Slogan March on “Let peace be the way to Mental health”

The photographs say it all. The Seher team, comprising, Pratik Kamble, Reshma, Nisreen Shaikh, Naziya Shaikh, Ratana Baygari, Almas Momin, Eknath Tongire, Dharma Padalkar, Bhagyashri Kulkarni, Kirti Jadhav, Kavita Nair,  and Bhargavi Davar, supported by Bhagyalaxmi Teli, Kimberly Lacroix, Niharica Shah, Sannuthi Suresh and Ritika Gupta (TISS-BALM interns),  raised slogans on Peace as a way to community development wellbeing and mental health. Some key messages included,

= Peace is important not only for people, but for the planet.

= When thoughts roam endlessly, apply the brake!!

= Give up violence. Adopt the path of peace.

= Anger, fear, sadness and other emotions rock the boat. Hold steady on the path of peace.

= Peace is in you. Just experience it.

= For mental wellbeing, cultivating peace is important.

 

Seher UCMH&I program

Slogan March Day in Yerawada
Slogan March Day in Yerawada

Seher, Urban Community Mental Health and Inclusion Program (2004- )

Seher, (meaning ‘Dawn’ in Urdu), envisions sustainable psychosocial health and disability inclusion through community development. We aim to reach the ‘bottom of the pyramid’ population through providing comprehensive psychosocial services, thus providing a service delivery model for bridging a huge gap in Disability Inclusive Development. The Seher program is built upon principles of social entrepreneurship, i.e. multiplying resources for care and support through capacity building and community participation, and where needed, direct psychosocial services, to enable the full inclusion and participation of people with mental health issues and psychosocial disabilities.

Giving life to Article 19 (CRPD): The touchstone of the Bapu Trust since the advent of the CRPD in 2007, is ‘transforming communities for inclusion’ of persons with mental health problems and psychosocial disabilities. Towards this end, since 2009, the Bapu Trust has invested in developing a sustainable service delivery, inspired by the CRPD, and inspired by the vision of Article 19.

Strategizing for social Innovations: The program started with modest modules on awareness through corner meetings, peer and support counselling, as a way of implementing inclusion. Then, individual counselling and family counselling modules were introduced. Evaluations were done on program and client impact by an independent team. Following better understanding of community social networks, a satellite program (‘Therapeutic Groups’) was started, and also studied intensively over several cycles. Following external evaluation, the TG strategy is now mainstreamed into the overall Seher program. In the process of these modular and studied innovations, Arts Based Therapies, awareness services, and strategies for addressing community inclusion were also integrated as cross cutting strategies. With support of student interns, the program has been studied in most of its key elements. At the moment, several components of our studies have been incorporated into a ‘8 Point Recovery Framework’. The integrated framework is due for evaluation in the year 2018.

Highlighting Outcomes:

1. A tested and evaluated modular program on Community mental health and inclusion services, using the ‘8 Point Recovery Framework’.
2. Reached out to upto 2000 persons with mental health and psychosocial disabilities in low income communities (bastis) of Pune city. Upto 400 people with ‘high risk’ for mental distress and disturbances provided peer support group services.
3. Based on the belief that inclusion is about everybody, over 200000 population covered with a diversity of services serving community information needs over a 5 year period.
4. Developed many tools and protocols for psychosocial interventions,
5. Design is geared for ownership by communities.
6. Strong partnership with the local authority (Municipal Corporation of Pune.)

Financing:

The program is now transitioning for upscaling to 5 centers of Pune, in collaboration with local authority (Pune Municipal Corporation). Each center requires upto 9000 USD per year, totalling 36000 USD per year. A small budget is released from government per center, this year. The government pays for space, infrastructure, medical and social services where needed. A number of local NGOs, CBOs, philanthropists, student interns and volunteers share our costs further.

Contact:

Kavita Pillai, Project Leader (Seher)
camhpune@gmail.com

Civil Society Response to COSP Background paper “Promoting the humanrights of persons with psychosocial and intellectual disabilities”

Promoting the human rights of persons with psychosocial and intellectual disabilities

 

Note by Civil Society Co-ordination Mechanism

 

The present document was prepared by a small working group for the Civil Society Co-ordination Mechanism, on the basis of available information, towards the round-table discussion on the background paper, “Promoting the rights of persons with mental and intellectual disabilities”, to be held at the ninth session of the Conference of States Parties to the Convention on the Rights of Persons with Disabilities, New York.

The members of the Civil Society Co-ordination Mechanism are extremely concerned that the background paper is developed completely within the bio-medical paradigm, and not the social paradigm as framed by the CRPD. The paper, while promoting the global mental health agenda of ‘filling the treatment gap’, remains silent on the topics of forced institutionalization, coercive psychiatry, and the vexatious continued use of inhuman, degrading, cruel treatments amounting to torture, within the mental health systems worldwide. In referring to outmoded documents such as the 1991 MI Principles, and promoting mental health legislations, this document is far from compliant with the UNCRPD, [vide the emerging General comments, Concluding Observations, observations by visiting SRs, thematic studies, research papers and various other developments within the UN system].  Finally, the paper makes no reference to the many good practice examples of community support systems that exist for persons with intellectual and psychosocial disabilities, facilitating their inclusion and full and effective participation in community life.

 

________________________________________________

 

Conference of States Parties to the Convention on

the Rights of Persons with Disabilities

Ninth session

New York, 14-16 June 2016

Item 5 (c) of the provisional agenda*

Matters related to the implementation of the

Convention: round table 2

 

       * CRPD/CSP/2016/1.

 

 

Promoting the rights of persons with mental and intellectual disabilities

Note by the Secretariat

 

The present document was prepared by the Secretariat on the basis of available information to facilitate the round-table discussion on the theme “Promoting the rights of persons with mental and intellectual disabilities”, to be held at the ninth session of the Conference of States Parties to the Convention on the Rights of Persons with Disabilities.

