Bali
Declaration 2018
Transforming Communities for Inclusion- Asia Pacific
[TCI Asia
Pacific]
We, persons with psychosocial disabilities and
cross disability supporters from 21 countries of the Asia Pacific region, in
Bali, on August 29th 2018, and at the Plenary meeting of Transforming Communities for Inclusion – Asia Pacific [TCI Asia Pacific], [1]
Hereby confirming
·
The systematic and pervasive violation of all
our human rights; including all forms of discrimination, exclusion, violence,
inhuman, degrading and torturous treatments taking place, in higher and lower
income countries; in cities and rural areas; in outer islands; in institutions
and communities; in schools, universities, health care centers, and in social
services.
·
The failure of the most current, and new policy responses framed by the medical model
which are restricting freedom, choice and opportunities; the gatekeeping by the
mental health system, by assessing, conditioning, controlling and restricting
our exercise of our rights; often ignoring resources for inclusion within
communities, cultures, belief systems that may increase our choices and chances
of full inclusion.
·
Those policy responses often centered on
mental health do not comply with international human rights standards and, frameworks
provided by various international Conventions and treatises, most importantly,
the UN Convention on the Rights of Persons with Disabilities [CRPD].
Encouraged by the progress made by some countries in the region
ensuring the inclusion of persons with psychosocial disabilities within policies
and legislation for the inclusion of all
persons with disabilities, in accordance with the CRPD; confirming the absolute relevance of the paradigm shift towards
'inclusion' and away from medical model or a sole focus on 'mental health';
Alarmed by
the extent to which even the most progressive mental health environment still
control and deny our rights to education, work, have a family, access to social
protection, food, basic needs and an adequate standard of living; rights to
vote, life and liberty, equal recognition before the law, among all other
rights guaranteed by the human rights framework;
Among the issues
of sustained discrimination, and exclusion of persons with psychosocial disabilities,
we highlight as grave:
·
The growth of new mental health laws in the
Asia Pacific region with core provisions of involuntary admission and
treatment; often leading to highest rates of stay in psychiatric hospitals [2];
the terrible conditions in mental institutions, including physical and sexual
abuse of people with psychosocial disabilities of the region [3];
risk of life due to infections, starvation, malnutrition, direct shock
treatment (Shock treatment without the use of anesthesia)[4]
, unregulated use of restraints and solitary confinement, and other inhuman,
degrading, and torturous treatments;
·
Violations in the families and communities-
including pasung, (shackling) a
practice commonly found; being cast out
and deprived of all access to any kind of family, or community engagement;
seclusion in inhuman, degrading, cruel and torturous conditions within social
care institutions, unregulated houses, shanties and animal coups;
·
The complete silencing of voices of persons
with psychosocial disabilities through State sanctioned discrimination using
incapacity laws more frequently practiced in the Commonwealth; the systemic
discrimination against our inclusion within development especially of women,
children, LGBTI, indigenous and other groups otherwise facing multiple discriminations
in our societies.
That, such
concerns are not being a sporadic occurrence but confirmed as frequent
occurrences, in all parts of Asia Pacific; deeply embedded within legal,
normative, and social structures; being reinforced by colonial, historical
traditions set within national laws;
That, such
violations in law and practice cannot be addressed by marginally improving
mental health systems that perpetuate the denial of human rights in the name of
'our best interest', but by adopting the full shift of paradigm of the CRPD
towards inclusion in accordance with our choice, will and preference.
Recalling,
·
Commitments of all UN members states to
implement the sustainable development goals to leave no one behind reduce
inequalities and empower and promote the social,
economic and political inclusion of all,
·
Obligation of most Asia-Pacific countries that have ratified the CRPD to promote, protect and ensure the full
and equal enjoyment of all human rights and fundamental freedoms by all persons
with disabilities, and to promote respect for their inherent dignity, autonomy
and independent decision making, on equal basis with others
·
Commitments of all Asia
Pacific states to "Make the right real" for all persons with
disabilities through the implementation of the Incheon Strategy
·
Commitments of
Pacific countries to the Pacific Framework on the Rights of Persons with
disabilities
Recognising, that an inclusive implementation of
Sustainable Development Goals and the full realisation of human rights
mutually reinforce each other,
Welcoming,
·
The concluding
observations and recommendations of the UN CRPD committee to Asia – Pacific
countries to date, as well as the General Comments on Equal Recognition before
the law (Art 12)[5],
Women with Disabilities (Art 6)[6],
Living independently and being included in the community (Art19)[7],
Non-discrimination and equality (Art 5)[8]
among others,
·
The reports of the UN
Special Rapporteur on the Rights of Persons with disabilities to the UN Human
rights Council on Social protection[9],
Inclusive policy[10],
Legal capacity[11]
and participation and rights-based support for persons with
disabilities [12],
·
The report from the
Special Rapporteur on the Right to highest standards of physical
and mental health to the human
rights council on Mental Health, statement on the "corruption" in the
mental health systems around the world[13]
and the denunciation of the "global burden of barriers" faced by
persons with psychosocial disabilities[14],
·
The 2017 Human Rights
Council Resolution on Mental Health and Human Rights[15],
including call to address the underlying social, economic and environmental
determinants of health; to abandon all
practices that fail to respect the rights, will and preferences of all persons;
de-institutionalization; to prevent
over medicalisation and to promote and respect the enjoyment of the rights to
liberty and security of person and to live independently and be included in the
community.
