Mission on Psychosocial Disabilities: Brief Report

Final Report (Philipines), April 9th

Mission on Psychosocial Disabilities: Brief report

Bhargavi Davar

Arrival in Manila: 21st March, 7 p.m.

There were three broad activities planned for the Mission:

a)      Field visits of Coalition delegation to a diversity of groups, services and facilities

b)      The Preparatory workshop with the core members of the coalition

c)       Exchange and sharings with the local user survivor group

a)                  Field visits of Coalition Delegation to a diversity of groups, services and facilities

 

Visit to Life Haven, 22nd March 8.30 AM – 10.30 AM:

 

I met Janice Cambri, a survivor from Manila in the morning, on our way to Life Haven.  After introductions with the members of LH, I shared some experiences from India (e.g. about circle of care and neighbourhood alert system for homeless). We discussed some pressing concerns that LH faced, particularly on the homeless. A social worker from the government system joined us: the difference in perspectives was stark and led to more sharp questions on support systems. She favoured institutions, saw people with psychosocial disabilities as violent and preferred the use of force.

Giving support to any person with any disability is always on a customised basis. There was discussion on a woman who drops in at the LH center ever so often, but denies having a mental health problem. This too is not special to psychosocial disability. On the question of ‘how to help someone who does not admit to having a disability’: We cannot help someone who does not feel they have a problem. We cannot assume, attribute, or judge a problem on their behalf. Not everyone who behaves strangely has a (psychosocial) disability: It is good to sit them down and talk, how we can support someone, if at all. Even giving support to a person with physical disability takes time. It does not come naturally or spontaneously, and we have to acquire a habit of giving care. And, we have to admit that in some cases we cannot force our ‘help’. Janice shared her experiences of living with bipolar.

We also discussed the importance of having user survivors (perhaps Janice and her group) involved in peer support / providing assistance in other ways. LH could also consider identifying other local resource people / organisations.

For LH, which is based on principles of independent living, it is important that a community project not become a pathway to institutional care. So, LH could try apply the very same philosophies on disability that they are presently using, to people with psychosocial disabilities.

22nd March, Visit to National Center for Mental Health, Manila (2 pm – 3.45 pm)

 

The meeting with NCMH lasted about 2 hours, with the superintendent and his staff, in their conference room; followed by a visit to some of the wards or ‘pavilions’ as they are called. In our ‘delegation’ there was Weng, Liza, Janice, myself. Dr. Vicente shared many details about the hospital and how the system works. As elsewhere in the region, the mental hospital (earlier called, interestingly, ‘Insular Psychopathic Hospital’) is not prominently a Public Health institute, and continues to work as an asylum. It is built on 46 hectares of land, and can house upto 4000 people. Meagre community mental health services exist in Philippines, which is done at the initiative of the hospital, and there is no mandate for this. There is no law for commitment to the asylum. The superintendent did not know of any law, how involuntary commitment is possible (but believed that something must exist in the legal books). He gave an overview of the services provided by the hospital. 20% of ‘patients’ come through the criminal set up (court ordered). NCMH takes legal responsibility for the ‘criminal insane’, but not for non-forensic (e.g. insanity petition in context of marriage). For non forensic admissions, 2 psychiatrists need to certify (reminiscent of the practice in India), a job left to private psychiatrists.

On field visit to the wards, I found the situation to be the same as elsewhere in the asian region: 60 to 70% of ‘patients’ are in double or triple lock up (cell within cell within cell, ending in final cell of solitary confinement). The wards are bare and dirty, the women with hair shorn off, and in drab hospital clothes, with the pavilions having the ageless and deliberate stink of mental asylums anywhere in the region. (While still in the taxi a few meters away from the asylum, I mentioned to Liza that “I can smell the asylum, we are in the vicinity”.) We did not visit the male wards or the criminal wards. Many children are found in the facility in solitary (triple lock up), with MR or mental disabilities. We found one person tied to her bed. The nurses said that she was a ‘rush out’ patient, means, someone who had attempted to run away from the facility, and was re-arrested and towed back into the facility. Solitary is very widely used, with every ward having many such cages lined along the back walls. We found many people with physical disabilities (particularly many deaf women). Weng, a coalition member from our delegation, had many exchanges with them about sign language interpretation and how they can be sure that the ‘mental illness’ found is right or wrong, or even applicable, if they had no sign language interpretation. This is a very important issue, about how ‘mental illness’ is determined, which needs to be explored further in the Philippines.

