia, secondo cui è stato previsto di rivedere e revisionare il paragrafo attinente alle prossime riunioni della  Commissione (Venezia, 16-18 giugno 2011). Il paragrafo riveduto e proposto reciterebbe  quanto segue:

Il suffragio universale è un principio fondamentale del Patrimonio Elettorale europeo. Persone con  disabilità non possono essere discriminate a questo riguardo. Ciononostante, un tribunale con una sua decisione individuale, può decidere,in mancanza di un giudizio di adeguatezza riguardo ad una persona disabile, di impedirgli di esercitare il proprio diritto di voto o di candidarsi alle elezioni.

Secondo la Commissione di Venezia, la Dichiarazione interpretativa è in
conformità con gli strumenti internazionali pertinenti e della giurisprudenza. Dicono
che l'art CRPD 29 non prevede un diritto assoluto. Il giudizio della Corte Europea dei Diritti dell'uomo nel caso di Kiss contro l'Ungheria, chiede decisioni individuali in materia di privazione del diritto di votare sulla base della disabilità mentale e perciò non preclude tale privazione. Per quanto riguarda la Commissione, la Dichiarazione interpretativa si basa sul principio chiave del suffragio universale, in quanto parte del Patrimonio Elettorale Europeo, ed è pienamente applicabile a persone con disabilità, senza alcuna discriminazione.

Nelle sue osservazioni conclusive in merito alla Tunisia, il Comitato sui diritti
delle persone con disabilità, alla sua quinta sessione, ha raccomandato l'urgente
adozione di misure legislative per garantire il diritto delle persone con
disabilità, comprese le persone che sono attualmente sotto tutela o
amministrazione fiduciaria, a poter esercitare il loro diritto di voto e di partecipare alla vita pubblica
sulla base di eguaglianza con gli altri.

La posizione di MDAC è che il lavoro della Commissione di Venezia è minato da una chiara
lettura erronea del diritto internazionale dei diritti umani. Il suffragio universale si applica a
tutti, a prescindere di abilità o disabilità e la Commissione di Venezia dovrebbe
adottare un documento modificato in base all'interpretazione CRPD della Commissione
sui Diritti delle Persone con Disabilità.

MDAC vorrebbe organizzare un pre-evento a Venezia (Italia) il 15 giugno 2011 per influenzare il lavoro della Commissione di Venezia sul diritto di voto delle persone con
disabilità. Stiamo progettando di far arrivare un invito a tutti i membri della Commissione di Venezia per il pre-evento, dove noi difenderemo il suffragio universale per tutte le persone senza alcuna discriminazione. Abbiamo anche in programma di organizzare una protesta con la partecipazione delle persone con disabilità, DPO e ONG. 

European MadPride 2011 - Disegno n° 2

Beyond the walls: Deinstitionalisation and International Cooperation in Mental Health


Beyond the walls: the transition from hospital to community based care.
Deinstitionalisation and International Cooperation in Mental Health.