 

Introduction

 

  1. Persons with psycho-social and intellectual disabilities are among the most vulnerable, marginalized and excluded groups in society. They often face various forms of social and cultural stigma and discrimination, as well as barriers to exercising their civil, political, economic, social and cultural rights. The barriers are heightened because of the fast pace of urbanization, depletion of natural resources and the increasing human insecurity, poverty, natural calamities, migration, hunger, malnutrition, violence and conflict, etc. Barriers are posed by discriminatory legislation and practices authorizing deprivation of legal capacity and liberty, and various acts of violence, abuse, cruel, inhuman, degrading treatment and torture on the basis of disability, contra, General Comment No. 1[1] and the Guidelines on Article 14 [2].
  2. The discrimination against persons with psychosocial and intellectual disabilities is widely embedded in legislation, policy, case law and social and customary practices, throughout the world, resulting in systematic violations of human rights and exclusion. Additionally, it prevents access to justice and citizenship rights, locking people out of Development. We recognize that the UNCRPD is the highest applicable standard on the rights of persons with disabilities, to protect and fulfil the human rights of persons with psychosocial and intellectual disabilities. The UNCRPD overrides all other discriminatory instruments such as Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care (1991, WHO). All existing mental health standards, policies, definitions and data need to be reviewed by Member states, to ensure the enjoyment of human rights and fundamental freedoms of persons with psychosocial and intellectual disabilities on an equal basis with others in line with the UN CRPD.
  3. We recognize that the Right to good quality, accessible and affordable health care and wellbeing services is indivisibly linked to all other human rights and full and effective participation within Development processes, as defined by the SDGs. The SDGs provide a global, universal Development practice for all peoples of the world and a strong commitment made to communities and ecologies by all countries of the world. Poverty and hunger mitigation, ensuring clean water and sanitation, cultivating good health and well being, fostering peace, addressing gender and other inequalities, work, ensuring sustainable cities and communities, climate action, ensuring justice, and building strong institutions will result in better health and wellbeing for persons with disabilities and provide a social environment for highest attainment of all human rights for all[3].
  4. While persons with psychosocial disability and intellectual disability face similar barriers to the realization of their rights and full and effective participation in Development, it is important to acknowledge that psychosocial disability and intellectual disability are distinct from each other.
  5. The present paper addresses the rights of persons with psychosocial, and intellectual disabilities offers guidance to the social and human rights based model of psychosocial and intellectual disabilities, so that the highest attainable standard of health and wellbeing are enjoyed by them, on equal basis with others. Wellbeing is not just the absence of disease. It is the enjoyment of personal freedoms and choices, meaningful occupation, opportunities for learning and growth, having fun and leisure, spiritual and cultural pursuits, being within chosen support systems, being with family, friendships, having peer support systems and circles of care, and having access to good nutrition and being able to access fitness services, on equal basis with others.
  6. While persons with psychosocial and intellectual disabilities may fully enjoy good health and wellbeing on equal basis with others, nowhere in the world should it be allowed that, they are only seen as subjects of medical or / and psychiatric treatment. In this context, recognizing the Concluding Observations of the CRPD Committee in a variety of countries, and consistent observations by SRs, we recognize certain practices in medical treatment of disabilities as cruel, inhuman, degrading treatment, such as forced institutionalization, forced medication, solitary confinement and forced treatment[4], which continue to exist in many parts of the world. We recognize the problem of secondary disability caused by institutionalization, ECT and use of psychiatric drugs, which are closely associated with the high mortality rate of this population; and the significant harm to social and personal wellbeing caused by the trauma of forced psychiatric interventions.
  7. We recognize that the overall general health of populations can be compromised due to a variety of social, structural, economic, geographic, occupational, environmental, climactic and other factors, and confounded greatly due to poverty, gender, ethnicity, age and disability. In low income economies women who face severe occupational hazards, intensive physical labour, domesticity and manual work may be viewed by health providers as imagining their physical symptoms and referred to invasive medical treatment or psychiatry, instead of attempts to provide social protection and / or raise their standard of living to an adequate level (Article 28 of the CRPD). Women and adolescent girls are also referred for forced psychiatric treatment and institutionalization when faced with acute domestic and sexual violence within the household and in society.
  8. Upto 36% of people living in low income countries continue to experience coercive mental health legislations, and countries which do not have them, are making new mental health legislations, based on existing formats. OECD countries are all governed by coercive mental health laws and treatment practices. In most countries of the world, old colonial views of ‘unsound mind’ and ‘lunatic’ continue to be found within law. Further, a finding of ‘incapacity’ may result in forced and life-long institutionalization, creating a legal nexus for deprivation of human rights. As a result of the discriminatory legislation and colonial practices of segregation, citizens with psychosocial disabilities face intensive attitudinal and other barriers and threat to inclusion in community life. The necessary financial and human resources must not be used for perpetrating human rights violations, but be made available for realizing CRPD-compliant support for persons with psychosocial disabilities, including access to mainstream community based supports services and alternatives to the medical model, in compliance with the Article 19 of the UNCRPD , to ensure their being able to live independently and being fully included in communities.
  9. Consequently, states parties shall make all efforts to raise awareness, complying with Article 8 of the UNCRPD, to change the negative and discriminatory stereotypes of persons with disabilities and project them as primary holders of all human rights who can contribute to society in a positive way.
  10. The economy of institutionalization and de-institutionalization must be studied by pilots as described in the World Disability Report[5], Health care Budgets must be analyzed against outcome on the inclusion of persons with intellectual and psychosocial disabilities, their general quality of life, standard of living, and wellbeing. We recognize that in this sector, ‘more money’ does not mean ‘better services’; and that community based psychosocial and wellbeing services for all persons of communities, including persons with disabilities, may be cost effective and inclusive. Towards this end, we propose Member states to pursue economic studies to create good quality evidence base relating to service delivery.

 

International normative framework

 

  1. The Convention on the Rights of Persons with Disabilities includes those with psychosocial and intellectual impairments and addresses the barriers that may hinder their full and effective participation in society on an equal basis with others.[6] This includes persons with psychosocial disabilities, persons with dementia, and autistic persons, as well as well as persons with intellectual disabilities. Persons with psychosocial, and intellectual disabilities are guaranteed equal rights, treatment and opportunity by all provisions of the Convention and other relevant international norms and standards relating to disability.
  2. All Conventions and treatises are relevant to persons with psychosocial and intellectual disabilities, including the CEDAW, ICESCR, CERD, CRC, ICCPR. Jurisprudence is evolving in a number of older instruments with respect to persons with disabilities; UNCRPD jurisprudence is providing guidance, and explication through COs and GCs. Vide this recent knowledge, we recognize that abolishing mental institutions would be a way to end the ill-treatment, violence and torture against persons with intellectual and psychosocial disabilities, who are health care subjects on equal basis with others [7].
  3. Increasing international attention to disability is also reflected in the resolutions adopted by the General Assembly, the Security Council and the Economic and Social Council that mention disability.[8]
  4. The General Assembly also declared March 21 as World Down Syndrome Day,[9] April 2 as World Autism Awareness Day,[10]and December 3 as the International Day of Persons with Disabilities.[11]

Lessons learned and persistent challenges in the inclusion of persons with mental and intellectual disabilities in society and development development.