What struck me most about these visits were

(1) the high number of children with MR / physical / mental disabilities interned here, and in triple lock up

(2) the high number of deaf and blind women over here without any kind of support for their disability and

(3) the extent of solitary confinement found in the wards (the total number of cages in each pavilion as well as the total number of people within each of the cages).

Constitution of Philippines and Rule 101

 

The constitution of the Philippines was made in the late 1970s, and carries the flavour of human rights. It is quite progressive. Chapter XIII makes provisions for social justice and human rights for all people; and prioritizes provisions for health of people with disabilities by the establishment of an agency which will address this specific need. A human rights section provides for visitorial provisions in jails, and all detention facilities, presumably including the mental asylums. Similarly chapter XIV on culture, science and technology, education provides for opening up of vocational and other services for people with disabilities. On bars due to disability, I have found only Article VII, section 7 (2) of Philippine Constitution which bars elected Presidents who may (have died or) have become permanently disabled, from performing their job. This is not specifically about ‘unsound mind’ but may have implications for all persons with disabilities. The Civil Code of Philippines defines the imbeciles, insane and the deaf mute as disqualified by law. The provisions, while granting full legal capacity, denies capacity to act for these people.

While there is no full law on involuntary commitment, as in India, there is a Rule 101, which gives the “Proceedings for hospitalization of insane persons”. There is the ‘Presidential Decree of 603’ (1974) which gives a Code for Child and Youth Welfare. Under this code, every child has the right to a well rounded development of his personality to the end that he may become a happy, useful and active member of society. An emotionally disturbed or socially maladjusted child may be treated with sympathy and understanding, and shall be entitled to treatment and competent care. Elaborate procedures are outlined in this Code for the involuntary commitment of abandoned, deserted or destitute children in suitable institutions.

22nd March, The Sanctuary, 3.45 pm – 5 pm

 

We visited the Sanctuary, which is a tranquil place. About 139 women live there, it is run by the government as a transit home, where recovered women can live, earn a livelihood and move on. It is however a closed facility (No one can go out, and no one can walk in). It is a closed door institution even though their philosophy is different. It is run by social workers. There are recreational facilities, places for activities. However there is a ‘medical’ ward where ‘violent’ patients are interned, and, there is a solitary. Many deaf women are found here also. They had a ‘workshop’ where women made arts and crafts: but, as with many NGOs, the products were not well finished and there was no market.

23rd March, Visit to Philippines Mental Health Association, 8.30 AM – 9.30 AM

Our team (Liza and myself) met staff from the Philippines Mental Health Association, a non-profit, who are working on mental health promotion and prevention on a large scale. They are working with the government on healthy lifestyles, and seem to be a kind of well being service with a public health approach. They made a special mention that they do not work with ‘people with mental disorders’. They do make referrals to the mental hospital. However, they have core mental health services at their center comprising of a multi disciplinary team of professionals, including psychiatrists, psychologists and others. They are doing extensive work in the community on awareness, and are focussing on community development through their 9 chapters. They occupy an important place within the mental health sector in the country.

23rd March, Meeting a ‘progressive’ psychiatrist,  11.30 AM – 12.30 PM

 

Following this, we had an informative conversation with a private psychiatrist who is also part of the radical left movement in the country, to which Janice owed allegiance. Wendy, a peer supporter from the ‘movement’ joined us. He confirmed that there were not too many private hospitals, and that, doctors do not like to get embroiled in legal issues relating to marriage, etc. He said that it may so happen that one can bribe a doctor and get a certificate, but he did not over emphasise the abuses or doctor’s roles in this, nor did he know this to be a huge publicly debated topic. He also talked about ‘homely’ residential facilities, which seemed like, there were no involuntary commitment procedures in private facilities or involuntary commitment was rather the exception rather than the rule. He did emphasize the totally apathetic role of the Philippines Psychiatric Association and of the government, even in the wake of the huge calamities the country has faced.