Erveda Sansi - 2011 April 15th

I thank the organizers of this conference for inviting me to speak. First of all I would like to announce the European MadPride, organized by two Belgian mental health users associations, Till Uilenspiegel and Psitoyens with the support of the European Network of (ex) - Users and Survivors of Psychiatry (Enusp), that will be held during the days around October 2011 the 8th. Accepting others in all their diversity is key to positive and nurturing societies. Such is the basis of the Mind Freedom concept, from which MadPride events take inspiration, whose aims are: to celebrate our diversity, including our own madness; to celebrate the power of self-determination of the free human spirit; to introduce to a wider public the degree of stigma and social exclusion suffered by people who are deemed mentally ill or psychologically different, including abuses of psychiatry; to support and promote the interests of people who are deemed mentally ill or psychologically different; to acknowledge our sincere desire in wanting a constructive dialogue, even if critical at times, with mental health professionals and policy makers at all levels. There will be joyous and peaceful demonstrations in streets, local joyful and non-violent happenings, outdoor theatre performances, stands, speeches, writings, poetry readings and so on. Jacques Bonnafé once said: “It is possible to judge the degree of evolution of a society by the way it treats its mad people”.
I am here as a representative of Enusp, and although I’m Italian (I’m coming from the Lombardy region), it seems to me that I’m arrived from abroad, in the sense that I found here a reality of the psychiatry completely different from that one I knew. I’m very surprised that despite the facts that here they are operating since many years to realise the de-institutionalization and the overcoming of the asylum ideology, and that the positive results, both in economically and human terms, are before anybody’s eyes, this model is only scarcely imitated. In Italy, out of a total of 321 SPDC (Psychiatric Services for Diagnosis and Treatment), there are only about 15 that constitute part of the Club of open SPDC no-restraint, that means that they declare publicly not to lock the doors and not to use any means of restraint.
The situation in Italy, with some exceptions, and also in some other realities in Europe, has worsened from the period of questioning psychiatric institution, in the beginning of the sixties. Italy has been at the forefront of the closure of mental hospitals. Not only Franco Basaglia and many professionals, but also a good part of the common people realized that psychiatric hospitals were not places of care. Civil society, then, was sensitive to the issue of smash-down asylum culture, launched by Franco Basaglia. Publications appeared, there was an open debate, workers and students organized themselves, and entered in asylums to see the conditions in which their fellow citizens were locked up. They protested and denounced the deplorable conditions the internees were forced to live in.
But since several years, we observe a re-institutionalisation process and, at the same time, in some Italian hospital’s psychiatric wards happened many deplorable facts, due to the institutionalization and forced restraint.
Some of these facts have become infamous after that committees and relatives have seeked justice, as in the case of the teacher Franco Mastrogiovanni, that was debated also on national television channels. Franco Mastrogiovanni, after a forced psychiatric treatment in 2009, in circumstances that have been the subject of pending penal proceedings, has been heavily sedated, tied to the bed of Vallo della Lucania’s hospital psychiatric ward, and left to die after four days of abandonment. A hidden camera recorded everything; the video is of public domain.
Giuseppe Casu, guilty of having wanted to pursue his peddler job in the village square, died after being hospitalized against his will, bound hands and feet to the bed during seven days, after having been heavily sedated.
A 34 years old Nigerian, Edhmun Hiden, was voluntarily hospitalized in a psychiatric ward in Bologna in May 2008; the next day he decided to be discharged, because he did not feel cared. At this point he was sedated, tied to the bed and held in place with the help of police; he died soon after, due to a heart attack.
These are just some of the cases that came to the limelight, but many more of them are not known when they happen. As, for example when people that live in loneliness are involved, or people whose relatives have given their consent, or simply when people want to get rid of a person perceived as annoying. Personally, I am constantly getting acknowledged of forced psychiatric treatments, during which treated people suffer heavy damages. Forced treatments are often made on request of relatives, when patients refuse to take any longer the psychiatric medications, or when their behaviour is perceived as annoying. A friend of mine tried to escape, but he was chased and filled with drugs; shortly after he was found dead at the bottom of a ravine. He was 40 years old. Another friend of mine was walking on a path between fields and was stopped by police, because he was known as a “mentally ill” person. Then they called the psychiatrist on duty and told him: “He was walking near the railway and could possibly have in mind to commit suicide”; so they locked him up. I know this person, who often walks in the fields, where, however, it’s easy to be located near the railway, because of the constitution of the territory. Another acquaintance of mine died, throwing himself under a train, terrified by the fact that his mother, according to the psychiatrist, would refer to forced psychiatric treatment for him. Another one has suffered of heavy harassment, after having reported his superior’s embezzlement, noticed during his duties as a municipal technician. He was subjected to forced psychiatric treatment, kidnapped by police in riot gear. While he was sleeping, his door was smashed down, and he was thrown on the ground face down and handcuffed. He says that at least they could have tried to open the door, which was not locked. Now he is terrified and he even fears the dark; he is forced to take psychiatric drugs. We can not think of de-institutionalization before we have dismissed the rules that allow forced psychiatric treatment, that allow to hold a person against his will, without him having committed any crime, without the right to an equitable process, based on the alleged dangerousness and only because this person was diagnosed with a mental illness. Legislation of forced psychiatric treatment provides ample scope for arbitrariness and it is in strong contrast to the human rights regulations, that aim at preserving even people with disabilities from inhuman and degrading treatments. For those who commit a crime, it is expected that the judicial authority, within certain specific procedural rules, sanctions or imposes restrictive measures. I constantly deal with people in forced psychiatric treatment, that can no longer find a way out of the psychiatric institution.
Dr. Calchi Novati, a Niguarda’s Hospital psychiatrist, was strongly mobbed because she opposed the practice of restraining patients, not only by the straps, but also through the shoulder (“spallaccio”) of asylum memory, or with other degrading practices. She preferred to have an open dialogue with her patients, resize or scale down the intake of psychiatric drugs, deal with their existential problems. In a few days Dr. Calchi Novati would undergo the third disciplinary proceeding of the Disciplinary Board, and now she is in danger of dismissal, because in 2010, she had complained about her working difficulties with a small circle of friends on facebook. Meanwhile her patients have signed a petition with 500 signatures asking that the doctor would be readmitted into her workplace. Other professionals who disagreed with the practice of restraint in respect of patients in the Niguarda’s psychiatric wards - which otherwise is a hospital of excellence - have been mobbed or transferred. In December 2010, a series of complaints was presented by relatives of people who died or have suffered as a result of restraint. Following these complaints, since 2006, at Milano Niguarda Hospital’s psychiatric wards Grossoni I, II and III, 13 people died, mainly due to the practices of restraint and abuse of psychiatric drugs. It would be important to spread the awareness that the restraint is an anti-therapeutic act, that makes cures more difficult, rather than to facilitate them. Physical restraint is not exercised only in the field of psychiatry. The areas of operation where should be discussed the problem of legitimacy, usefulness and appropriateness of physical restraint, do not consist only in hospitals, but also in nursing homes for the elderly, therapeutic communities for drug addicts and nursing homes for people with disabilities related to congenital or early acquired disabilities. An improvement in psychiatric nursing practice, characterized by the renunciation of physical restraint, would be a strong signal in order to spot out the problem also in other operating environments, urging those who work in this field to act with similar treatment practices, rather than restrictive ones. Recently I have been given the opportunity to visit the Psychiatric Service of Diagnosis and Treatment (SPDC) in Trieste, and Dr. Assunta Signorelli has showed us the ability to take care of people never using restraint instruments, but using a friendly, human scale approach, where an open dialogue and understanding take the place of a mere deletion of the “symptoms”. In addition, people are hospitalized for only one day, or for some days in presence of particular physical problems.
In the “Istanbul Protocol - Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment”, paragraph g) Review of torture methods, among other torture methods is listed also: b) positional torture, suspension by using stretching of limbs, prolonged restriction of movement, forced positioning; u) compulsion to attend to torture or other inflicted atrocities.
The 2010 July the 29th Italian Conference of Regions and Autonomous Provinces, approved a document entitled “Physical restraint in psychiatry: a possible strategy of prevention”. The document, contains seven recommendations to the regions, originated from an intervention by the CPT (European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which is emanation of the European Council), on psychiatric wards in Italy. In the chapter “Measures of restraint in Psychiatric establishments for adults”, the report says: “The potential of abuse and mistreatment that the use of restraints implies, is of particular concern to the CPT. Unfortunately it seems that in many of the visited structures, an excessive use of restraints is practiced”. The document draws up a grading rank of rules to be put in practice, in order to deal with the patient’s violence, and include psychological means, verbal interaction and belief, and hold the patient by the hands for a short time. All this is proposed as an alternative to chemical sedation and restraint by straps. The final objective of the Recommendations is that all regions take steps to introduce changes in psychiatric care (knowledge, attitudes, resources, management, organization) that can lead to a stable and safe zero the number of restraints applied in mental health services.
Despite this, the tying by shoulder, obtained by means of a sheet rolled up properly, which stops the patient’s back on the bed top, tied behind his headboard, is part of the Niguarda Department of Mental Health’s Protocol and it is even taught to the students of Milan’s University Specialization School of Clinical Psychology. Since many years, in a portion of the former Paolo Pini asylum, the Olinda association organizes cultural activities, music review, theatre, cinema, children's activities, sports activities, various workshops, the Jodok bar restaurant, the hostel and numerous other activities throughout the city and with the active participation of users. It would be a paradox if the Olinda cultural experience was to be used to cover the disturbing reality of the three Grossoni psychiatric wards, that would be not wrong to define similar to an asylum.