  1. In the present scenario of UNCRPD and SDGs, we recognize that inclusion of persons with psychosocial and intellectual disabilities in society and development, goes beyond just giving medical treatment and improvement of medical psychiatric personnel and facilities; and that inclusion will happen when all human rights are fulfilled, all stakeholders are involved, where there is a justice environment for all on equal basis, and persons with psychosocial and intellectual disabilities fully participate in all policies and processes that impact them.
  2. Poverty and hunger mitigation, ensuring clean water and sanitation, addressing gender and other inequalities, work, ensuring sustainable cities and communities, climate action, ensuring justice, cultivating community wellbeing, fostering peace, and building strong institutions will result in better inclusion for persons with intellectual and psychosocial disabilities [12].
  1. Access to appropriate voluntary care and support based in the community is extremely limited for many persons with psychosocial, and intellectual disabilities. In most countries, people are still deprived of their liberty and segregated in institutions as a method of medical treatment, despite the fact that voluntary community-based psychosocial and wellbeing services, with an emphasis on fitness, lifestyles, social engagements, family empowerment and various holistic alternatives to the medical model,[13] have been shown to be effective, less costly, reduce the socially disabling features of disability and are better at lessening social exclusion. Such support services must be accessible, address diversity of needs, and be located near the homes and communities where people live, in compliance with the Article 19 of the CRPD.
  2. Human resources for community based psychosocial and inclusion services to support people with psychosocial, and intellectual disabilities are severely lacking in all countries, particularly in OECD countries, where, due to insurance, health policy and legal systems, there is overdependence on medical and institution based care and communities have to be rebuilt. In low income economies, usually, social capital and natural care giving is high, traditional systems of social exchange and community life is still present, and can be resourced in realizing the right to living independently and being included in communities. Mutual exchange between all stakeholders in this diversified global scenario may bring clarity on modalities of building communities around wellbeing, involving different kinds of family and community arrangements, while respecting local experiences of family, culture and community.
  3. Persons with psychosocial and intellectual disabilities disproportionately face barriers to accessing and maintaining life long education. This is due in large part to a lack of understanding of the disability among families of children with psychosocial and intellectual disabilities, teachers and the local communities at large. In many countries, some children and adolescents with psychosocial and intellectual disabilities are institutionalized in facilities that do not offer education or are otherwise unable to access education. Children with psychosocial, and intellectual disabilities who do attend school often face stigma and discrimination by their peers and, sometimes, by their teachers, or leading to dropping out, as well as worsened well-being and quality of life. Inclusion in education establishes lifelong patterns of inclusion. Lack of training and awareness among teachers regarding provisions for inclusive and accessible education for persons with psychosocial, and intellectual disabilities results in inaccessible education facilities and education policies and practices that are discriminatory against children with psychosocial, and intellectual disabilities in many countries.
  4. People with psychosocial and intellectual disabilities experience high rates of unemployment. In some low- and middle-income countries, 90 per cent of persons with psychosocial disabilities are unemployed. Persons with psychosocial, and intellectual disabilities can work if universal design, support systems and reasonable accommodations are available, yet a lack of knowledge on the lived experience of people with psychosocial, and intellectual disabilities and stereotyping and discrimination have led to challenging situations.
  5. Implementation of article 12 of the Convention, relating to equal recognition before the law, has been particularly challenging owing to the general perception that persons with psychosocial and intellectual disabilities have difficulties in decision-making on their own, and due to harmful stereotyping of such persons as dangerous and untrustworthy, leading to anticipatory coercive measures that violate the rights to liberty and security of the person and freedom from torture and ill-treatment, as well as the right to legal capacity. Further efforts are needed to dismantle legal regimes that accord inferior and restricted legal capacity to persons with psychosocial, and intellectual disabilities, and to develop supported decision-making mechanisms that can meet the wide range of diverse needs experienced by persons with psychosocial, and intellectual disabilities in this regard.
  6. In situations of disasters or humanitarian crises, persons with psychosocial, and intellectual disabilities often suffer from the inaccessibility of emergency management and services and are left behind. Persons with psychosocial, and intellectual disabilities often experience high levels of distress due to the stress of emergencies, in addition to inability to access their accustomed support providers. Emergency health and social support services tend to lack services related to psychosocial well-being, and persons with psychosocial, and intellectual disabilities face difficulties in accessing immediate and emergency attention and, health care, social support, information, or even practical support and accessibility measures to enable them to meet basic needs. Overall, during and after disasters and crisis situations, people experience mental and emotional distress, affecting quality of life, resilience and the ability to prepare, recover and reconstruct. These conditions can have long-term consequences physically, psychologically, socially and economically and require both short- and long-term commitments of resources and solidarity as part of recovery and reconstruction as a whole, in ways that are healing and reparative for the individuals and communities concerned.  This means, inter alia, ensuring that support measures are offered a wide range of services and supports and are not automatically channelled into medical model mental health systems or subjected to non-consensual mental health interventions or non-consensual hospitalization. In such situations, persons with psychosocial, and intellectual disabilities are more susceptible to physical and sexual violence.
  7. Over the last 20 years we have witnessed the emergence of a vibrant self-advocacy voice around the world. Yet, this development has been uneven. Much work remains to be done to build self-advocacy in places where the is no tradition of self-advocacy and where persons with intellectual disabilities remain isolated and marginalized. Self-advocacy is about having control in your life and being heard. We know that self-advocacy begins at birth and it begins at home. Families need support to understand self-advocacy and how to nurture and develop it. Self-advocacy is essential for securing the full rights and inclusion of persons with intellectual disabilities.
  8. In low and middle income countries, persons with psychosocial and intellectual disabilities are coming together, forming civil society movements, and engaging in dialogue with policy makers. However, their experiences are not recognized in forming national policies due to attitudinal and other cultural barriers. Full and effective participation of persons with disabilities is the key to the success of efforts on fostering wellbeing and inclusion.

