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The politics of suicide prevention

By David Webb - posted Wednesday, 21 December 2011


Despite all the hoopla of "stigma-busting" campaigns (which many people actually find patronising and indeed stigmatising), the single greatest source of the stigma around suicide, and mental health in general, rarely gets mentioned. The most severe discrimination occurs when it is enshrined in legislation, such as the racism of the White Australia policies, the homophobia that criminalises homosexuality, and so on. Most of these legalised forms of discrimination have now been abolished, at least on paper, but not yet in mental health. By far the major source of the toxic discrimination against suicidal people is mental health laws that make second-class citizens of people labelled as "mentally ill".

I think most people believe that one of the reasons we have mental health laws is to help prevent suicides. This noble aim is used to justify depriving people of their liberty and, furthermore, to force unwanted medical treatment on them. So let's assume, cautiously, that these laws come from good intentions, keeping in mind though that so did the Stolen Generation policies. But are these laws effective? Or do they possibly make things worse for (some) suicidal people? To use the medical jargon, what are the efficacy and safety of these laws? Do mental health laws help or hinder suicide prevention?

The first extraordinary thing about this question is that nobody seems to (want to) ask it. There is no research at all on the efficacy and safety of incarceration and/or medical force for the purpose of suicide prevention. This really is extraordinary. If we applied medical standards of evidence, then such an intervention with zero evidence of its efficacy or safety would never be permitted. All we have are status quo assumptions that detention and force are necessary to prevent suicides. But does this stand up to scrutiny? In the absence of any contrary evidence, I say there are powerful arguments against such laws, at least for the purpose of suicide prevention.

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Suicidal people, just like everybody else, do not want to lose their liberty, nor do they want to have medical treatments forced upon them against their wishes. So we find that mental health services are often deliberately avoided by the very people they are supposed to help. At the very least, this contributes to the suicide toll by failing those in need of help. But even worse, some suicidal people are finally pushed over the edge into suicide by the violence they encounter from these services. And even worse again, detention and medical violence can actually trigger suicidal feelings in people who have never previously been suicidal.

Glimmers of hope ...

Although the medicalisation of suicide and its collaboration in the legalised discrimination against suicidal people seem deeply entrenched, it is possible to detect some faint glimmers of hope for the future. Most notably, we can look to our disability cousins for a clear, comprehensive and very good roadmap of a way forward.

The UN Convention on the Rights of Persons with Disabilities (CRPD) was adopted by the UN General Assembly in 2006 and ratified by Australia it in 2008. It represents a huge milestone and an outstanding achievement of the disability rights movement over the last generation or so. At the heart of the CRPD is a shift away from the paternalistic "father knows best" medical model of disability to a social model based on human rights and social inclusion, which is precisely what is needed in mental health and suicide prevention.

A core feature of the CRPD is a move away from substituted decision-making, such as involuntary psychiatric treatment, to a model based on supported decision-making. Space does not permit a full discussion of what this might mean for our mental health system, other than to say that it entitles an individual to have access to whatever supports they need to ensure their rights and their wellbeing. There is currently debate whether the CRPD actually prohibits substituted decision-making entirely but, at the very least, it requires that those who wish to maintain it are obliged to present very compelling reasons in order to justify it. Status quo assumptions can no longer govern our mental health laws.

We can no longer hide from the politics of suicide prevention. The CRPD was born through years of political struggle by people with disabilities. A similar struggle is required, now with the help of the CRPD, if we are to make meaningful progress in reducing the suicide toll.

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About the Author

In 2006 David Webb completed the world’s first PhD on suicide by someone who has attempted suicide in which he argued that suicide is best understood as a crisis of the self rather than the prevailing view that it is the consequence of some pseudo-scientific “mental illness”. He has been a board member of the World Network of Users and Survivors of Psychiatry (WNUSP) and currently works part-time as a research/policy office with the Australia Federation of Disability Organisations. He regards human rights as the core issue in mental health and that justice will not be possible for users and survivors of psychiatry until the mental health industry moves to the social model of disability that is the basis of the UN Convention on the Rights of Persons with Disability.

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