Although in recent times campaigns and seminars on the theme of the abolition of physical restraint in psychiatric wards and facilities for the elderly were organized by various organizations, and that in the programs of these campaigns and seminars very firm statements can be read, such as: “The restraint is not a medical act, it is an affront to the dignity of the person who suffers, and it is a symptom of serious inefficiency and ineffectiveness of the services that adopt it”, and “Tying a person in a condition of suffering at a hospital bed is an inhuman act, unworthy of a civilized country” and “We propose a proactive path toward a progressive ban of any coercive practice”, it seems that despite everything, there is still an underestimating of the urgency of this “progressive ban on all coercive practices”. When you declare that the practical and organizational health care could prevent a rapid ban on physical restraint, it seems that in reality it continues to underestimate the deep human and civil unacceptability of this instrument of physical coercion of inmates. The underestimation of the effects on people tied with this instruments, strictly prohibited since 200 years in the prisons, continues to result in hospitals.
The deplorable situation of the six Forensic Psychiatric Hospitals recently became more visible, after surprise-inspections of a parliamentary committee. The videos of the visits, showed by the national television, and the press releases can be found on the web. A parliamentary report had already been made in June 2010, but the photographs show a situation that until now has not yet changed. People held for decades for minor offenses, whose penalty would have expired long time since, if not repeatedly and automatically renewed. Dirt and decay, asylum’s instruments and methods of restraint, bottles placed in the toilet’s drain in order to prevent rats to come up, neglected physical problems such as those of a person with gangrene in his feet. On 2011 April the 12th, a Romanian citizen has committed suicide at Aversa’s Forensic Psychiatric Hospital, because his imprisonment was automatically renewed. Francesca Moccia of the Tribunal for Patients' Rights of Active Citizenship, remembers that there is a reform that waits to be implemented from 2008, what requires the closedown of the Forensic Psychiatric Hospitals. If we don’t shut these places once and for all, we can not talk about de-institutionalization. Close them not in order to transfer their users to other psychiatric institutions, but to give these people a life dignity.
A research (source: British Medical Journal) conducted in 6 European countries (Italy, Spain, England, Netherlands, Sweden, Germany), that have closed asylums in the 70s, saw that between 1990 and 2003 an increase in the number of beds in forensic psychiatric hospitals, in psychiatric wards, in so-called safe houses. Supported housing is seen as an alternatives to asylums, as a sign of de-institutionalization, but they are rather a form of institutionalization. Also forced treatments increased. It is not clear the reason why the number of beds in Forensic Psychiatric Hospital increased, since there is no correlation between crimes like homicides and de-institutionalized persons.
Erik Olsen of Enusp told that recently a survey made in Copenhagen, in a way, has given positive results: about 90% of the people who receive assistance in the socialpsychiatric field, lives independently in their apartments. Only 10% live in the centers/halfwayhouses. But there are still 3 or 4 mammoth institutions, where 173 people live in small rooms (27 x 30 m) and toilets are shared with ten more people. Users with cognitive problems are facing abuses in some of these institutions, a recent  television program broadcasted clips filmed with a hidden camera, which has shocked the viewers in Denmark. In any case, says Erik Olsen, how can we be sure that people living in institutions do not fall victim of abuse? According to him the institution itself is a violation of human rights, destroys the human agency instead of rebuilding it.
In all European countries lobotomy and electroshock treatments are not prohibited, although it is widely demonstrated that these non-therapeutic treatments are invasive and destructive. We can not think of a de-institutionalization if we don’t remove these practices and if we don’t replace them with dialogue, re-socialization, empowering, practices that, as Trieste’s Department of Mental Health and other departments have demonstrated, it works fine. It is necessary that human rights laws already enacted will be implemented.
Referring to the psychiatric drugs there are rules of the Convention on Human Rights, which require user’s fully informed consent, before administering, even if he’s disabled. Most psychiatric drugs are prescribed for a long time, sometimes for life, without informing the user on their effects, and without any help in the resolution of his real and existential problems. Akathisia, dyskinesia, are very unpleasant effects and can throw a person in despair. The psychiatric drugs can cause neurological diseases, that sometimes become irreversible. Often the user is encouraged to continue taking the drugs even when he asks to withdraw them, and there are few professionals who help and give directions for withdrawal. Peter Breggin, a psychiatrist, working with institutions as WHO (World Health Organisation) and FDA (Food and Drug Administration), wrote hundreds of pages on the harmful effects of psychiatric drugs. Peter Lehmann, who tested the effects of drugs on himself during his hospitalization in a psychiatric clinic, has published and continues to publish the results of his research for which he uses pharmaceutical and medical literature. The effect of psychiatric drugs is known, but the billion-dollar business behind it is too big to lose it. Peter Lehmann is the first survivor of psychiatry to be awarded with the honorary degree, conferred him by the clinical psychology faculty of the Aristotele’s University of Thessaloniki, for his work as researcher and activist in the field of mental health.
A person who starts to take drugs, in most cases will be induced to take them for life, because they create addiction problems. The psychiatric user develops a very strong dependence toward the psychiatric service too. Lack of compliance is in fact intended in it self an aggravation of the disease. Then the conditioning that takes place, goes in the direction of dependence from psychiatric services, of becoming childish and “chronic patient”. As long as we continue to administer the drugs in this way, as real chemical straitjackets, we cannot talk about de-institutionalization.
Although in almost all European countries asylums and psychiatric hospitals have been eliminated or substantially reduced, this does not mean that in the new post-asylum structures, asylum-dispositifs have been eliminated. People are, with few exceptions, completely sedated by psychiatric drugs, even though apparently there are implemented programs such as art therapy. The intake of psychiatric drugs is induced also in order to make the user unconscious.
Erwin Redig, a German psychiatric survivor, says: “There are people putting us under pressure to force us to take them (psychiatric drugs). If we do not take them, our changes embarrass them. If this is our case, we must make clear to ourselves that we are swallowing drugs for other people’s welfare, because they find us unpleasant if we do not”. “The dispositif of discomfort-complex, that operates in a small residence, acts more broadly in the society”. Neuroleptic drugs affect thinking, block the flow of thoughts, and make people flatten. I relate the words of a healthcare professional: “As soon as psychiatric drugs are given to people, they literally get extinguished. To what extend is it fair to cancel the person?” Although in the European countries, the asylum psychiatry and the psychiatric hospitalization of users have given way to communities, the psychiatric institution culture has not changed. Although many examples exist that  prove that you can accompany a person in troubles out of his problems, through dialogue and support in the resolution of the objective and material difficulties, and helping him to get awareness of his own rights, these experiments and their positive results continue to be deliberately ignored.
In recent years, many non-profit organizations have flourished, that deal with the so-called social “reintegration” of the psychiatrised person. After the closure of mental hospitals in Italy, several small residential “intermediate” psychiatric facilities were opened, such as group homes, protected dwellings, shared apartments; they often have no substantial difference in rapport to the classic psychiatric institutions. The rule is: “This flat is an ASL (health institution) structure, so if you live in it you must follow the rules of life that the institution gives you”. The tenants, that are the users, have no control over the money for household management, bestowed in the form of regional subsidies, and could never say a word in the choice of another tenant; they are obliged to keep the apartment according to the criteria established by the health professionals. Recently a friend who lives in such an apartment was complaining because “they pay for a cleaning lady who comes and sits, giving us orders on how to clean, and when we finish she goes away”. The control also extends to external relations. So the typical devices of total institutions are restated in mental health structures who should be the alternative to institutions, either in “intermediate” residential structures or in the “alternative communities”. Old asylums heritage as totalitarian relational devices still operates in the structures, and professional’s adaptation modes are still the same. The patterns of asylum residentiality are still active. But most of all it is still alive an asylum mentality, therefore it is important for everyone to be aware how much everybody’s mentality is crucial in creating or not creating devices that belong to psychiatric institutions; operating devices that constitute a widespread operating module.
A Mental Health Department professional stated that “you certainly can not talk about family-home, where everyday acts are not self-determined by residents”. “Residential Intermediate Structures”, foreseen in Italy by the 1983 law, should have had the transitoriness as their specificity; therefore they should not constitute either a definite admission or a final place for forced hospitalization; they should have been  transitional housing, that could break prejudice and exclusion logics. In March 1999, by a special decree, to the Italian Regions was imposed the definitive closure of the asylums, under threat of strong economic sanctions, because despite the birth, on paper, of the new “local services”, mental hospitals were still crowded with patients. Named by the derogatory title of “asylum residuals”, for these people that nobody wanted, residential structures accounted for an illusion of freedom; they founded themselves to be again in a mental institution. “Many patients”, writes one of them in an autobiography, “have never been so well in terms of comfort, but nevertheless they are in a state of fearful desolation”.
An induced need of security, the defence from a potentially dangerous mind sick person that at any time, during an outbreak, could commit heinous actions against others or against himself; shortly, on the basis of this need and of this false scientific fundamentals, we build the myth of the need of post-asylums psychiatric institutions. If we don’t get reed of the psychiatric prejudice, the “mental health” institution remains. There are many alternatives pursued by individuals, associations or institutions, but they are deliberately ignored. The responsibility for solving the problems of institutionalization, is not up only to psychiatrists or to mental health professionals, but to the whole civil society. Everybody contributes to the asylum mentality. Users as well, who have internalized the psychiatric diagnosis and can no longer live without it.
Mary Nettle, chairman of Enusp until 2010, expects an increasing involvement of users and survivors of psychiatry in researches about psychiatry; while they often are excluded or not paid on the pretext that they are not professionals.
Yesterday, I talked with a “Radio Fragola” (Trieste ex-asylum’s “Strawberry Radio”) young operator. To my observation, that usually common people are afraid of people labelled as mentally ill, because after the closure of asylums there is no possibility anymore to lock them up, he replied: “Here it's different, now this different way of relating to the problem is rooted in our territory and we could not do without it”.