                      The way forward

25. Urgent efforts should be made to advance the rights and inclusion of persons with psychosocial, and intellectual disabilities by taking immediate steps to end harmful practices in violation of their human rights under the CRPD, increasing the accessibility of services fulfilling CRPD human rights standards, and promoting greater understanding of their lived experiences and perspectives.

26. Harmful practices in violation of human rights under the CRPD, including guardianship, substituted decision-making, restriction of legal capacity, compulsory or non-consensual treatment, compulsory or non-consensual hospitalization or institutionalization, and use of restraint or seclusion in mental health or social care facilities, can be meaningfully addressed in the following ways:

a. Reform of all laws and policies in order to prohibit guardianship, substituted decision-making, restriction of legal capacity, compulsory or non-consensual treatment, compulsory or non-consensual hospitalization or institutionalization, and use of restraint or seclusion in mental health or social care facilities, and until States repeal such laws and policies, a moratorium on any new instances of mental health legislations, forced treatment, hospitalization, or institutionalization, or guardianship or substitute decision-making regimes.

b.Immediate legislative, administrative, or judicial measures to ensure that all persons currently under forced treatment, hospitalization, or institutionalization, or guardianship or substitute decision-making regimes, are provided with the right and opportunity to end the regime or convert it to a support regime that respects the individual’s autonomy, will and preferences.

c.Reparative measures for individuals subjected to such regimes, including information, opportunity, and support to withdraw from psychiatric institutions, treatments or medications or reduce their use, in accordance with the individual’s will and preferences; compensatory preference (affirmative action) schemes for education and employment, including reasonable accommodation measures; social healing including apologies and other symbolic recognition, designed with the full and active leadership of people with psychosocial, and intellectual disabilities who have been so harmed; other measures to be designed according to local needs and preferences of those who have been harmed.

27.Services to meet the support needs of persons with psychosocial, and intellectual disabilities can be improved through:

(a)    Development of comprehensive community-based psychosocial and inclusion services with an emphasis on alternatives to the medical model of mental health, and strengthening the knowledge and skills of service providers in human rights-based support that fulfils the requirements of CRPD and respects individual autonomy, integrity, privacy, dignity, and choices

(b)    Developing and updating policies, and updating or repealing laws relating to mental health within all relevant sectors in line with the Convention on the Rights of Persons with Disabilities, in particular by enacting and enforcing clear prohibition of any treatment, hospitalization, intervention, or support without the express free and informed consent of the person concerned, including a full stop of court-ordered guardianship, treatment or placement regimes, including those based on notions of “protection” and “dangerousness caused by psychosocial disabilities”, and by promoting the social and human rights based model of support, and strengthening coordination among key stakeholders at the international, national and community levels, including as primary stakeholders with a leadership role the representative organizations of persons with psychosocial disabilities at every level;

(c)    Increasing skilled human resources for services to meet the support needs of persons with psychosocial, and intellectual disabilities, subject to their being trained in alternatives to the medical model of health and respect for human rights under the CRPD, such as community health workers and specialized mental health professionals, peer support providers with an equal pay scale as other professionals with comparable qualifications, as well as social workers and human rights advocates;

(d)    Utilizing electronic and mobile technologies and outreach subject to respect for the autonomy, will and preferences of the person concerned;

(e)    Accelerating deinstitutionalization and promoting the availability of a wide range of supports and services to meet needs related to the rightto live independently in the community,, based on the prohibition of coercive practices and the obligation to support the choices, autonomy, will and preferences of the person concerned.

28.It is also important to develop support systems for persons with disabilities using support services, so as to maximize their exercise of choice and control with respect to such services, and for families and support providers of persons with disabilities, provided that such systems should be geared to meeting family members’ and support providers’ own support needs and not violating the privacy of those they support or infringing their rights.

29.Education is important to raise awareness about the human rights of persons with psychosocial, and intellectual disabilities as full and equal members of society and of every community. It should be noted that efforts are under way to develop inclusive education systems that are designed to meet the needs of children with psychosocial, and intellectual disabilities on an equal basis with others. In addition, effective individualized support measures need to be provided in environments that maximize life long learning and social development.

30.Particular attention should be paid to strengthening education and training for employers, schoolteachers, human resources staff and supervisors on the rights of persons with psychosocial, and intellectual disabilities and the obligations of accessibility and non-discrimination including reasonable accommodation, to enable accessible and inclusive employment.

31.In the area of promoting preparedness, resilience and effective response for disasters and humanitarian crises, it is critical to include the perspectives and express needs of persons with psychosocial, and intellectual disabilities in all stages of planning and response.

32.We recognize that peaceful and just communities cannot be wrought by medical interventions; and that a wide range of peace building strategies and services towards conflict amelioration and reconciliation, building bridges of trust and nonviolent communication, forgiveness and emotional detachment, restoration of justice and trauma informed counselling services must be made widely available within communities.

33.Promotion of public awareness is imperative in tackling the stereotypes and discrimination faced by persons with psychosocial, and intellectual disabilities. Specific information and communications technologies and other innovations may be adopted to promote accessibility for persons with psychosocial, and intellectual disabilities, as well as sensitivity to the lived experiences and perspectives of persons with psychosocial, and intellectual disabilities as reflecting a full spectrum of human diversity and humanity.. Cultural and artistic means and innovations by persons with psychosocial, and intellectual disabilities can be used to promote awareness and understanding of the capabilities, strengths and achievements such individuals contribute to communities, and combat stereotypes and discrimination against them.

34.In all of these steps, it is essential to closely and actively involve persons with psychosocial and intellectual disabilities as leaders and primary stakeholders in consultations, decision-making, implementation, monitoring and evaluation, as well as follow-up actions. In particular, there is an urgent need to include the voices of organizations of persons with psychosocial, and intellectual disabilities in low-income countries, and to promote the independent development of such organizations where they do not exist.

35.In order to achieve inclusion at that level, the rights and perspectives of persons with psychosocial, and intellectual disabilities, the normative content and state obligations of the CRPD and the General Comments and Guidelines of the Committee on the Rights of Persons with Disabilities, need to be integrated in key considerations and planning for all United Nations work, including those related to peace and security, sustainable development, disaster risk reduction and humanitarian action, and human rights.

