Outlines consumer / survivor perspectives on common human rights issues in mental health systems, and outlines opportunities for change. Presentation by Indigo Daya, VMIAC Human Rights Advisor, at The Mental Health Services (TheMHS) conference 2018.

1. Indigo Daya
Human Rights Advisor, VMIAC
Adjunct Research Fellow, Swinburne University Honorary
Research Fellow, University of Melbourne
I know
why the caged
bird sings

2. A free bird leaps
on the back of the wind
and floats downstream
till the current ends
and dips his wing
in the orange sun rays
and dares to claim the sky.
But a bird that stalks
down his narrow cage
can seldom see through
his bars of rage
his wings are clipped and
his feet are tied
so he opens his throat to sing.
The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom.
The free bird thinks of another breeze
and the trade winds soft through the sighing trees
and the fat worms waiting on a dawn bright lawn
and he names the sky his own
But a caged bird stands on the grave of dreams
his shadow shouts on a nightmare scream
his wings are clipped and his feet are tied
so he opens his throat to sing.
Inspiration for this talk
Caged Bird
Maya Angelou
The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom.

3. Human rights in
Australia … a poor
record
Image credit: The Guardian
Image credit: The Conversation
Image credit: 7.30 Report
Image credit: Australian Human Rights Commission

4. Image credit: ABC News
Image credit: 7.30 Report
Imagecredit:ABCNews
Imagecredit:DailyTelegraph
Mental health is no different…
despite the Burdekin report over
25 years ago

5. Image credit: ABC News
Image credit: 7.30 Report
Imagecredit:ABCNews
Imagecredit:DailyTelegraph
Mental health is no different…
despite the Burdekin report over
25 years agoThese images wouldn’t normally be
shown at a mental health conference
because they might be distressing.
But if you think it’s upsetting to look at, just
imagine being on the receiving end.
If you want to see less distressing images like
this, please help change this system
so we stop causing people distress.
A message to workers & policy makers

6. I am calling on States to
move away from
traditional practices and
thinking, and enable a
long overdue shift to a
rights-based approach….
Mental health policies
and services are in crisis
– not a crisis of chemical
imbalances, but of
power imbalances.’
United Nations Special Rapporteur
on The Right to Health (2017)
The United Nations has been
strong in its criticism of mental
health systems. But no-one seems
to be listening.

7. Mental Health
acts do NOT exist
to give people
rights
Their main role is
to make it lawful
to breach
fundamental
rights
Misunderstandings about human rights & mental health
They give us a
few lesser rights
to try & make
up for the loss

8. Misunderstandings about human rights & mental health
Compulsory
treatment does
NOT uphold the
‘right to health’
It breaches the
right to health
because this right
includes informed
consent.

9. Human rights
breaches
in mental
health services
Occur as a
matter of
routine
Hurt
people
Lack
reasonable
justification
What can
we do?

10. Human rights
breaches are
common
practice

11. Human Rights from:
International Covenant on Civil & Political Rights
(1976)
Right to
recognition
before the law
Freedom from
torture or cruel,
inhuman or
degrading
treatment
Right to
life
Freedom
from slavery
& forced
labour
Right to
liberty &
security of
person
No-one
imprisoned
for inability
to fulfil a
contract
Humanity &
dignity when
deprived of
liberty
Freedom of
movement
&
residence
Right to a
fair hearing
Freedom
from
retrospective
criminal laws
Freedom from
interference
with privacy,
home, family
or reputation
Freedom of
thought,
conscience
and religion
or belief
Freedom of
information,
opinion &
expression
Prohibition of
national, racial
or religious
hatred
Freedom of
association
Right to
respect for
the family
Right to name
& nationality
Freedom of
assembly
Right to take
part in public
affairs
Rights of
members of
ethnic, linguistic
& religious
minorities
Right to
equality
before the
law

12. Rights that can be breached
for people using mental health
services (under ICCPR)
Right to
recognition
before the law
Freedom from
torture or cruel,
inhuman or
degrading
treatment
Right to
life
Freedom
from slavery
& forced
labour
Right to
liberty &
security of
person
No-one
imprisoned
for inability
to fulfil a
contract
Humanity &
dignity when
deprived of
liberty
Freedom of
movement
&
residence
Right to a
fair hearing
Freedom
from
retrospective
criminal laws
Freedom from
interference
with privacy,
home, family
or reputation
Freedom of
thought,
conscience
and religion
or belief
Freedom of
information,
opinion &
expression
Prohibition of
national, racial
or religious
hatred
Freedom of
association
Right to
respect for
the family
Right to name
& nationality
Freedom of
assembly
Right to take
part in public
affairs
Rights of
members of
ethnic, linguistic
& religious
minorities
Right to
equality
before the
law