23rd March, Meeting an ‘alternatives’ psychiatrist 3 PM – 4 PM

 

We (Janice, Weng, Maffy, Abner, Liza, George, Juliet and myself) then met the founder, Dr. Randy, and Dr. Agnes from the Life change and recovery center, a ‘for profit’ project on ‘alternatives’. They are doing ‘life coaching’, and a whole host of other things including massage, hypnosis, etc. But, they had confinement …. and we did ask them a few questions on this practice. Weng had many questions to ask about how they dealt with the deaf. They didn’t know better and were interested in extending the scope of their alternatives. They were open to training on this subject, how to give support to people in crisis and also people with disabilities, particularly the deaf.

23rd March, 6 PM – 8 PM Meeting some resident doctors

 

Moosa Salie arrived in the evening, and joined us (Liza, Janice, Weng, Maffy and myself) for a meeting with 2 resident doctors. The doctors had not been exposed to community mental health, and our 2 hour meeting focussed largely on their concerns about how to work from the community, whether this is a possibility. One of them had given a proposal to their supervisors on mental health and disabilities; but that proposal was rejected, and the young doctor was quite upset about this.

 

b. 24th and 25th, Preparatory Workshop on Inclusion of People with Psychosocial Disabilities

 

The final objectives of the workshop was set in Bangkok, in a meeting with Alexandre, Liza, Rennel, Ka Lauro, Abner and myself, in 2 meetings. The first meeting elicited many questions from the group about services and how to give support, especially to someone in crisis. We finally set the objectives as follows:

 

–          Participants would be able to ‘know’ the disability: what is it? Can it be named and identified? What are the grey areas where questions and dilemmas arise? Making connection between experience of disabilities. Addressing myths.

–          Participants would be able to relate the discussions to the on-going activities of the core group: the parallel report, forthcoming laws and policies, and mobilisation (addressing the question, how to ‘fill the gap’ for parallel report, absent any user survivor movement or representation? What can be done as ‘coalition’ and what needs to be done only with representation? And, how to start inclusion / support user survivor leadership? To share process of India as illustrative.

–          Address laws / legal capacity / socio-economic and civil political rights. (3 laws – 1 alternative law)

–          To develop some ideas on ‘interventions’, ‘social services’, what to ask of the government: pathway to community care.

24th March, 9 AM – 5 PM

Moosa Salie (of WNUSP) joined us for the 2 days. Most coalition group members were present. The session elicited many questions on what is the disability, what services are required, and giving support to persons with psychosocial disability. I introduced the preparatory workshop by giving the background: Need expressed from Philippine Coalition; discussion within IDA; and meetings in Bangkok to finalise the objectives.

Different kinds of definitions given by various medical, social and human rights agencies were shared to facilitate dialogue. The medical definitions typically did not consider social barriers; focussed on the individual; and placed restrictions on who can be considered as having a disability (e.g. those with ‘psychosocial problems’ or ‘stressors’ were not considered eligible; and only those with ‘mental disorder’ were). Other definitions (UNCRPD, NAAJMI) were shared and discussed.

A group session was done, where participants had to

  • Describe very briefly, to their neighbour, what is most disabling for them, covering all dimensions of disability (physical / mental / sensory / intellectual)
  • And say what social barriers compounded their problems.

While this session was meant only as a simple warm up, stories started to pour in with much intensity and emotion, leading to a kind of peer support session. Since the content of the stories was very much psychosocial, I could not pull the plug by stopping the session mid way. Everyone had to speak. For many, this was the first time they had ever shared their stories, even though most knew each other. For others, the session brought back memories from far away. For some, the session triggered off anxiety and fears because of addressing very personal, emotional questions. And for others, the session brought back memories of people in their networks who were ‘psychosocial’, and not being able to support them. The traumas of Weng, Maffy and others in giving care were also shared.  Nearly all shared the physical, and mental components of their particular disability, and the mix and match was evident in the sharing.