36.Technical tools and guidance notes on policies and programmes on the rights of persons with psychosocial, and intellectual disabilities, based on the normative content and state obligations of the CRPD and the General Comments and Guidelines of the Committee on the Rights of Persons with Disabilities, for coordination to develop global, regional and national networks for inclusive development designed to meet the needs of persons with psychosocial, and intellectual disabilities on an equal basis with others, with due regard for the leadership of persons with psychosocial, and intellectual disabilities, will be useful. In this regard, the implementation of the 2030 Agenda should take into consideration the expressed needs and perspectives of those with psychosocial, and intellectual disabilities and their full and equal human rights as guaranteed by the CRPD and interpreted by the Committee on the Rights of Persons with Disabilities.

Questions for consideration

  1. What are the main challenges and gaps in the inclusion of persons with psychosocial, and intellectual disabilities as part of efforts to achieve sustainable development?
  2. What are good practices and lessons learned at the local, national, regional and international levels in integrating the human rights, expressed needs, and perspectives of persons with psychosocial, and intellectual disabilities as a development issue?
  3. What kinds of measures and innovation have been successful or useful in improving accessibility for persons with psychosocial,  and intellectual disabilities?
  4. What concrete measures and actions should be taken by Member States, the United Nations system, civil society and academic institutions to implement the relevant Sustainable Development Goals for the full realization of all civil, political, economic, social, and cultural rights by all persons with psychosocial, and intellectual disabilities?
  5. What indicators should be considered to ensure that the human rights of persons with psychosocial, and intellectual disabilities, as guaranteed under the CRPD and explained by General Comments and Guidelines of the Committee on the Rights of Persons with Disabilities, are given due consideration in the follow-up and review of the implementation of the 2030 Agenda?

 

[1]CRPD/C/GC/1

[2]Committee on the Rights of Persons with Disabilities, “Guidelines on Article 14 of the CRPD, Right to LIberty and Security of persons with disabilities”, Adopted during the Committee’s 14th Session Held in September 2015.

[3]https://sustainabledevelopment.un.org/?menu=1300

[4]GC1, Paragraph 42

[5][5] World disability Report (WHO and World Bank, 2011).

          [6] Article 1 of the Convention.

[7] International Disability Alliance (2012). The Role of the inspectorates in promoting the right to live in the community. IDA: Geneva.

          [8] Numerous references were made to disability and mental well-being in resolutions adopted by the General Assembly, the Security Council and the Economic and Social council during the period 2000-2014. See AtsuroTsutsumi, Takashi Izutsu and Akiko Ito, Mental Health, Well-Being and Disability: A New Global Priority — Key United Nations Resolutions and Documents (University of Tokyo, 2015).

          [9] See General Assembly resolution 66/149.

         [10] See General Assembly resolution 62/139.

         [11] See General Assembly resolution 47/3.

[12] https://sustainabledevelopment.un.org/?menu=1300

[13]See Guidelines on Article 14, paragraph 24.

[14]Inclusion International (2014). Independent, but not alone. A global report on the right to decide. http://inclusion-international.org/wp-content/uploads/2014/06/Independent-But-Not-Alone.pdf

Submission to CRPD Committee on Article 19

Submission to the UNCRPD Monitoring Committee,

Day of General Discussion, Article 19

The CRPD Monitoring Committee has invited submissions towards the Day of General Discussion, and towards General Comment on Article 19.

http://www.ohchr.org/EN/HRBodies/CRPD/Pages/CallDGDtoliveindependently.aspx

Submission by TCI Asia 

Executive Summary

TCI Asia is an Asian alliance of persons with psychosocial disabilities and their supporters, which exists to enhance the pedagogy and practice of Article 19 for the region. We are delighted to participate in DGD proceedings towards a General Comment on Article 19. Our submission appeals to the Committee to (1) elaborate on the meaning of ‘communities’ and ‘inclusion’. (2)  Recognize that inclusive communities are a reflection of the human aspiration to love, support and share. (3) Recognize that a number of good practice models do exist, to explicate 19(2) of the CRPD, cited herein. (4) Stipulate those enabling CRPD compliant laws for states parties so that the right to live independently and be included in communities is a legally recognized human right everywhere (5) Ensure that international co-operation in implanting universal design in realizing Article 19 does not erase cultural / individual capability, Asian psychosocial healing practices and the rights of indigenous peoples.

About TCI Asia

TCI Asia (Transforming communities for Inclusion of persons with psychosocial disabilities, Asia) is an independent  Asian Alliance of organizations and persons with psychosocial disabilities, and cross disability supporters, focussing on Article 19 and its realization in the Asian region. Since 2012, TCI Asia has made several country visits, 4 annual plenary consultative processes, 1 strategy development workshop, conducted research and trainings; and has engaged upto 15 member countries and over 100 members, to enhance the pedagogy and practice of Article 19 for the region[1]. We are delighted that the Monitoring Committee of the Convention on the Rights of persons with Disabilities (CRPD) is holding a Day of General Discussion, towards a General Comment on Article 19 and we want to contribute constructively to this process.

General provisions of Article 19

Other than being a human right, Article 19 is the overall purpose of realizing the CRPD: All persons with disabilities will live independently and be included in communities, without discrimination and on equal basis with others. Article 19 may be considered as the heart of the convention, though it is not a new or a higher human right. Here, it is expressed with the full strength of Article 5 on Equality and Non-Discrimination provided for generally, and also in each and every provision. Article 19 compels us to locate the source of change, not in the individual, but in society which will establish equality, create opportunity, choice and support on equal basis with others. The four key stakeholders States must address in implementing article 19 are persons with disabilities, their families; neighbourhoods; service providers (both disability specific services mainstream services, government and private); and the society at large. The comprehensiveness of Article 19 invites an inclusive world for everybody, also ensuring the full and effective participation of all persons with disabilities on equal basis with others. The General Assembly interventions at the time of HLMDD and the making of the SDGs suggest that policy must shift the frame of access to Development from Welfarism to a framework of self-determination, inclusion, choice and human rights[2]. The CRPD committee, in May 2013 [3], recommended that international communities should ‘Take measures to ensure that persons with disabilities enjoy their right to development on equal basis with others’.

Article 19 makes reference to “Community”  [7] times. We urge the Committee to provide a rich picture of what an “Inclusive community” would have as key elements. The Thematic study by the OHCHR on Article 19 has exemplified what does not constitute community. The Thematic Study makes a contribution to guiding states parties in removing traditional barriers[4], echoed more recently by the OHCHR Expert meeting on Deprivation of liberty[5]. It is important to also elaborate constructively on what is community, in a modern human rights compliant society that is inclusive of persons with disabilities.