In full realization of all human rights as enshrined in the CRPD,
and especially the human right to live independently and be fully included in
communities (Article 19, General Comment 5), we want (1) to be able to decide
our place of residence and who we want to live with (2) have access to a range
of in home, residential and / or community support services nearby our places
of residence (3) be included in all services available on equal basis with
others and (4) all services should be responsive to our specific needs.
Call
for Actions
That recognize, inclusion of persons with psychosocial
disabilities involves a paradigm shift and reframing of policy environment from
medical model to social model; mental disorder to psychosocial disability;
public health to inclusive development; institutionalization to inclusion;
treatment to support systems, evoking the guidance of CRPD and the SDGs to
bridge such reframing;
·
That will place Inclusion of persons with
psychosocial disabilities as the purpose, process and outcome of all social,
legislative, policy, program, service actions, across all sectors, involving all
actors including, but not limited to health care, and within all Development
agendas, plans, programs, and partnerships for change,
·
Going beyond recent harm reduction approaches
for example, by the WHO, to revive and reform towards "humane" mental
health care; and also expressing apprehensions about the continuing
"reform" efforts to maintain the systemically flawed, archaic
colonial designs of psychiatric detention; and concerned that the WHO Quality
Rights[16]
would be wrongly considered as the solution to our problem of inclusion,
·
Adopting the movements for non-violent, peer
led, trauma informed, community led programs, healing, cultural practices
preferred by local groups of persons with psychosocial disabilities; attentive
to the movement of non-medical alternatives worldwide, and in the Asia Pacific
region; and progressive models for support in the communities,
We submit, the
following measures be realized, with the due consideration that persons with
psychosocial disabilities be engaged at every step-
·
The right
to education be realized within all educational systems supported by reforms
towards lifelong learning; access to alternative and augmentative means of
communication such as non verbal / arts
based expression; reasonable accommodation; access to flexible programs and a
range of support services; prohibition of hazardous, forced or over
medicalization and institutionalization of children;
·
The right
to work and employment be realized with the inclusion of persons with
psychosocial disabilities in all job markets, employment exchanges, job
placements and support for livelihood opportunities; provision of support,
flexible hours and reasonable
accommodation within work places; disability benefits at work, on equal basis
with others; due recognition of contributions; possibilities of professional
growth, access to trainings, promotions, etc. on equal basis with others;
·
The right
to adequate standards of living and social protection be realized for the inclusion
of persons with psychosocial disabilities in all social security programs; the right to food ensured; the right to housing being of utmost
importance, especially for relieving the persons in detention / shackled in the region, to prevent institutionalization
and to live in communities; social protection
schemes to help persons to escape poverty and to thrive; such schemes be designed to ensure the dignity, respect,
autonomy and independent living of all persons with psychosocial disabilities.