The session was done to emphasize that every disability had both physical and mental components, and that this is a spectrum. External barriers aggravated the disabling aspects of these components. With psychosocials also, the same picture emerges: both physical and mental components may be found. The same equation of impairment x social barrier applied. For example, components in psychosocial disability may include

– Changes in sensory experiences (e.g. auditory, visual, skin, sensations, nightmares, flash backs, etc.)

– Changes in health condition (e.g. eating, sleeping patterns, pain)

– Changes in the experience of space, location and time (sense of being lost, wandering, being stuck in time)

– Changes in experience of one’s self (empty, being inhabited by many personalities within oneself,

wanting to ‘exit’ from oneself)

-Psychological changes may include emotional changes (sadness, fears, loss of safety);

changes in thought patterns (cyclical thoughts, having racing thoughts, suspicions, strange beliefs, focus)

We need not and cannot know the ‘medical condition’ behind the disability, just as we cannot know the specific diagnosis received by a blind person, or a deaf person, or someone with orthopaedic impairment. What we need to know is how to listen to each other, how to protect all rights and how to give support. This is the same story for all persons with disabilities. Just as in the case of deaf, there is a ‘pause’ period when we do not know what is the disability, and what is the meaning of support, in case of psychosocial also, such a pause period will be there, when we may not know how to give support. We can always ask. This is common etiquette in case of any disability.

Psychosocial disability is not about ‘lifestyle problems’, though life style changes will go a long way in improving lives of all people, and all people with disabilities. At the core it has ‘impairment’ which is measurable with comprehensive tools, but disability is more than the disorder. This insight too is not uncommon in the disability experiences. It is not also uncommon for some people to deny the disability, in such a case, we cannot force our support on them. Letting go is an option.

A person with psychosocial disability – is often feeling unwanted, unsafe, scared, in terror, frozen, ‘low’, in confusion, etc. and scared of themselves and their experiences. We can see more hidden, invisible and passive people with psychosocial disabilities in our communities, (at least in the south countries) than violent people. Angry people are everywhere. That is not a disability in itself. Bad behaviour must not be confused with psychosocial disability. Mostly, anger is just anger, found commonly in societies, and not always a symptom. There is a difference between the ‘mad’ and the ‘bad’, and both may be our judgement sometimes. Psychosocial disability is one area from where the call for peace, tolerance and caring for self / other has emerged (definitely so, from India.)

The session repeatedly emphasized two points:

1)      Knowing the medical condition is not necessary for giving support.

2)      The disability experience and questions thereof are the same for all disabilities.

March 25th

Janice and Weng made a presentation to the whole group on their findings from the field visits.

Some movies on possible support systems and interventions were shared the next day. The films led to a discussion on the role of traditional healing systems as systems of support and care. Moosa and Yeni’s experiences in their countries in this regard were not too good. However, in India, such spaces did provide support. Each country may have its own context.

Group work on laws:

 

Draft laws from Philippines (Mental health act), India (excerpts from the Indian disability legislation, mental health care act, civil society draft for a new mental health act) were given out for discussion. The time was too short for a studied approach. The groups presented the findings. I suggested that the group must engage more intensely with the Philippino act, because, while in general being far more positive than the Indian Act, with provisions for promotion of mental health for populations at large, it did have certain sections on involuntary commitment of people with disabilities. The day ended with a brief discussion on legal capacity. Even though everyone felt that this was a topic which is most confusing, time did not permit extensive discussion or dialogue on this.  The UNCRPD monitoring body had given out clear messages on legal capacity. World organisations such as the IDA and WNUSP had also put out their statements. Legal capacity must be seen in context to each person. There can be no universal picture about legal capacity. Legal capacity is about being a person and about being a citizen: it is more often a legal condition, rather than a medical condition or any measure of care, treatment and support needed. We don’t need to know how much legal capacity a person has before we provide a measure of care, treatment and support. Legal capacity denial in India is not only for people with psychosocial disabilities, but for people with disabilities at large. In Philippines, too, the situation may be the same, though not as intense: those disqualified by law are the ‘imbeciles’, the ‘insane’ and the ‘deaf mute’. This is possibly the reason why we are finding so many deaf people in the institutions.