In a meeting in Pune (May, 2013) TCI Asia members from 5 countries advocated that personal identity and experience cannot be reduced to a diagnostic label or being just a user of a medical service, as often happens in communities. Identity encompasses having opportunities in experiencing multiple roles with dignity and autonomy, such as parent, sibling, spouse, teacher, banker, pastor, farmer, artist, postman etc.  and to be able to contribute emotionally and materially to the welfare of the society with dignity and autonomy.

In most cultures of the world caring for others, emotional connection and altruism prevail as a basic human duty or even a personal aspiration for living a happy and meaningful life. Article 19 could be interpreted as a reflection of this aspiration to give and receive support and care, while not compromising on the right to equality and non-discrimination. Extensive studies linking neuro-diversity with ‘happiness’, and recent Happiness studies in the field of economics, are evidence that empathy is essentially human[6].

A community is the availability of ‘social capital’[7] and ‘local actor networks[8], a collection of individuals, groups, families, neighbourhoods in local environments who come together on a platform of mutuality and respect, to reach a functional objective together, or to connect as human beings for sharing and caring without any necessary preconditions or outcomes. Such psychosocially founded networks bind families, individuals, cattle, plant life, other life forms, inanimate objects, land, water, food, and other actions and artefacts of human social living into an organic whole. This is the vision for a sustainable world contained within extant Development frameworks such as the Incheon Strategy and the SDGs. The Thematic Study also recognizes ‘virtual communities’ available in a variety of social media. The Committee may please strongly recognize the importance of transforming communities so that they become emotionally sustainable, to facilitate the inclusion of everybody, and for the preservation of a peaceful and caring planet.

New development theories provide concepts to capture this shift in thinking about community, the diversity and self determinism of peoples and the sustainability of human habitats, especially cities[9]. In the ‘capability’ approach’[10], an economic theory based on the theory of Justice, there is a need to evaluate policy outcomes based on the equability in the range of opportunities a person has, to achieve a certain desired state of being. In this approach, two aspects are important to address (1) recognizing agency and personhood of all persons with disabilities and (2) creation of choice by improving community inclusion.

Specific provisions of Article 19

In the Asian region, even though mental health legislations do not exist in many countries, and some have recently adopted new coercive mental health laws, mental institutions are coming up quite fast, resulting in the escalation of barriers to inclusion  [11] [12] [13]. This trend to associate modernisation with imposing buildings and infrastructure, and closed door facilities as compulsory places of residence, has elicited strong Concluding Observations from the CRPD Committee in the Asian context, illustratively, in the case of China and Korea. We propose that, the General Comment on Article 19 must restrain this worrying trend emerging in Asia, by

(1) giving specific guidance to state parties to prohibit old or new laws that create barriers; and enact enabling laws and revise constitutional jurisprudence by unconditionally protecting the right to live independently and to be included in communities in the manner provided for in the CRPD.

(2) enlisting  illustrative actions and programs that need to be supported by state parties to capacity build and transform families and communities for inclusion and for independent living of persons with psychosocial disabilities, including exemplifying ‘choosing the place of residence’.

We appeal to the Committee that local, cultural contexts may determine choice of residential facilities and services. Comprehensive enlistment of illustrative examples can be cited in the General Comment, which will explicate the diversity of services that need to exist, to fully embody the Article 19(b) provision of choice.

A number of ‘alternatives’ in community, neighbourhood and family development can be illustratively enlisted, such as Intentional Peer Support[14], Soteria house, Open Dialogue [15] [16], etc. which may be applied universally. In high income countries of Asia, there exist self managed models that can be adapted such as the ClubHouse, Independent Living or Hostel models preferred by persons with psychosocial disabilities[17]. Personal assistance would include simpler acts of companionship and offer psychosocial support, that come within the rubric of ‘Being with’ or ‘being present to’ someone with a psychosocial disability. There is strong advocacy globally, and in Asia region, for peer support and community based care giving systems, based on the values and principles of the CRPD.

Asian low income country examples also exist of ‘good practices’ when a person is in crisis, impoverished, homeless or wandering. A program provides peer support, night shelters and other essential services on the streets [18] with the support of local authorities. Another program provides a ‘circle of care’ establishing a ‘neighbourhood alert’ system to be with persons who may be in need of crisis support [19], involving a diversity of trained non-formal care givers, community members, and family members.  When there is conflict over the question of forced care, a community negotiation and capacity building module is initiated by the service provider, so that families feel empowered to give love, care and support. In such standardized community care programs, which are accessible and affordable, the community is reminded of their aspiration and duty to give love and care. The families are taught to provide reasonable accommodation, respect decision making and restore dignity of the person. Foster care giving and functional proxy relationships in neighbourhoods are accepted practices in some of these programs[20] to expand and protect the right to live in place of choice. The programs also multiply emotional effects by plugging into and capacity building existing Local Actor Networks, for example, the education system, local healers, health workers, development workers, traditional healers, etc. While these social relationships may have their stresses and strains, they may be devoid of the legal normative power of penal admission, institutionalization or guardianship. Inclusion International, in the context of empowering families and communities, brought out two useful reports [21] [22], on Inclusion within Development practise.

General Obligations of the State in realizing Article 19

Article 7– Childhood must be protected by state regulation, from needless ‘early intervention’, particularly the use of hazardous psychotropic medication and early institutionalization to contain behaviour in schools and at home.  Nutrition of households must be recognized and regulated as a highly impacting factor on mental health of all, but particularly of children.

Article 8- State parties must (1) recognize the importance of raising awareness and enhancing skills of the community and the family, on psychosocial disabilities to remove stigma, encourage inclusion into the community, create nurturance and ‘circles of care’; (2) Capacity build communities in areas where de-institutionalization is planned, so that communities may receive, accept, adapt, support and include  persons with psychosocial disabilities on equal basis with others; and also appreciate the contributions that the persons will make in turn to the community that welcomed them.

Article 10- State parties must ensure Right to life for persons with psychosocial disabilities who live in home environments and communities, as they may face higher risk for malnutrition, hunger, neglect, or other discrimination leading to poor health status, dependency and impoverishment.

Article 11- Asia region is prone to natural disasters, and other humanitarian strife and emergencies. State obligations and planning should responsibly cover for Inclusion aspects of all persons with disabilities.

Article 12 – States must ensure that laws exist that will recognize full legal capacity, recognize support systems for decision making, allow for autonomy, independent living, and full and effective participation in all life domains within families and communities.