Milan's Violet Telephone- Abuses


The 23rd of November 2010 we, as Telefono Viola di Milano (Violet Phone from Milan), had a press conference at the Milan justice court’s press room. A series of atrocious events had happened in one of the greatest and notorious hospitals in Italy, the Milan’s “Ospedale Niguarda Ca’ Granda”. A 43 years old man, Tullio Ceccato, died because he was tied to a restriction-bed, inside the “Grossoni” psychiatric ward of this hospital. Another person, Francesco Defeo died in the same circumstances and others had very serious physical consequences, like arm-paralysis, nerve injuries, etc.
A psychiatrist, Dr. Nicoletta Calchi, was subjected to mobbing because she refused to practice coercive treatments, like restraint, and because she wanted to have human relations with her patients, instead of forcing them to take psychiatric drugs. Afterward, having she relieved her feelings with facebook friends, she was suspended from her job by the Psychiatric Service’s direction and her patients transferred to other psychiatrists. Other staff employees as well were moved to different services, or subjected to mobbing. 112 Dr. Calchi’s patients wrote an open complaint letter and made a petition collecting 500 signatures.

The press release was collected by the major Italian newspapers and news agencies, and reported the following days (Corriere della Sera, La Repubblica, Il Giornale ecc.), of witch it’s possible to find a complete documentation on my blog (senzapsichiatria.blogspot.com), together with an article I wrote myself on the matter, for a magazine.
Tomorrow at 12.00, an other press conference will take place at the Milan justice court's press room.
 Best wishes
Erveda 


Report


It’s a matter of last days Lazio Region President Polverini’s decree on Lazio hospital system: the number of beds in Psychiatric Institutions raise from 369 up to 629; more 70%.
50 beds for the public structure and 210 for the private structure trigger the chronicization circuit.
260 beds = 90.000 life days subtracted to the people at the cost of 10.000.000 €.
Didn’t the Basaglia Law foresee the closing up of madhouses?
http://www.ilmanifesto.it/archivi/fuoripagina/anno/2010/mese/10/articolo/3498/


Reported below are only a few emblematic cases reported from the press, television and internet, regarding the Italian situation of psychiatry.

27 October 2005: RICCARDO RASMAN dies during a coercive treatment by the policemen, for a hospitalization against his will, in a psychiatric ward in Trieste.
it.wikipedia.org/wiki/Caso_di_Riccardo_Rasman

21 June 2006: GIUSEPPE CASU dies in a psychiatric ward in the hospital “Santissima Trinità” of Cagliari, as a consequence of a thromboembolism, after a forced hospitalization. He was tied hands and feet to the bed, for 7 days and was sedated with high doses of psychiatric drugs against his will.
italy.indymedia.org/news/.../1165206.php

28 August 2006: A.S., the 17th of August 2006 is admitted to the psychiatric ward in Palermo, for medical investigations. A.S. died after 2 days coma, the 28th of August, probably for excessive doses of psychiatric drugs.

26 May 2007: EDMOND IDEHEN, a 38 years old Nigerian man, went voluntarily into the psychiatric ward of Bologna’s hospital “Istituto Psichiatrico Ottonello – Ospedale Maggiore Bologna”. As he tried to leave the hospital, the doctors forced him to stay, with the help from policemen. EDMOND IDEHEN died as a consequence of a hearth attack while nurses and policemen held him down. He was also strongly sedated with psychiatric drugs.
artaudpisa.noblogs.org/post/category/documenti

12 June 2006: ROBERTO MELINO, 24 years old, dies for a hearth attack; he entered voluntarily the psychiatric ward of Empoli’s “San Giuseppe” hospital. As he tried to leave the hospital, he was forced to stay by the doctors, and obliged to take high doses of psychiatric drugs, in spite of his evident and serious breath difficulties.
www.informa-azione.info/morte_di_un_ragazzo_in_reparto_psichiatrico_ad_empoli

15 June 2008: GIUSEPPE UVA, 43 years old, was brought inside a police station, because he was driving in state of high alcoholic level. There he was subjected to ill-treatments. After 3 hours he was forced to an obligatory hospitalization in the Varese’s “Circolo” hospital and was forced to take psychiatric drugs. He died because of the stress provoked by the mix of alcohol and psychiatric drugs. www.repubblica.it/.../varese_pestaggio-2778623/

30 August 2010: LAURETANA LA COCA, 32 years old, entered voluntarily in Termini Imerese’s “Salvatore Cimino” hospital. After 10 days of hospitalization her condition got worse, till she got into a comatose state and died.

4 August 2009: FRANCESCO MASTROGIOVANNI, 58 years old, a well liked teacher, died in consequence of a forced hospitalization, in a hospital of Vallo della Lucania. He was in a touristic village, where he was on holiday. Nobody knows the reason of the forced hospitalization. During the 80 hours hospitalization he was nourished only with saline solutions; he was tied hands and feet to the bed, in such a position that his respiratory functions where compromised, and he was sedated with high doses of psychiatric drugs, without supervision from the staff. At wrists and ankles there are 4 cm wide grazes.  www.giustiziaperfranco.it/


Giuseppe D.: A man, more than 70 years old, was interned in Reggio Emilia’s psychiatric prison. His problem was that the neighbour’s daughter is a psychiatrist. His lawyer took a legal action to the European Court of human Rights, but until now there has been no answer, so the Pisa’s student group “Collettivo Antipsichiatrico Artaud”, together with “Telefono viola” from Milan, decided to release the documentation relating to this case in Internet, according with Giuseppe D.’s will, his lawyer, and his relatives. www.ecn.org/telviola and www.artaudpisa.blogspot.com


2 April 2010: ERIC BEAMONT, 37 years old, the 2 April 2010 was hospitalized in Lamezia. After 2 days he entered coma, so the doctors transferred him to the Catanzaro’s “Pugliese – Ciaccio” hospital, where he died. There is the suspect that the death of Eric was caused from a high dose of benzodiazepine. Diagnosis was: subarachnoid hemorrhage. www.tirrenonews.it and calabria.indymedia.org/article/4758

Here below we report some data extracted from the text of the parliamentary relation on the June 2010 inspection of the 6 Italian psychiatric prisons still active. After the 1978 “Basaglia law”, madhouses had to be closed, but the 6 psychiatric prisons mentioned above keep doing the same job.
The regulations and logics that manage these psychiatric prisons (OPG), are the same inherited by the fascist Rocco Code (1934). Now that the heirs of that Code are back to the power of Government, they want to put their hands on the 1978 “Basaglia law” (law 180), that abolished madhouses.
40 % of the 1500 actual convicted should already have been released, for detention terms expired, but they see their penalty end terms deferred in order of their supposed social dangerousness.
Nine people each cell, dirty bathrooms and bed sheets; dirty nurses’ gowns as well.
In Barcellona Pozzo di Gotto (Messina), 329 convicted are owercrowded in cells built in 1914. Dirt everywhere. One patient was found naked, tied up to his bed, with a haematoma on his head.
Aversa, built in 1898. 320 people locked up six by cell, in inhuman conditions.
NAS (Antisofistication and health nucleus of carabinieres) reported and denounced all this to the Public Prosecutor’s Office, but this office is often made by the same persons that sentence patients to life.
Secondigliano, the psychiatric prison is interior to the jail. Here stays since 25 years a patient who was sentenced two years. Burns and black eyes are not reported on the clinical diary. Feet and hands go gangrenous.
In Montelupo Fiorentino they are 170 in a very scruffy building.
In Reggio Emilia they are 274 where they should be 132. 3 showers serve 158 patients. One is tied up to his bed since 5 days for disciplinary reasons. 3 in 9 meters square.
“The OPG (psychiatric prison) are one of the “silence zones”, explains Alberto, of the Pisa Antipsychiatric Collective dedicated to Antonin Artaud, “and they show the political use of psychiatry. The consume of psychiatric drugs is more and more pushed, the electroshock comes back “in fashion”, perhaps to “heal” post partum depression. And a law lies in ambush in order to bring the forced hospitalization terms from 7 to 30 days”.
http://www.liberazione.it/news-file/E-i-senatori-scoprono-i-manicomi-criminali---LIBERAZIONE-IT

written by Erveda Sansi – november 2011

Niguarda affair update


I update you about the Niguarda affair:
1°: on  2010 December the 13th, Milan’s Telefono Viola, together with some patient’s relatives, registered a complaint to the Milan’s Public Prosecutor’s Office, whose object concerns 5 death cases (3 more than those reported in my previous article) and 5 abuse and violence cases linked to the restraint (Rita F. after having been restrained to the bed, is forced to live on a wheelchair . In all these cases documentation and medical reports are lacking/missing.
2°: on  2010 December the 14th UNASAM (National Union of Mental Health’s Associations) asks for an inquiry to be open on Niguarda’s Psychiatric wards.
3° on  2010 December the 13th the City Councilwoman Chiara Cremonesi settles a Parliamentary Inquiry about the Niguarda affair.
4° on  2010 December the 13th Ignazio Marino, National Health Service Inquiry Commission’s president asks the NAS (Anti Sophistication Nucleus) Carabiniers an investigation.