Institutional relationships in Philippines and India are different, and was shared and discussed in the group. In the Philippines, there was no special law of institutionalisation, fewer institutions and greater scope for community based mental health work; Unlike in India, where the presence of the MHA has led to ferocious development of an institutional culture for people with psychosocial disabilities. It is more difficult to establish Article 19 in India, than in the Philippines.

PERSONS (as defined in the Philippines Civil Code / Republic Act 386)

Art. 37.  Juridical capacity, which is the fitness to be the subject of legal relations, is inherent in every natural person and is lost only through death. Capacity to act, which is the power to do acts with legal effect, is acquired and may be lost. (n)

Art. 38. Minority, insanity or imbecility, the state of being a deaf-mute, prodigality and civil interdiction are mere restrictions on capacity to act, and do not exempt the incapacitated person from certain obligations, as when the latter arise from his acts or from property relations, such as easements. (32a)

Art. 39. The following circumstances, among others, modify or limit capacity to act: age, insanity, imbecility, the state of being a deaf-mute, penalty, prodigality, family relations, alienage, absence, insolvency and trusteeship. The consequences of these circumstances are governed in this Code, other codes, the Rules of Court, and in special laws. Capacity to act is not limited on account of religious belief or political opinion.

Experiences from Indonesia

 

Yeni Rosa Damayanti had brought many many pictures of violence and abuse against people with psychosocial disabilities in Indonesia. We were particularly struck by several pictures of small bamboo cages, found outside people’s homes or in the open, where people had been kept interned. The picture of a young boy who had been tied to a post for several months touched our hearts and made us shocked. She also shared the pathetic condition of people interned in some traditional healing centers, but challenging them may mean taking on the religious sentiments in the country. Yeni Rosa also shared her work with the support group in Jakarta.

26th March 10 AM – 5 PM

We were delighted to have a room full of user survivors (about 15) and through the day, we went round the room, asking people to share their stories. Most users and survivors in the room would be willing to participate as a group with the coalition activities in future. A woman from Pavilion 10 attended the meeting, chaperoned by a staff from the asylum. We asked the chaperone to step off the room, which disturbed her a lot. The contributions from the room were rich that day, and documented by the coalition documenters.

Overall considerations: For the parallel report

  1. The field visits, the 2 day deliberations, and sharing; and finally, the data coming out from the user survivor meeting; can already provide the basis for inclusion in the parallel report.
  2. From available literature pertinent to the Philippines, it is clear only government data and WHO data is available. The coalition needs to make some more field visits (e.g. private psychiatric centers and community in patient wards) and find out more data about the systems in place. Are the community centers really there, who is financing them, how much, how are admissions made, what is the quality of care, etc.
  3. Emerging user survivor movement could be supported both in the Philippines and Indonesia. Janice, along with Weng, can play an important role in bringing the psychosocial perspective into the cross disability movement in the Philippines. The deaf have an intimate association with the mental health system because of the laws, and Weng, with her history of activism in the movement is in good position to represent / be a close ally of people with psychosocial disabilities. The user survivor group we met in Manila are also keen to link up with this policy discussions, and even if ‘not out’, they can contribute through emails and correspondence. Janice could bring them together in a forum in the context of the UNCRPD related activities of the coalition.
  4. Focussed attention need to be given to a full length law review, and not just the consultancy hitherto created in this area for the coalition. As much as in India, the legal capacity issue has overarching implications for all people with disabilities in the Philippines; though, in its favour, the Filipino incapacity laws do not seem to be as many as in India, or as overwhelming in its exclusion. The country has a constitution which was drafted in the ‘human rights’ era and does not have archaic colonial provisions, as in India.
  5. Child rights activism is big in the Philippines. The institutional abuses of disabled children can be brought to their notice, and they can come into the coalition with the child rights perspective.