13. Protection from
torture & cruel,
inhuman or
degrading
treatment
Equality before
the law without
discrimination
Right to
life
Right to
liberty &
security
Equal
recognition
before the
law & legal
capacity
Freedom from
exploitation,
violence &
abuse
Right to
physical &
mental
integrity
Freedom of
movement
&
nationality
Right to
participate in
cultural life
Right to
health
Right to
work
Right to
adequate
standard of
living
Right to
participate
in public life
Right to live
in the
community
Respect for
privacy
Freedom of
expression
& opinion
Respect for
home &
family
Right to
education
Human Rights from:
Convention on the Rights of Persons with
Disability (2006)

14. Protection from
torture & cruel,
inhuman or
degrading
treatment
Equality before
the law without
discrimination
Right to
life
Right to
liberty &
security
Equal
recognition
before the
law & legal
capacity
Freedom from
exploitation,
violence &
abuse
Right to
physical &
mental
integrity
Freedom of
movement
&
nationality
Right to
participate in
cultural life
Right to
health
Right to
work
Right to
adequate
standard of
living
Right to
participate
in public life
Right to live
in the
community
Respect for
privacy
Freedom of
expression
& opinion
Respect for
home &
family
Right to
education
Rights that can be breached
for people using mental health
services (under CRPD)

15. 1. Being subject to the Mental Health
Act
2. Being treated less favourably than
non-mental health patients
3. Lower standards of services or
facilities
4. Compulsory detention
5. Locked units
6. Denial of leave from hospital
7. Seclusion
8. No access to clean clothes
9. Physical restraint
10. Mechanical restraint
11. Chemical restraint
12. Body searches, strip searches
13. Inaccessible toilets
14. No toilets in seclusion
15. Lack of privacy for toilet and
bathroom use
16. Being prevented from observing
your religious practices while at a
service
17. Denied access to outdoors/sunlight
18. Punitive and/or humiliation by staff
19. No access to less restrictive
treatments
20. Denying visits
21. Being diagnosed with mental illness
based only on your thoughts, beliefs
or spirituality.
22. Having your mobile phone
confiscated
23. No access to privacy while using
phones
24. Information not accessible or not
provided
25. Being diagnosed with mental illness,
or deprived of choice, because of
your cultural beliefs.
26. Being prevented from cultural
practices while in services.
27. Having to appeal compulsory
treatment at the Mental Health
Tribunal instead of an independent
and open court.
28. Being given sedating medication just
before a Tribunal hearing.
29. Not being given notice of a Tribunal
hearing, or access to your notes
before a hearing.
30. No access to a lawyer
31. No access to an advocate
32. Denied access to service
33. Assaulted by security guards
34. Ignoring requests for help
35. Not responding to serious side
effects
36. Being forced to reside in a service or
facility not of your choosing.
37. Advance statement ignored
38. Compulsory treatment
39. Not provided support to make own
decisions
40. Not told about your rights
41. Undue influence / coercion
42. Not provided complete information
about treatment side effects and
risks
43. Not being given adequate time to
give informed consent
44. Failure to respond to your physical
health concerns with appropriate
physical health assessments and
treatments
45. Being physically or sexually
assaulted, or harassed, within
services — by staff or other patients
46. Not being believed after sexual
assault
47. Not allowed to lock bedroom door
48. No cognitive assessment with ECT
49. Being harmed by the health service,
including physical harm, mental
harm, emotional harm and spiritual
harm.
50. Breaching privacy by contacting
people you don’t want told
These are just some of the
human rights issues in
mental health services we’re
asked to address at VMIAC.

16. 1. Being subject to the Mental Health
Act
2. Being treated less favourably than
non-mental health patients
3. Lower standards of services or
facilities
4. Compulsory detention
5. Locked units
6. Denial of leave from hospital
7. Seclusion
8. No access to clean clothes
9. Physical restraint
10. Mechanical restraint
11. Chemical restraint
12. Body searches, strip searches
13. Inaccessible toilets
14. No toilets in seclusion
15. Lack of privacy for toilet and
bathroom use
16. Being prevented from observing
your religious practices while at a
service
17. Denied access to outdoors/sunlight
18. Punitive and/or humiliation by staff
19. No access to less restrictive
treatments
20. Denying visits
21. Being diagnosed with mental illness
based only on your thoughts, beliefs
or spirituality.
22. Having your mobile phone
confiscated
23. No access to privacy while using
phones
24. Information not accessible or not
provided
25. Being diagnosed with mental illness,
or deprived of choice, because of
your cultural beliefs.
26. Being prevented from cultural
practices while in services.
27. Having to appeal compulsory
treatment at the Mental Health
Tribunal instead of an independent
and open court.
28. Being given sedating medication just
before a Tribunal hearing.
29. Not being given notice of a Tribunal
hearing, or access to your notes
before a hearing.
30. No access to a lawyer
31. No access to an advocate
32. Denied access to service
33. Assaulted by security guards
34. Ignoring requests for help
35. Not responding to serious side
effects
36. Being forced to reside in a service or
facility not of your choosing.
37. Advance statement ignored
38. Compulsory treatment
39. Not provided support to make own
decisions
40. Not told about your rights
41. Undue influence / coercion
42. Not provided complete information
about treatment side effects and
risks
43. Not being given adequate time to
give informed consent
44. Failure to respond to your physical
health concerns with appropriate
physical health assessments and
treatments
45. Being physically or sexually
assaulted, or harassed, within
services — by staff or other patients
46. Not being believed after sexual
assault
47. Not allowed to lock bedroom door
48. No cognitive assessment with ECT
49. Being harmed by the health service,
including physical harm, mental
harm, emotional harm and spiritual
harm.
50. Breaching privacy by contacting
people you don’t want told