I update you about Francesco Mastrogiovanni’s case:

-     On 2010 December the 6th’s hearing, all the exception raised by the accused have been rejected. The trial continues with the rite of immediate judgement.
-     On 2010 December 14th’s hearing: The judge rejects the requests to exclude the associations that instituted a civil action (Roma’s Telefono Viola, Unasam (National Union of Mental Health’s Associations), Robin Hood Association, Iniziativa Antipsichiatrica (Antipsychiatric Initiative).
-     On 2010 December the 22nd hearing: Francesco Mastrogiovanni family’s request is accepted to summon Salerno’s Asl (Hospital) as civil responsible.
-     On 2011 March the 22nd will have course the next hearing at 9.30 am, with a new Sit in by the Vallo Della Lucania’s Tribunal.


Best wishes
Erveda Sansi


Serious abuse and coercive practices in Milano’s Hospital Niguarda Ca' Granda


Serious abuse and coercive practices in Milano’s Hospital Niguarda Ca' Granda

The return of asylum ideology as an instrument of repression

by Erveda Sansi

What happens in the psychiatric wards of Milano’s Hospital Niguarda Ca' Granda and in other hospitals, incredibly contrasts with the excellent results that women and men of culture and science have otherwise produced and still produce. It seems a return to the days of the infamous Inquisition. The scandal that came to light in recent weeks, following the heavy mobbing and the suspension from her job suffered by Dr. Nicoletta Calchi, leading psychiatrist at the Mental Health Department of Milano’s Niguarda Hospital, decided by the Board of Discipline, shows in all its savagery as the scientific progress has in many areas not only arrested, but has made giant steps backward.
Giorgio Antonucci, through his decades of work with patients who had previously been diagnosed with the most dire psychiatric diagnoses, has shown that neither the existential problems can be solved by locking up people in hospital wards, nor binding them to the beds, stuffed with drugs in order to get some sort of brain lobotomy. Indeed, it is when a person tries to cope with the difficulties of life that he needs understanding, sensitivity, empathy, help or more often, to be left alone. To be respected in all cases. Giorgio Antonucci, who has directed during twenty-three years two madhouses’ wards, has demonstrated, through concrete actions, that only through dialogue and support you can solve human problems. In facts, what has happened within the Niguarda Hospital’s SPDC (Psychiatric Service for Diagnosis and Treatment), and that reflects the way many psychiatric wards work, it is simply inhumane and criminal. The list of national and international institutes that put compulsory treatment perpetrated against people, defined as psychiatric patients or mentally disabled, under the heading “torture”, is long and includes the 1948 Universal Declaration of Human Rights, the 1950 European Convention for the Protection of Human Rights and Fundamental Freedoms, the 1991 United Nations Principles for the Protection of Persons with Mental Illness in (Principles on Mental Illness), the 1966 International Covenant on Civil and Political Rights, the Law of ' WHO (World Health Organization) on Mental Health: ten basic principles of 1996, the  1998 Human Rights Act in the United Kingdom, the 2006 UN Convention on the Rights of Persons with Disabilities, the 2008-8-28 UN General Assembly, 63th session, Item 67 (a) report by Manfred Nowak, Special Rapporteur of the Human Rights Council against Torture and Other Cruel, Inhuman or Degrading Treatments and Punishments.
Only about 15, (the number changes following the head physician, the head nurse, etc.) of the 321 SPDC existing in Italy, have publicly stated that they make no use of restraints, and do not lock the doors. They are part of the SPDC Club Open No Restraint. They are, at the moment, the SPDC of Aversa, Caltagirone-Palagonia, Caltanissetta, Enna, Mantova, Matera, Merano, Novara, Perugia, Portsmouth, Treviso, Trieste, Rome C., Verona Sud, DSM (Department of Mental Health) Venice.
Even Franco Basaglia, Edelweiss Cotti, Peter Breggin, Marc Rufer, Thomas Szasz, as well as the ENUSP’s (European Network of Ex-Users and Survivors of Psychiatry) members, to recall just a few of a long list of names, have shown through their theoretical works and practical methods the groundlessness of the psychiatric use of seclusion, restraints, electroshock and psychiatric drugs injurious to health. Michel Foucault explains very effectively how the psychiatric system functions as a Panopticon, as a social controller, and fulfills the specific function to maintain the class division of society.
On November 23, 2010, in the press room of the Court of Milan, was held the press conference of Milan’s Purple Telephone (Telefono Viola), on the serious facts happened in the departments Grossoni I, II and III of the Niguarda Hospital. Which was the reason why the Dr Calchi has been so heavily mobbed? The answer lies in her concern for her patients’ health, which led her to have human relations with them: her refuse to go against medical ethics, to participate to practices of restraint, as well as her will to resize, or scale down the administration of psychiatric drugs.
A clear example of what is the meaning of restraint in psychiatry, and its consequences, is shown by the death of Francesco Mastrogiovanni. After being restraint to bed for 80 hours, he dies in a state of extreme neglect. His agony was recorded by a hidden camera, and this is the reason that made it possible to see the footage on Youtube, where you will also find the video aired by “Mi manda Rai 3”. More information is available at <<www.giustiziaperfranco.it>>. The ruling of the Supreme Court, annulling the previous order of the Court, that did not believe to suspend the Vallo della Lucanias’ SPDC doctors, does not recognize the “exceptional, occasional, contingent” character to the Mr. Mastrogiovanni’s prolonged physical restraint (restraint that caused the death), and also condemns the widespread violation of criminal laws, health standards, human dignity respect rules, and highlighting over all the responsibilities of the manager and the doctors, emphasizing that there was not an exceptional case, but a practice extended to other patients, therefore systematic. The judge of the Supreme Court was horrified analyzing what happened in Vallo della Lucanias’ SPDC.
One more death imputable to restraint is the one of the stallholder Giuseppe Casu. Guilty of having pursued his will to work as a peddler in the town square, he was fined, not only, but he was subjected to Coercive Psychiatric Treatment, even after having paid all his fines. He was tied up to the psychiatric ward’s bed, where he died after a week without anybody would untie him. The experts who investigated the case, consider “excessive” to bind a patient to bed, also in order to prevent him suicide or force him to heal, and come to this conclusion: “The direct coercion is not among the services requirable to the psychiatrist. And since the psychiatry’s new organization chart does not foresee custodial staff figures (as it did before the Basaglia law that closed asylums); having failed this requirement that characterized the old asylum legislation, the use of physic strength is outside of the therapeutic relationship”. Seven doctors at the Cagliari’s Santissima Trinità’s psychiatric ward, were charged with kidnapping and aggravated abuse of power (by Unione Sarda, 21 October 2010).
Let's go back to the most serious abuses of coercive practices in use in the three Grossoni departments of Milan’s Niguarda Hospital, exposed in the press release of the Milan’s Telefono Viola (here below summarized and fully available on www.ambulatoriopopolare.org, www.news-forumsalutementale.it and senzapsichiatria.blogspot.com).
Meanwhile, 112 patients have written an open letter denouncing the situation and in defence of Dr. Calchi, where they state that “more health professionals, a doctor and a nurse are actually mobbed, other health professionals were forced to leave the hospital because of the DSM (Mental Health Department) Director. This letter was undersigned by 500 signatures.
“What happens since long time in the Grossoni I, Grossoni II and Grossoni III wards, seriously obscures the public image, the professional reputation and even the honourableness of the Hospital Niguarda Ca’ Granda”, say the Telefono Viola’s volunteers.