Long term:

  1. Supporting the formation of a national user survivor group and leadership in the Philippines.
  2. Further, lawyers need to be brought in to contest strategic litigation relating to involuntary commitment and incapacity.
  3. There has been a call from various people who we met on understanding support and services for people with psychosocial disabilities: A CBR or other such community mental health program for people with psychosocial disabilities could be supported in the country with UNCRPD led values.
  4. In terms of future investments, Article 19 related investments are likely to find better appeal and outcomes in Philippines, because the environment is not as institutionalised as in India. The constitution already favours a rights regime for people with disabilities. And examples of community based services exist in the country.

Thanks:

Liza, Abner, Weng, Janice, George, Juliet, for being part of the delegation, and for being very actively co-ordinating and providing support throughout the Mission exchange.

Moosa Salie had the role of mentoring and supervising over the IDA supported training and exchange. He was present throughout the 2 days, and his role and his contributions are much appreciated by me and by the coalition. He brought a global / WNUSP picture to the discussions, sharing at every step the position that WNUSP has taken on various topics.

Alexandre Cote for opening up new action channels for the region and the mentoring throughout the planning and implementation of the Mission.

For more regional level actions:

1)      A strategy paper on this (which perhaps NAAJMI / Bapu Trust can take up for the region) will be useful.

Article 19 has more relevance in some countries than Article 12. Philippines and Nepal are good examples. There are spaces in the world (Nepal, Philippines) where there is no mental health law, fewer number of institutions, and the regime of legal incapacity is not overwhelming. And, those spaces are far more favourable for inclusion of people with psychosocial disabilities within CBR, independent living, alternatives…. etc., or immediately applying Article 19. Nepal is a clean slate, and it is possible to directly implement Article 19, without having to go through a turf war on Article 12.

Philippines (and Indonesia also perhaps) are hybrid, with a small number of mental asylums ungoverned by any constitutionally driven law on deprivation of liberty; where it is possible to apply Article 19 and directly contest the constitutionality issues through court. In these countries (unlike India) I have not seen pitched battles on Article 12.

I hypothesize that where there is a mental health law, the struggles over Article 12 are more sharp. In places where there is no mental health law, UNCRPD and article 19 can thrive. It will be very useful to compare the constitutional, legal and institutional relationships in Philippines with the case of India and Nepal.

2)      User survivor mobilisation and demystifying psychosocial disabilities extensively in the region, and beyond.

 

For us in Bapu Trust and NAAJMI, it took 4-5 years to slowly be included in the larger disability coalition. It required open heart and listening minds from both sides, and an environment of peace. However, the learnings of these 4 years have been huge, and can be translated into ‘crash courses’ on inclusion. This is a must in the region to speed up the integration process in cross disability work. Such work is much needed at the national / zonal levels also within India itself.

Annexure – I

VISIT OF DR. BHARGAVI DAVAR & MR. MOOSA SALIE (Mar 21-27)

Schedule

Date / Time Activity / Place Persons involved Remarks
21st (Wed) Arrival of Dr. Davar at NAIA Terminal 1(via Thai Airways TG624, 715pm) Pick-up by Liza at Arrival Hall with Thai Airways staff; George accompanying Taxi to hotel
  Check-in at Great Eastern Hotel Liza / George; Juliet will be at hotel Great Eastern Hotel (Quezon Ave, Quezon City)Tel: 3718282
22nd(Thu)830-1030 am Visit to Life Haven, meeting residentsAlso meeting with social worker from government systemLeave 7.30 A.M. and arrive at LH at 8.30 A.M. Janice / George / Juliet w/ Dr. Davar; Abner at LH Taxi to Life Haven4013 Gen. T. De Leon, Valenzuela City; Telefax: 3553572; Mobile No. 09238491064 (Abner)
11-1215 Meet up / lunch at EDSA Shangrila Food Court Basement 11.30am Janice /George /Juliet w/ Dr. Davar Liza / Weng[1] / Maffy from Sulo Hotel
1pm Session with Dr. Bernardino A. Vicente (Medical Center Chief) and all staffField visit at NCMHVisit deaf client at National Center for Mental Health (NCMH):