Article 13- Ensuring an Enabling legal environment for Article 19, by fulfilling the obligation for a non-discrimination law inclusive of all persons with disabilities. The right to mental healthcare on the basis of personal choice may be a part of comprehensive health care legislation. If some countries in Asia choose to create mental health law, it must be CRPD compliant and recognize the right to live and receive healthcare in the community, with sustainable community supports towards de-institutionalization.

Article 14– Assuming the availability of new CRPD compliant laws ensuring de-institutionalization, and that the few existing mental institutions in Asia are in urban areas, a separate Guideline for a vibrant and Comprehensive Urban Psychosocial and Inclusion Program must be considered by the Committee. Such a design must include systems which are experience driven, contextual, keeping the person with disability at the center, and involving entire communities.

Articles 15, 16- State parties must address institutional abuses and those occurring in more voluntary community spaces on urgent basis.

Article 18- Constitutional support in enjoying nationality and full citizenship status on equal basis with others must be ensured by amending incapacity laws.

Article 22- (1) Colonial incapacity and guardianship laws found in many Asian countries, particularly Commonwealth nations[23]; place at risk confidentiality of medical treatment records and admission in a mental institution, especially of women with psychosocial disabilities, in the context of property, marriage and divorce. (2) In communities, ‘self’ and ‘other’ boundaries may be culturally and socially defined; However, the privacy of persons with psychosocial disabilities must be protected and ensured, on equal basis with others.

Article 25 – The gatekeeping practice of medical professionals to prohibit the choices of persons with psychosocial disabilities to seek out and use non-medical or traditional alternatives, oftentimes leading to reduction in their social capital and self healing resources, must be addressed. No intrusion should be made upon self care choices and lifestyles of persons with disabilities.

Article 28– States will ensure that persons with psychosocial disabilities and their families living in poor socio-economic settings receive the support they require, inclusion in insurance, pension and other social protection schemes; housing; poverty reduction and public distribution schemes.

Article 32 – States will ensure that international co-operation in implanting universal design in realizing Article 19 does not erase cultural / individual capability, Asian psychosocial practices and ways of life and the rights of indigenous peoples.

 

TCI Asia Contacts:

Convenor (2014- ): Bapu Trust for Research on Mind & Discourse

704 Fillicium, Nyati Estate, Mohammedwadi, Pune 411 060, India

www.baputrust.com, bt.admfin09@gmail.com 91-20-26441989

[1] This submission draws from the consultative processes done between 2012-2015 of TCI Asia. We are grateful to all member participants, allies, partners, and sponsors for the support and contribution.

[2] WNUSP and Bapu Trust, (2013). “Human Rights of persons with psychosocial disabilities in the post 2015 Inclusive Development Agenda: Towards HLMDD, September 2013”.

[3] ‘Statement of the Committee on the Rights of Persons with Disabilities on including the rights of persons with disabilities in the post 2015 agenda on disability and development’, May 2013, United Nations Human rights, Office of the High Commissioner, Geneva.

[4] OHCHR (2014) “Thematic study on the right of persons with disabilities to live independently and be included in the community” A/HRC/28/37 12th December 2014.

[5]  Expert meeting on deprivation of liberty of persons with disabilities

8-9 September 2015. http://www.ohchr.org/EN/Issues/Disability/Pages/deprivationofliberty.aspx accessed 26-02-2016

[6] Matthieu Ricard, (2003) Happiness. A Guide to Developing life’s most important skill. Little, Brown and Company, New York.

[7] McKenzie, K. “Globalisation, Social Capital and Mental Health”, in Global Social Policy, 2008, Vol. 8, pp. 359-377.

[8] A concept developed by Latour, Bruno in his book, (2010) The making of law: An ethnography of the conseil d’etat. Cambridge: Polity Press.

[9][9] UNHABITAT, (2015). The right to adequate housing for persons with disabilities living in cities: Towards inclusive cities. [Eds.] Szporluk, M., Pal, A. and Bayer, M. UNHABITAT, Geneva.

[10] Sen, A. K. (2009). The idea of justice. London: Penguin, Allen Lane.

[11] TCI Asia, Working Group on Strategy Development Meeting, APCD Training Center, Bangkok, 9-11 June, 2015

[12] KAMI, (2013). Parallel report on the situation of persons with mental illness in Korea. Submission to the UNCRPD Committee.

[13] Mr. WonYong Kim, NHRC investigator, Korea, who presented the Parallel report before the CRPD committee, noted the higher occurrence of mental institutions in Korea, following adoption of a new mental health law. In Korea, 73.5% cases are involuntary, 4 times as high as other countries. 262 days average stay.

[14] http://www.intentionalpeersupport.org/

[15] Finland, https://www.youtube.com/watch?v=aBjIvnRFja4

[16] Peter Statsny and Peter Lehmann, [Eds.] (2007). Alternatives beyond psychiatry. Peter Lehmann Publishing, Berlin.

[17] TCI Asia, (2014). 2nd Plenary, Hotel Prince Palace, Bangkok.

[18] Ishwar Sankalp, Kolkatta, India.

[19] Seher program of the Bapu Trust for Research on Mind and Discourse, Pune, India. https://www.youtube.com/watch?v=t5PC0yBK3ow accessed on 25-02-2016

[20] Shared in TCI Asia consultation on Legal capacity, Incheon, Korea, 18-19 November 2015, Orakai Sangdo Hotel, Incheon.

[21] Inclusion International, 2012. “Inclusive Communities = Stronger communities. Global Report on Article 19”, London.

[22] Inclusion International, 2014. “Independent but not alone. A global report on the right to decide”. London.

[23] Dhanda, Amita (2000) Legal Order / Mental Disorder. New Delhi: Sage Publications.

Invitation to the Inclusion Survey

The Bapu Trust in collaboration with TCI-Asia is compiling a Survey Report on

‘Good practices on the Inclusion of persons with psycho-social disabilities’

 covering the Asia region. The report will cover the present status of Inclusion of people with psycho-social disabilities; and  good practices that will facilitate full and effective participation and inclusion in communities.

The survey invites your views on Good Practices on the Inclusion of persons living with (or who have experienced) mental health problems/psycho-social disability. Your participation in this study is crucial to understanding the evolving state of inclusion of persons with psycho-social disabilities: What facilitates their full and effective participation in families and communities?