The physical restraint of mental asylums inmates was one of the most common and inhuman practices: the straitjacket was for centuries the symbol of the suffering bestowed to persons deemed mind ill. Yet, since the second half of the 17th century to keep a person tied to a table (to a bed as well) was been considered by the European legal culture, an unacceptable act of physical violence, a real act of torture, like all other corporal punishments, ended up being banned by the continent’s criminal law. The rejection of physical pains in the punishment of crimes was one of the most significant signs of transition from feudal to modern times, yet this principle has never been able to cross the gates of many mental hospitals, which, again from the end of 1700 have spread across Europe. In our culture, the irrational fear of madness, the irrational fear against those who, were interned in mental hospitals as “mentally ill” (as well as a modern scapegoats) has allowed the torture of physical restraint (along with an extensive list of other horrors) remained in vogue at mental hospitals schools for nearly two centuries, until about the last decades of 1900. In fact, although the definitive end of the use of the straitjacket, the practice of physical restraint in psychiatric wards has remained, though not everywhere, even after the law 180. Too often physical restraint in psychiatric wards is of unspeakable violence, which produces injuries, wounds and irreversible damages.
The Niguarda Ca’ Granda Hospital’s DSM (Mental Health Department) advises Milan’s University Clinical Psychology Specialization students, as well as his mental health professionals, to contain unquiet patients with the infamous spallaccio (tied up by the shoulders) of asylums memory: “When the crisis shaking is uncontrollable, it may be necessary to force the patient supine; and this is achieved by a sheet, rolled up properly, which stops its back on the floor of the bed, tied behind the head of it. This must be regarded as an interim measure, pending the medication make the necessary sedation”.
In this way, the restraint becomes very painful, because of the high pressure that creates the sheet rolled up against the neck, shoulders and armpits of the person contained! In this way, the strong stretching and the strong muscles compression, in a short time rises up the risk of injury to the brachial plexus distal nerve, causing paralysis in the arms of the person fixed restrained to the bed .
It is clear to everyone that the spallaccio is a procedure that:
- Inflicts immediate pain to the bound person;
- Causes a stretching of the upper limbs and shoulders, armpit and neck;
- Forces the person so closely linked in a forced position which prevents all movements at all;
- Obliges the other inmates to attend the coercive treatment inflicted on one of them (which is not wrong to define atrocious).
“The "justification" that the spallaccio is a temporary measure”, Telefono Viola concludes, “is a blatant lie: everyone knows that an intravenous sedation gives his full effect after just 10-15 minutes. And we newer heard that a spallaccio (as well as any other form of restraint) that lasted less than several hours or days. Of course we know very well that the spallaccio is not rare at Grossoni, and that sometimes it lasts entire days, but, nevertheless, even we of the Telefono Viola have always thought that the DSM top managers formally deemed as illegal this kind of physical restraint proceed, while allowing its use in the wards. But no: the spallaccio is part of the Niguarda DSM protocol! It is also taught to the Milan’s University Clinical Psychology Specialization students! In other words: the madhouse is dead, long live to the madhouse!
In December 2008, Margherita De Bac on the daily newspaper Corriere della Sera, asks Lorenzo Toresini, SPDC Club open doors no restraint chairman, how comes that 30 years after the law 180, the vast majority of the 321 national SPDC still bind their hospitalized. Toresini's answer is:
“The base of these behaviours is ideological. The restraint is considered a medical act. This is unacceptable. Italian law does not specifically deny the straps to the mentally ill. But domestic violence is punished under the Criminal Code. Most traders prefer to bind the patients rather than to speak with them. The structural problems and a lack of staff are a pretext. It is a question of dignity. To tie is not professionally dignified”.
Physical restraint in psychiatry, as was the case in asylums, is a disguised form of punishment. The coercive psychiatric interventions are causing injury and suffering, terrorizing and causing damage to both psychological and physical, as reported in her presentation Tina Minkowitz to the Committee against Torture in 2006: "To see how every day I deteriorated intellectually, morally and emotionally, terrified me. First my interest for political issues disappeared, after my interest in scientific problems, and then my interest in regard to my wife and my children". The art. 3 of the European Convention of Human Rights declares that "No one shall be subjected to torture or to cruel, inhuman or degrading treatments or punishments". Tina Minkowitz, on behalf of Mind Freedom International, notes that the coercive psychiatric interventions should be classified under this head.
Milan’s Telefono Viola (Purple Telephone) complaint:
Mohamed M., because of the restriction at Grossoni I, undergoes a bilateral paralysis of the brachial plexus, which means that he has both arms paralyzed. Did Mohamed M. suffer the spallaccio? The treatment that in a contained person leads to a massive rhabdomyolysis, is the infamous spallaccio long time protracted. As soon as at Grossoni 1 they found that Mohamed had lost the use of his arms, they quickly transferred him to the medicine ward “Medicina 2”, and made all the ward’s documentation disappear.
Rita F. because of a long and senseless restraint suffered at Grossoni I, gets decubitus ulcers, pulmonary thromboembolism, deep vein thrombosis and an urinary tract infection.
Francesco D., admitted to MURG (Urgent medicine) for severe respiratory failure is transferred to Grossoni III and after just three days dies. Did Francesco D. die because contained? On 26 September 2008, Francesco D. goes to the Emergency Room for a psychological assessment; there isn’t any psychotic emergencies, he is hospitalized for dyspnea in Urgent medicine in order to be treated. Francesco D. is an obese person, and a chain smoker. The MURG doctor, highly irritated by the inability to make him stop smoking, calls the Dr. Calchi to transfer him to the Niguarda’s Grossoni II psychiatric ward. Dr. Calchi, knowing that in her ward a patient, in order to prevent him from smoking, would be tied up to the bed; and that for a patient in those conditions the restraint can be deadly, opposes firmly to this admission, and when asked by the MURG doctor, she writes dawn her opposition. A few hours later the attending psychiatrist that replaces Dr. Calchi accepts the request of the MURG, and Francesco D., with his severe respiratory failure is transferred to Grossoni II. After just three days, Francesco D. "was found in a condition of circulatory arrest and, vainly subjected to resuscitative cares, was pronounced dead."
By the blood tests and urine analysis done by the Niguarda Hospital Clinical Chemistry and Patology Laboratory, in 2010 October 21, it appears that Tullio C., just three days before his death was fine. Tullio C. was admitted to Grossoni III, whose head physician is Leo Nahon. All operators of the Grossoni wards and of the Department of Mental Health, knew that Tullio C. has been tied up to his bed at 11 clock in the morning and that 14 hours later, at 2 in the night, he was found dead in his restriction bed. That is: he felt ill, got worse, came in agony and died in an immense solitude, blocked by the wrists and ankles, crucified on his restriction bed. He had the great misfortune to die suddenly and prematurely in a particularly heinous and cruel way.
Marinella S. was a patient of Dr. Calchi. Dr Mariano Bassi, head physician of Grossoni II, in the perspective of "mobbing" Dr. Calchi, in the beginning of this year, assigns Marinella S. to a different doctor. With the new psychiatrist Marinella S. is tied to a restriction bed for 438 hours in a row.
Andrea S., until July was a Dr. Calchi’s patient. In July, after Dr. Calchi’s suspension, Dr. Mariano Bassi, head physician of Grossoni II 'turns' Andrea S. to a different psychiatrist of his team. Afterward Andrea S. was immobilized by 8 nurses, dragged by the neck along the Grossoni’s corridor in front of the other patients strongly impressed and frightened; he was than tied to the restriction bed, where he remained for 14 consecutive days! During this never-ending physical restraint to Andrea S. were carried as many as 9 daily injections of three drugs (three injections a day per each psychiatric drug)!

Milan, November 23, 2010


Diritti umani e salute mentale



ENUSP - European Network of (ex) – Users and Survivors of Psychiatry - (Rete europea degli (ex)-utenti e sopravvissuti alla psichiatria) presenta:
Diritti umani e salute mentale
“Argomenti scottanti” dell’ ENUSP
= Il diritto alla libertà
= Il diritto di essere liberi dalle torture e dai maltrattamenti
= Il diritto al consenso informato e all’integrità fisica e mentale
= Il diritto di essere riconosciuti come persone con identità e potestà, che decidono delle loro cure e a cui è dato un sostegno, se lo richiedono, nel prendere le decisioni.