Dr. Azucena (supervising MD for deaf client)

Janice / Liza / Janice / Weng  w/ Dr. Davar NCMHTel: 5343241
3 pm Visit deaf and other women clients at Sanctuary Center Janice / Liza / Janice / Weng  w/ Dr. Davar Sanctuary CtrTel:5321164
23rd(Fri)8-9am Visit Phil Mental Health Association at 8.30 A.M. – 10.00 A.M. Liza pickup Dr. Davar at hotel lobby 7.30am PMHAhttp://pmha.org.ph/
930am-noon Session with survivors from human rights defenders: 3 participants; and progressive psychiatrist11 AM – 12.30 PM Dr. Davar / Janice / Abner / Liza; Dr. R. Lesaca UP Alumni Center, ofc of Woman Health
  Lunch C/o George, Juliet UP Alumni Center
1-4 Meet Doctors from Life Change Recovery Center (2 PM – 3 PM)Meet young resident doctors in the evening (6 PM – 7.30 PM) Dr. Davar / Janice / Abner / Weng / Liza / Juliet / Maffy / George C/o Agnes Agbayani: Exec Director, LCRC
  Arrival of Mr. Moosa Salie & debriefing with Mr. Salie Pick-up by George  at airportDr. Davar / Mr. Salie Taxi to Great Eastern Hotel
24th25th(Sat – Sun)

8am

– 5pm

Psychosocial disability workshop with core group of Phil Coalition on CRPD: approx 20 participants8.30 A.M. – 5 P.M. Dr. Davar, Mr. Salie Great Eastern Hotel
  Brief debriefing with organizing teamDebriefing with IDA Dr. Davar, Mr. Salie
26th(Mon)8am – 5pm) Peer support session for users/survivors: approx 13 participants Dr. Davar, Mr. Salie, Liza, Yeni Rosa Damayanti National Vocational & Rehab Ctr; J.P. Burgos St, Proj 4, Q.C.
  Brief debriefing with organizing team Dr. Davar, Mr. Salie
27th(Tues) DepartureDr. Davar: via TG 621, 1.05p.m.

 


 

 

Annexure – II

List of readings for the training

  1. Towards a charter of actions of deinstitutionalisation in Europe and Worldwide, Proposals and concrete actions, Trieste, May 2011. WHO, Dept. Of Mental Health and Substance Abuse, Geneve.
  2. “The process of phasing out psychiatric hospitals as places of social exclusion and the shift to community services”, A background paper and a declaration. “Beyond the walls: From the hospital to community services. Deinstitutionalisation and international co-operation in Mental health”. Trieste, 13-16, April 2011. WHO, Geneve.
  3. World report on Disability, WHO, Geneve.
  4. IDA CRPD Forum: Principles for Implementation of CRPD Article 12
  5. Tina Minkowitz, ‘Why mental health laws contravene the CRPD – An application of Article 14 with implications for the obligations of states parties’. WNUSP declaration, 2011.
  6. ‘Interim report of the special rapporteur of the Human Rights council’: Torture and other cruel, inhuman or degrading treatment or punishment, UN General Assembly Resolution A/66/268, 5th August 2011.
  7. ‘Mad Lives India’, testimonies from India, Bapu Trust for Research on Mind & Discourse, 2010.
  8. Draft laws from India, Philippines mental health act (draft proposed), disability law India (draft proposed).
  9. UNCRPD text
  10. “Effective use of International Human Rights Monitoring Mechanisms to protect the Rights of Persons with disabilities”. IDA, New York, 2011.
  11. WHO – AIMS report on “Mental Health System in the Philippines. A report of the assessment of the mental health system in the Philippinesusing the World Health Organization – Assessment Instrument forMental Health Systems (WHO-AIMS)”,Department of Health, WHO, Manila, 2007.

Annexure III

 

Salient features of the Philippines mental health sector[2]

There is no mental health legislation and the laws that govern the provision of mental health services are contained in various parts of promulgated laws such as Penal Code, Magna Carta for Disabled Person, Family Code, Rule No. 101, vagrancy laws, and Dangerous Drug Act, etc.