The survey is an online Google survey. The form is in English, and will take about 20 minutes to fill (not including any translation time that may be involved.)

A big motivation for this study is to find out, what means “Reasonable Accommodation” (RA) for persons with psycho-social disabilities. In the disability movement, implementing RA is considered as key for full and effective participation. What is RA for persons with psycho-social disabilities?

We invite you to participate in the survey. Please also share in your networks, and invite your peers to participate in the google survey.

Shikha Aleya at shikha.aleya@gmail.com is co-ordinating the survey for TCI Asia. Do get in touch with her for any clarifications or questions.

Please follow the link below to participate in this survey:-
We request you to please share this link and invitation to participate, with all members of your network who self identify as persons with psycho-social disabilities.
The survey will be open for your kind participation till the 15th of February 2016.

INTAR INDIA 2016

INTAR INDIA 2016

INTAR INTERNATIONAL CONFERENCE 2016

in Partnership with Bapu Trust for Research on Mind & Discourse, are Hosting Their International Conference:

 

‘Trans-Cultural Dialogues about Mental Health, Extreme states and Alternatives for recovery’

26 – 28 November 2016 – PUNE, INDIA

intar_flyer_small

The conference will provide a space for critical dialogue and interaction representing South, East, West & Northern perspectives under the following themes:

  • Crisis/Existential Experiencing
  • Cultural Experiencing and Responses
  • Peers/Grass Roots Support/Survivors

Plenary topics and workshop explorations include:

Body Therapy – Global Mental Health – Human Rights – Open Dialogue – Peer Houses – Peer Support – Performance/Film/Art – Posters – Systemic Family Constellations – Trialogue – Voice Hearing 

Many speakers & Activists have already confirmed, such as:

Michaela Amering – Richard Bentall – Pat Bracken – Liz Brosnan – Bhargavi Davar – Elena Demke – Sabine Dick – Jacqui Dillon – Will Hall – Gabor Gombos – Chris Hansen – Laurence Kirmayer – Líam Mac Gabhann – Paddy McGowan – Brian McKinnon – Sherry Mead – China Mills – Marianne Schulze – Peter Stastny – Phil Thomas – Bob Whitaker – Michael Winkelman.

For more information on conference as it becomes available check online at www.INTAR.org

Or contact: Bhargavi Davar, Center for Advocacy in Mental Health, Bapu Trust for Research on Mind & Discourse, Pune, India.

Blog: http://camhjournal.com

Website: www.baputrust.org

Email: india2016@intar.org

Phone: 0091-20-65222442 – (Mobile): 91-20-26441989

WE INVITE YOU TO CONTRIBUTE ORAL WORKSHOP/PRESENTATION; POSTER; PERFORMANCE; FILM; & OTHER ARTISTIC PRESENTATIONS THAT FIT WITH CONFERENCE THEMES

Submit short abstract (no more than 250 words) of your proposed contribution to india2016@intar.org

Finally…. “Dignity must prevail’ – Special Rapporteurs on World Mental Health Day

Members of TCI Asia very warmly welcome this statement from Ms. Catalina Devandas-Aguilar, SR on Rights of persons with Disabilities, from the office of the High Commissioner on Human Rights.

“Dignity must prevail” – Special Rapporteurs on World Mental Health Day

“Dignity must prevail” – An appeal to do away with non-consensual psychiatric treatment World Mental Health Day – Saturday 10 October 2015

GENEVA (8 October 2015) – The United Nations Special Rapporteurs on the rights of persons with disabilities, Catalina  Devandas-Aguilar, and on the right to health, Dainius Pûras, today called on States to eradicate all forms of non-consensual psychiatric treatment.

Speaking ahead of the World Mental Health Day*, the independent experts urged Governments to put an end to arbitrary detention, forced institutionalisation and forced treatment, in order to ensure that persons with developmental and psychosocial disabilities are treated with dignity and their human rights respected.

“Locked in institutions, tied down with restraints, often in solitary confinement, forcibly injected with drugs and overmedicated, are only few illustrations of the ways in which persons with disabilities, or those perceived to be so, are treated without their consent, with severe consequences for their physical and mental integrity.

Globally, persons with developmental and psychosocial disabilities face discrimination, stigma and marginalization and are subject to emotional and physical abuse in both mental health facilities and the community.  And every year, the rights and dignity of hundreds of thousands of people across the world are violated as a consequence of non-consensual psychiatry interventions.

All too often persons with developmental and psychosocial disabilities are formally or informally destitute of their legal capacity and arbitrarily deprived of their liberty in psychiatric hospitals, other specialized institutions, and other similar settings.

Dignity cannot be compatible with practices of force treatment which may amount to torture. States must halt this situation as a matter of urgency and respect each person’s autonomy, including their right to choose or refuse treatment and care.

Without freedom from violence and abuse, autonomy and self-determination, inclusion in the community and participation in decision-making, the inherent dignity of the person becomes an empty concept.  The international community needs to acknowledge the extent of these violations, which are broadly accepted and justified in the name of psychiatry as a medical practice.

The concept of ‘medical necessity’ behind non-consensual placement and treatment falls short of scientific evidence and sound criteria. The legacy of the use of force in psychiatry is against the principle ‘primum non nocere’ (first do no harm) and should no more be accepted.

The Convention on the Rights of Persons with Disabilities offers a promising occasion for a shift of paradigm in mental health policies and practices. This year’s World Mental Health Day stresses more than ever the need to elaborate new models and practices of community-based services that are respectful of the dignity and integrity of the person.

It is a good timing to take stock of the recent entering into force of the Convention on the Rights of Persons with Disabilities to open a dialogue amongst all stakeholders, including users of services, policy makers and mental health professionals to work on human rights based solutions which may provide answers to the questions brought forward by the Convention’s standards.

We call on States to end all instances of arbitrary detention, forced institutionalisation and forced treatment, to ensure that persons with developmental and psychosocial disabilities are treated with dignity and are provided their rights to have their decisions respected at all times, and to have access to the needed support and accommodation to effectively communicate such decisions.”

(*) World Mental Health Day, which is supported by the United Nations, is annually held on October 10 to raise public awareness about mental health issues worldwide. This year’s theme is: “Dignity in Mental Health.”

See more at: “Dignity must prevail” – An appeal to do away with non-consensual psychiatric treatment World Mental Health Day – Saturday 10 October 2015

Office of the High Commissioner for Human Rights