17. Human rights
breaches are
harmful, not
neutral

18. Mental health services
create mental and
emotional distress

19. Like so many others, when I used
mental health services, they only
focused on the ‘obvious’ issues,
like hearing voices and suicidality.

20. They never stopped to try and
understand the real issues.
This is a collage I made during an
admission—and if anyone had asked
me about it, I might have told them
about my experience of child sexual
abuse.
So much of what hospital staff
did to me replicated this abuse:
being taken away from my
home, detained, drugged,
secluded.
Eventually I found my recovery and
healing outside of psychiatry
services.

21. The residual effects of rights violations
(after nine years)
Nightmares
Panic attacks
Hiding unusual
experiences
Fear of seeking
support

22. Human rights
breaches are
not
reasonable

23. Mental health legislation seems to
assume we have…
• Reliable diagnoses of mental illness
• Effective treatments that improve health
• Real reductions in harm to self & others
• A balanced range of unrestrictive and
restrictive treatment options
• Consumers are generally satisfied and
have safe and good quality outcomes

24. What mental health acts make assumptions about
Has a mental
illness
Requires
treatment
Prevention
of harm
No less
restrictive
option
Improved
health
outcomes

25. Has a mental
illness
Diagnoses lack reliability & validity,
they’re subjective and often change
Requires
treatment
Unreliable treatment efficacy. At least a third of people are not
helped by psychiatric treatments, possibly more. Some are
harmed by treatment.
Prevention
of harm
Violence by consumers is largely over-stated. Psychiatry can’t
predict harm – risk assessments lack evidence.
No less
restrictive
option
There are many rights-based, less restrictive service options that
remain unfunded. Social determinants & trauma? Community-
based support? Coping skills? Counselling and therapy? Peer
support? Living with experiences (eg HVA)? Peer-run crisis and
support services?
Improved
health
outcomes
We die 20 years younger, in part from the side effects of forced
treatments. The consumer movement is growing – our very
existence is evidence that too many are hurt.
Why mental health acts assumptions are unreasonable

26. So, what
can we
do?

27. Improve understanding of the mental &
emotional impact of rights breaches
Staff and policy makers need to hear our testimony much more. The
impacts of harm must be made visible.
And the
she said
I wondered if
they knew
that...
I felt like… It started
when…
I wanted
to…
I couldn’t
understandI just wish
they’d… When I lose my rights,
I lose my humanity
When I lose my
humanity, I have no
mental health
I was trying
to ...

28. Embed human rights into quality & safety
policy, practice and measures
Rights Rights
The child abuse royal
commission showed us
that harms in powerful
institutions must be
made visible before
there is change.
Measure breaches
of rights – make it
visible
Create policies &
practice that put
rights first

29. Less sitting at ‘their’ table,
more work setting our own tables.
As consumers/survivors, let’s spend less time sitting at the system’s ‘table’
discussing ‘their’ agenda, and more time building our own spaces and agenda.
If you don’t have a seat at
the table, you’re probably on
the menu (but you get no
say in the menu)
At our own table, we get
to set the menu and the
guest list

30. Bring the public with us—and for us

31. Create rights-based, genuinely healing,
alternative pathways
• Much more work with social determinants – particularly
trauma
‘I didn’t need a mental health system, I needed a trauma system.
And I didn’t need a health system—I needed a community.’
• Community-based supports
• Coping skills
• Diversify workforces – where is counselling and therapy?
• Peer support
• Living with experiences: hearing voices approach, living
with suicide, emotional CPR
• Peer-run services: crisis & long term, social enterprise

32. Learn more, and join us, check out our
election campaign online
www.vmiac.org.au/election-18

33. How will you
take up the
challenge?
Facebook
@TheVMIAC @IndigoDaya
Twitter
@VMIAC @IndigoDaya
www.vmiac.org.au