There is a program document on national mental health program at community level. Administrative Order # 8 s.2001. There are community based mental health inpatient services (19), 15 home care facilities. These seem to be smaller institutions but with some custodial practices. 46 outpatient services.

Prevalence is reported to be between 10 to 17%.

There are 3.47 human resources working in mental health for 100,000 general population with 500 psychiatrists. Rates are particularly low for social workers and occupational therapists. More than fifty percent of psychiatrists work in for-profit mental health facilities and private practice. Nearly all are in Metro Manila, with very few in the provincial areas.

Five percent of health care expenditures by the government health department are directed towards mental health. Of all the expenditures on mental health, 95% are spent on the operation, maintenance and salary of personnel of mental hospitals.

Forty eight percent of all admissions to community-based inpatient psychiatric units are involuntary. The proportion of involuntary admissions to mental hospitals is seventeen percent. The status of voluntary / involuntary admission to other facilities is in general not taken into account. However, it is estimated that the majority of admissions are involuntary. Over 20% percent of patients admitted at the mental hospitals were either restrained or secluded on admission due to violent and uncontrolled behaviors. In comparison to community-based psychiatric inpatient unit, it is estimated that 11-20% of patients were either restrained or secluded at least once within the last year.

No prevention or promotion programs are being done by the government.

Legal procedure for commitment comes from Rule Code 101. But doctors, even the superintendent of mental asylum did not report nor did they know of any law guiding the commitment process. This is surprising. Criminal procedure exists. Also institution culture does not seem to be so huge as in India.

 

 

Annexure -IV

Preparatory workshop on Inclusion of people with psychosocial disabilities in cross disability movement, Philippines, 24th – 25th March, 2012

Objectives of the workshop

–          Participants would be able to ‘know’ the disability: what is it? Can it be named and identified? What are the grey areas where questions and dilemmas arise? Making connection between experience of disabilities. Addressing myths.

–          Participants would be able to relate the discussions to the on-going activities of the core group: the parallel report, forthcoming laws and policies, and mobilisation (addressing the question, how to ‘fill the gap’ for parallel report, absent any user survivor movement or representation? What can be done as ‘coalition’ and what needs to be done only with representation? And, how to start inclusion / support user survivor leadership? To share process of India as illustrative.

–          Address laws / legal capacity / socio-economic and civil political rights. (3 laws – 1 alternative law)

–          To develop some idea on ‘interventions’, ‘social services’, what to ask of the government: pathway to community care.

Introductions to self / coalition members, going over objectives

Day 1

Session 1 (3-4 hours)

–          Group experiential session on ‘mental disturbance’ and debriefing on this (Adapted from Irish ‘Hearing voices network’)

–          Debriefing session with all participants

–          Exercise (distributing list and notching up on the board)

–          PPT presentation on key concepts on psychosocial disability as disability

–          Taking questions

Session 2 (rest of day)

–          Sharing personal story

–          Sharing NAAJMI experience on cross disability alliance: Value of inclusion and strategies for inclusion – PPT

–          Debriefing on application to core group work

Debriefing with organising team

Day 2

Session 3 (morning)

–          Short film on testimonies / brief presentation on field visit

–          Group work – on different formats of laws and implications for all persons with disabilities

–          PPT on civil political rights as foundation for disability rights

–          Debriefing in context of Articles 12, 14, 17, 19

Session 4 (afternoon)

–          (Self care) warm up / Short films on social services?

–          Group work / discussion on the WHO piece on social support [Board and pen activity]

–          PPT on social support systems with pictures?

–          Application to core group advocacy

Debriefing with organising team


[1]    Weng Rivera is President of Filipino Deaf Women’s Health and Crisis Center (FDWHCC)

[2] Soured from ‘WHO-AIMS, 2007, Mental health systems in the Philippines’, Manila; Department of Health, (2005). National Objectives for Health Philippines 2005-2010. Manila, Philippines: Department of Health.

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