Rispetto della dignità umana nelle crisi di salute mentale
= Il rispetto della dignità umana e della salute mentale sono strettamente correlate.
= Il coinvolgimento degli utenti non è una questione di correttezza politica, ma un principio necessario sia allo sviluppo delle norme dei diritti umani, che all’incremento degli approcci umani, finalizzati al supporto di coloro che stanno sperimentando crisi di salute mentale.

Consenso politico e partecipazione dei consumatori e/o utenti dei servizi
= Nello scorso decennio c’è stato un largo consenso sulla necessità di coinvolgere gli utenti in tutti gli aspetti della politica e della legislazione, relativi alla salute mentale.

= Tuttavia, questo principio condiviso, non si è sempre risolto in un avanzamento pratico e significativo.

La partecipazione separata dai diritti
= C’è stata una separazione tra la partecipazione degli utenti e i diritti umani nell’ambito della salute mentale.
= Il coinvolgimento e i diritti sono stati relegati ad attività secondaria, invece di costituire parte principale dello sviluppo e della pianificazione nella politica della salute mentale.

Leggi e convenzioni importanti sui diritti umani
= Dichiarazione Universale dei Diritti Umani, 1948
= Convenzione Europea per la Protezione dei Diritti Umani e delle Libertà Fondamentali, 1950
= Principi delle Nazioni Unite per la Protezione delle Persone con Malattia Mentale, 1991 (Principi sulla Malattia Mentale)
= Convenzione Internazionale dei Diritti Civili e Politici, 1966
= Legge dell’OMS sulla Salute Mentale: dieci principi basilari, 1996
= Atto dei Diritti Umani del Regno Unito, 1998
= Convenzione ONU sui Diritti delle Persone con Disabilità, 2006
= Assemblea Generale dell’ONU del 28.8.2008, 63°sessione, Item 67 (a) rapporto di Manfred Nowak, Incaricato Speciale del Consiglio dei Diritti Umani sulle torture e altri trattamenti o punizioni crudeli, inumani e degradanti.
Diritti umani e disabilità/malattia mentale
= Le leggi e le convenzioni sui diritti umani, hanno tradizionalmente fallito nell’indirizzare gli interessi specifici delle persone con disabilità, o del sottogruppo con “disabilità” o “malattia” mentale.
= Alcune convenzioni speciali contengono specifiche clausole, necessarie per garantire i diritti a gruppi verosimilmente esposti a discriminazioni e abusi.

Dichiarazione di Vienna, 1993
= Questa Dichiarazione, alla Conferenza Mondiale dei Diritti Umani, ribadisce che le persone con disabilità mentali e fisiche, sono protette dalla legge internazionale dei diritti umani, e stabilisce che i governi devono adottare la legislazione locale per realizzare questi diritti:
=  “che tutti i diritti umani e le libertà fondamentali sono universali e che perciò devono includere senza riserve le persone disabili”.

Gli standard dei diritti umani per le persone con disabilità si evolvono
= A partire dall’adozione dei principi dell’ONU sulla malattia mentale e dalla recente attenzione ai diritti basati sulla Convenzione, c’è ora una maggiore attenzione rivolta ai diritti umani delle persone con disabilità.
= Organizzazioni internazionali dei diritti umani come Amnesty International, hanno ora iniziato a riconoscere che le violazioni dei diritti della salute mentale sono violazioni dei diritti umani.

Convenzione ONU contro la tortura
= La Convenzione delle Nazioni Unite Contro la Tortura e altri Trattamenti o Punizioni Crudeli, Inumani o Degradanti
 (http://www.unhchr.ch/html/menu3/b/h_cat39.htm), è uno strumento internazionale per i diritti umani, inteso a prevenire la tortura e altre simili attività.

Convenzione Europea dei Diritti Umani art. 3
= “Nessuno può essere sottoposto a tortura o a trattamenti o punizioni crudeli, inumani o degradanti”.
= Tina Minkowitz, per conto di Mind Freedom International, rileva che gli interventi psichiatrici coercitivi dovrebbero essere classificati sotto questo titolo.

Rapporto dell’Incaricato Speciale all’Assemblea Generale dell’ONU, luglio 2008.
= 40 - Persone con disabilità sono esposte alla sperimentazione medica e a trattamenti sanitari irreversibili senza il loro consenso, come sterilizzazione, aborto e interventi tesi a correggere o alleviare una disabilità come l’elettroshock e i farmaci che alterano la mente, di cui fanno parte i neurolettici.

= 41 - L’Incaricato Speciale è preoccupato del fatto che in molti casi tali pratiche, quando perpetrate contro persone con disabilità, restano invisibili o sono giustificate, e non sono riconosciute come torture, o altri trattamenti o punizioni crudeli, inumani o degradanti. La recente entrata in vigore della Convenzione dei Diritti delle Persone con Disabilità … fornisce una tempestiva opportunità per riesaminare il quadro contro la tortura in relazione alle persone con disabilità.

= 44 – L’Incaricato Speciale fa notare, che in relazione alle persone con disabilità, la Convenzione dei Diritti delle Persone con Disabilità, integra altri strumenti dei diritti umani per la proibizione della tortura e dei maltrattamenti …L’articolo 3) della Convenzione per esempio, proclama il principio del rispetto dell’autonomia individuale delle persone con disabilità, e della loro libertà di scegliere. Inoltre, l’articolo 12) riconosce il loro uguale diritto di godere della capacità legale in ogni area della vita, come la decisione su dove vivere e se accettare i trattamenti sanitari. Inoltre, l’articolo 25) riconosce che le cure mediche delle persone con disabilità, devono essere basate sul loro consenso libero e informato.

= 44 - Così, nel caso di precedenti standard non-obbligatori, come i Principi per la protezione delle Persone con Malattie Mentali del 1991… l’Incaricato Speciale fa notare che l’accettazione di trattamenti e restrizioni involontari va contro i provvedimenti della Convenzione dei Diritti delle Persone con Disabilità.

= 63 - All’interno delle istituzioni, così come in un contesto di trattamento coercitivo di pazienti esterni, il trattamento psichiatrico, inclusa la somministrazione di neurolettici e altri farmaci che alterano la mente, può essere imposto a persone con disabilità mentale, senza il loro consenso libero e informato, contro il loro volere e sotto coercizione, o come forma di punizione. Durante la detenzione e nelle istituzioni psichiatriche la somministrazione di farmaci, inclusi i neurolettici che causano tremori, dondolii, contrazioni, rendono il soggetto apatico e istupidiscono la sua intelligenza, è stata riconosciuta come forma di tortura.

= 63 – L’Incaricato Speciale rileva che la somministrazione coercitiva e non-consensuale dei farmaci psichiatrici, e in particolare dei neurolettici, per il trattamento di una condizione mentale deve essere controllata da vicino.

= A seconda delle circostanze, la sofferenza inflitta e gli effetti sulla salute degli individui possono costituire una forma di tortura o di maltrattamento.

=70 – Contro i continui rapporti che riferiscono di umiliazioni, negligenze, violenze ed abusi perpetrati contro persone con disabilità, il riconoscimento di queste pratiche per quello che sono, cioè torture e maltrattamenti, e l’utilizzo del quadro internazionale anti-tortura, permetterà vie legali per la protezione e i rimedi.

La coercizione non è medicina
= Interventi psichiatrici coercitivi non possono essere considerati pratiche mediche legittime.

= I trattamenti effettuati contro la volontà della persona interessata sono in contrasto con la maggior parte degli altri trattamenti sanitari.

= Negli anni scorsi sono stati fatti alcuni tentativi per estendere il consenso libero e informato nel contesto della salute mentale.

= Tuttavia, la legge e la consuetudine sono ancora basati sulle vecchie pratiche manicomiali, quando i pazienti non avevano alcun potere di rifiutarsi.

La coercizione non può guarire

= Le persone che sono nell’angoscia e nella sofferenza psicologica cercano di guarire ed alleviare il loro dolore. Molti trovano sollievo negli psicofarmaci o ritengono che siano un modo per gestire pensieri e sentimenti disabilitanti.