·
The right to health care be realized
including comprehensive general health care, on equal basis with others; that
psychiatric care does not become a barrier to access highest standards of
health and wellbeing; that reporting of iatrogenic concerns by persons with
disabilities and their families (for example, zombism, tardive dyskinesia,
Parkinson's, psychosis, suicidal ideation and behaviours, in addition to
metabolic, cardiovascular and other general health complications) be recognized
and addressed; various kinds of culturally sensitive healing and well being methods,
including diet therapy, yoga, tai chi, qi gong, meditation, trauma informed
counselling, talk therapies, arts therapies and other, be available within
health care coverage;
·
Program measures be available for
de-institutionalization, ensuring community support systems, such as personal
assistance, community circles of care, peer support, formal and informal
networks for support, family empowerment, listening spots, refuge / drop in /
quiet rooms, spaces for creative expression, personal insight building
especially about crisis, support persons trained to dialogue and negotiate the
safety on the basis of the will and preference of persons with psychosocial
disabilities, support to be available nearby where the person is living,
especially concerning the homeless, and environments of peace and safety within
communities;
·
The Right
to political participation is ensured in all countries of the region,
especially the right to vote, stand in elections, and hold public office;
We
recommend,
That, our right to full and equal recognition before the law be
immediately recognized by all countries in our regions; that laws be so
harmonized with the CRPD so that noone with a psychosocial disability shall
ever be denied a civil, social, political, economic or cultural rights on the
basis of "incapacity" or "unsoundness of mind"; that the legal system be cleansed of its
colonial legacy, especially in the Commonwealth;
That, the dictum of "Nothing about us without us" be
ensured in all processes including the development of technical, ethical and
other guidelines, policies, legislations, and any other efforts towards our
inclusion;
That, all United Nations and allied agencies, aid agencies, and
global actions of governments towards the development of our regions, including
the WHO, to consider our participation and inclusion in all co-operations
towards inclusive development; that all such actions be mindful of the paradigm
shift from mental health to inclusion;
We aspire,
· To
the extent that all such progressive actions for our inclusion are in our
interest, to contribute to those actions through co-operations on trainings,
capacity building, guidance on inclusion, research and any actions thereof,
towards re-directing the legislative and policy environment towards
inclusion;
· To
work with organisations whose goals are aligned with ours, and which respect
the principle of leadership and full and effective participation of persons
with psychosocial disabilities and our expertise on all matters that concern our lives and our
rights, in the drive for social change;
· To
have a meaningful place in our societies, be it through paid work, social
justice work, creative work, informal care and support work, or so on. We
believe that an environment that facilitates the full development of our human
potential in all its diversity will also further the social, economic, cultural
and political advancement of our societies.
Declaration adopted by TCI Asia Pacific
5th "Classic Edition" Plenary of TCI
Asia Pacific,
Bali, Indonesia,
29th August 2018.
Convenor:
Bapu Trust for
Research on Mind & Discourse,
704 Fillicium, Nyati
Estate, Mohammedwadi, Pune 411060 India
Email:
tciasia.secretariat@gmail.com
Web:https://tci-asia.org
[1] TCI Asia Pacific is an Asia Pacific
alliance of persons with psychosocial disabilities from the Asia and Pacific
regions, and their cross disability supporters, from 21 countries. The vision
of TCI Asia Pacific is the implementation of CRPD for all persons with
psychosocial disabilities. TCI Asia Pacific is focussed on expanding the
pedagogy and practice, of the inclusion of persons with psychosocial
disabilities (Article 19 of the UNCRPD).
[2]
Korean DPO and NGO Coalition for parallel report on CRPD (2014).
INT_CRPD_CSS_KOR_18207_E. After the new mental health was implemented, over 90%
admissions are involuntary. Average stay in mental hospitals is 247 days; 3693
days for those living in psychiatric sanatoriums. See
CRPD Monitoring Committee List of Issues in relation to the initial
report of the Republic of Korea. CRPD/C/KOR/Q/1 of 12th May, 2014.
[3]
Human Rights Watch, (2014). "Treated worse than animals. Abuses against
women and girls with psychosocial and intellectual disabilities in India".
https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girls-psychosocial-or-intellectual
Human Rights Watch, (2016). "Living in Hell.
Abuses against people with psychosocial disabilities in Indonesia".
https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia
[4]
Center for Advocacy in Mental Health (2006). "ECT in India". http://www.ect.org/?p=551, accessed online on
04-09-2018
[5] CRPD
/C/GC/1, (2014) CRPD General Comment 1 on Right to Equal Recognition before the
Law.
[6]
CRPD/C/GC/3 (2016) General Comment on Women with disabilities.
[7]
CRPD/C/GC/5 (2017) General Comment on Right to Living independently and being
included in community.
[8]
CRPD/C/GC/6 (2018) General Comment on Equality and Non - Discrimination.
[9]
A/70/797
[10]
A/71/314
[11] A/HRC/37/56
[12]
A/HRC/34/55
[13]
A/72/137
[14]A/HRC/35/21
[15]
A/HRC/34/32
[16]
WHO Quality Rights Initiative (2017). http://www.who.int/mental_health/policy/quality_rights/en/
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