= Ciò nonostante gli interventi psichiatrici, con questi stessi psicofarmaci e contro il volere della persona, non possono essere giustificati come pratica medica.

= Gli interventi forzati dovrebbero essere intesi come una profonda violazione dell’integrità fisica e mentale di qualunque persona, attuati con il proposito di cambiarne la personalità individuale.

La coercizione causa ferite e sofferenza
= Gli interventi psichiatrici coercitivi terrorizzano e causano danni sia psicologici che fisici.

= “Vedere come di giorno in giorno deterioravo intellettualmente, moralmente ed emotivamente, mi terrorizzava. Prima sparì il mio interesse per i problemi politici, poi il mio interesse per i problemi scientifici, e poi il mio interesse nei riguardi di mia moglie e dei miei figli”.
[La presentazione di Minkowitz al Comitato contro la Tortura, 2006]

Aiuto medico o controllo sociale?

= In psichiatria, la coercizione cambia il ruolo del medico, che non è libero di concentrarsi nel servire i bisogni espressi dal paziente, ma è mosso dal dovere verso terze parti, per il controllo del “paziente” stesso.

= Questo è in conflitto con la prioritaria lealtà nei confronti del paziente da parte del medico.


Coercizione e diritti umani
= La coercizione in psichiatria è largamente diffusa e centinaia di migliaia di cittadini europei sono privati della loro facoltà legale.

= In molti paesi l’istituzionalizzazione di lunga durata è ancora una routine.

= In quasi tutti i paesi la legge presume che il trattamento sanitario sia un bene indiscutibile, e che le persone diagnosticate siano costrette ad accettarlo.

= Tuttavia, persino entro la professione medica non esiste un accordo sull’efficacia e i benefici dei farmaci e dell’elettroshock.

Le diagnosi psichiatriche non sono basate né sulla scienza né sul consenso
= Le rivendicazioni della psichiatria come scienza sono controverse, nonostante guadagnino terreno in tutto il mondo.

= La psichiatria non è basata su una scienza naturale. Per la malattia mentale non esiste alcun test biologico conclusivo.

= Le diagnosi sono approvate da comitati internazionali, e non emergono dall’osservazione della natura o dal consenso sociale e dei pazienti.

La psichiatria istituzionale può essere (ab)-usata a scopi politici
= La storia della psichiatria evidenzia che è stata originata dal bisogno di controllare elementi della popolazione, non da un’innovazione scientifica.

= In tante parti del mondo e sotto i governi totalitari, la psichiatria è stata chiaramente uno strumento politico.

= La Convenzione Europea permette la “detenzione legale di persone dalla mente difettosa, alcolizzati, tossicodipendenti e vagabondi”.

L’Atto dei Diritti Umani e la legislazione sulla salute mentale
= Il potere di definire una mente difettosa, ricetta per un controllo paternalistico, è ancora nelle mani degli psichiatri, nella speranza che usino questo potere umanamente.

= Secondo Bindman e altri (un gruppo di psichiatri britannici), le cure mentali coercitive sono state affrontate (art. 3 dell’Atto dei Diritti Umani del Regno Unito), ma la giurisprudenza risultante è descritta da Gostin 2000 come “altamente deferente nei confronti delle autorità sulla salute mentale”.

= Alcune sentenze possono essere intese dai clinici di oggi non tanto come protezione dei diritti dei pazienti, ma come autorizzazione per pratiche indesiderabili.

Atto dei Diritti Umani del Regno Unito
= Nell’incorporare la Convenzione Europea sui Diritti Umani, l’Atto dei Diritti Umani del Regno Unito perpetua, invece di contrastare, la minore tutela dell’autonomia dei pazienti con malattia mentale rispetto agli altri pazienti, che rappresenta lo spirito della legislazione convenzionale sulla salute mentale (Szmukler & Holloway, 2000).

= Bindman e altri (2003) argomentano che, nonostante l’Atto, la capacità dei pazienti di prendere decisioni sui trattamenti è essenzialmente ancora ignorata.

Dai Privilegi ai Diritti
= Il rapporto del Consiglio Nazionale sulla Disabilità degli Stati Uniti, NCD, (Gennaio 2000, “Dai privilegi ai diritti: persone etichettate con disabilità psichiatriche, parlano di loro stessi”) raccomanda:
·      che le politiche pubbliche si muovano verso un sistema di salute mentale totalmente volontario;
·      che i trattamenti di salute mentale siano per curare e non per punire; e che alle persone etichettate con disabilità psichiatriche sia dato il ruolo centrale nel definire le politiche e i servizi.

Citazione dal NCD (Consiglio Nazionale sulla Disabilità)
= Quando le persone sono ricoverate in un ospedale generale per ogni altro problema: infarto, cancro, bacino rotto, test, queste persone non si sognerebbero di permettere ai dottori, alle infermiere o agli assistenti di metterle sotto chiave, di sottoporle ad elettroshock, di legarle o di drogarle; e il personale non farebbe queste cose a loro. Quei pazienti sono trattati con compassione, cura, rispetto e dignità; e le persone che hanno seri problemi mentali/emozionali necessitano dello stesso trattamento (Bernice E. Loschen)
Consiglio Nazionale della Disabilità, Gennaio 2000)

La coercizione non è scomparsa ma si è diffusa di più
= La psichiatria coercitiva si espande, come evidenzia la decretazione in tutto il mondo di varie forme di reclusione di pazienti esterni, che autorizza i giudici ad imporre interventi psichiatrici sulle persone che vivono nelle comunità.

= Tuttavia è l’attitudine sociale non la carenza di trattamenti, che hanno dimostrato ancora e sempre, di essere la principale barriera all’inclusione sociale, per molte persone diagnosticate e trattate come malate mentali.



Dal rapporto del Consiglio Nazionale sulle Disabilità
= Le risorse per la ricerca del governo dovrebbero porre una priorità più alta sullo sviluppo di alternative culturalmente più appropriate rispetto all’approccio medico e biochimico della cura di persone etichettate con disabilità psichiatriche. Inclusi l’auto-aiuto, il sostegno dei pari e le alternative al sistema tradizionale della salute mentale introdotte dagli utenti/sopravvissuti.

Convenzione delle Nazioni Unite sui Diritti delle Persone con Disabilità, 2006
= I paesi che hanno sottoscritto e ratificato questa convenzione, si impegnano a promulgare leggi e altre misure, atte a migliorare i diritti e ad accordarsi, per sbarazzarsi delle legislazioni, dei costumi e delle pratiche discriminanti nei confronti delle persone disabili.

= L’idea è che l’assistenza e la carità debbano essere sostituite da nuovi diritti e libertà.

= 150 paesi hanno firmato questa Convenzione, ma molti, incluso il Regno Unito, non l’hanno ratificata.

Diritti e sviluppo = vera democrazia
= La convenzione delle Nazioni Unite del 2006, fornisce un modo per correggere anomalie esistenti nei diritti delle persone con disabilità mentale.

= I diritti umani non possono essere rispettati senza il coinvolgimento significativo degli utenti. Il coinvolgimento degli utenti è un diritto come parte della democrazia.

= I diritti e il coinvolgimento, nella concettualizzazione, nei sistemi diagnostici, nella legislazione e nelle decisioni sui trattamenti, potrebbero creare un più accettabile sistema umano di psichiatria.

Conclusioni
= L’esistenza di un forte movimento internazionale di sopravvissuti che richiede cambiamenti è una prova che esistono problemi seri nel sistema corrente.

= Le nostre voci non possono essere escluse dal dibattito per le riforme, specialmente per quanto concerne le diagnosi, i trattamenti, i diritti e le leggi.

= L’aumento di coercizione è un errore costoso. Abbiamo bisogno del diritto alla buona qualità, al trattamento volontario, e al sostegno per l’integrazione sociale.

Dr. Jan Wallcraft e Dr. Gabor Gombos
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