by Erveda Sansi
Campaign to Support CRPD Absolute Prohibition of Commitment and Forced Treatment
In
Italy, the situation in the psychiatric field, with almost no exception, has
worsened from the period of questioning psychiatric institution, in the
beginning of the sixties. Then, Italy
has been at the forefront of the closure of mental hospitals. Not only Giorgio
Antonucci, Franco Basaglia and many professionals, but also a good part of the
common people, realized that psychiatric hospitals were not places of care.
Civil society, then, was sensitive to the issue of smash-down asylum culture.
Publications appeared, there was an open debate, workers and students organized
themselves and entered in asylums to see the conditions in which their fellow
citizens were locked up. They protested and denounced the deplorable conditions
the internees were forced to live in.
However, since several
years, we observe a re-institutionalisation process and, at the same time, in
some Italian hospital’s psychiatric wards happened many deplorable facts, due
to forced treatment, institutionalization and forced restraint. Some of these
facts have become infamous after that committees and relatives have asked
for justice, as in the case of the well liked teacher
Francesco Mastrogiovanni, 58 years old, that was debated also on
national television channels. Franco Mastrogiovanni, after a forced psychiatric
treatment the 4th August 2009, (because of a road traffic offense: circulation, at night, on a street
closed to traffic), has been heavily sedated, tied to the bed of Vallo
della Lucania’s hospital psychiatric ward, and left to die after
four days of abandonment. During the 80 hours hospitalization he was nourished
only with saline solutions; he was tied hands and feet to the bed, in such a
position that his respiratory functions where compromised, and he was sedated
with high doses of psychiatric drugs, without supervision from the staff. At
wrists and ankles there are 4
cm wide grazes. A hidden camera recorded everything; the
video is of public domain. At the trial the responsible physicians were found
guilty and sentenced to 3 and 4 years detention, that, with the mitigating
clauses, they won’t have to serve. The 12 nurses were acquitted because “they obeyed an
order”. The Committee truth and justice for Francesco Mastrogiovanni, asks for truth and justice. Watch also the
film 87 ore (87 hours), gli ultimi giorni di Francesco
Mastrogiovanni (Francesco Mastrogiovanni’s the last days) by Costanza Quadriglio.
In Italy
some deaths due to forced hospitalization and/or prolonged or short-time use of
mechanical and chemical restraint have been reported by the press, television and
network (this mean that there are a lot of other such “incidents”, we don’t
know):
27 October 2005:
Riccardo Rasman dies during a coercive treatment by the policemen, for a
hospitalization against his will, in a psychiatric ward in Trieste.
21 June 2006:
Giseppe Casu, guilty of having wanted to pursue his peddler job in the village
square, dies in a psychiatric ward in the hospital “Santissima Trinità” of
Cagliari, as a consequence of a thromboembolism, after a forced hospitalization
and having been heavily sedated. He was tied hands and feet to the bed, for 7
days and was sedated with high doses of psychiatric drugs against his will.
28 August 2006:
A.S., the 17th of August 2006 is admitted to the psychiatric ward in
Palermo, for
medical investigations. A.S. died after 2 days coma, the 28th of
August, probably for excessive doses of psychiatric drugs.
26 May 2007:
Edmond Idehen a 38 years old Nigerian man, went voluntarily into the
psychiatric ward of Bologna’s
hospital “Istituto Psichiatrico Ottonello – Ospedale Maggiore Bologna”. As he
tried to leave the hospital, because he did not feel cared, the doctors forced him to stay, with the help of
policemen. Edmond Idehen died as a consequence of a hearth attack while nurses
and policemen held him down. He was also strongly sedated with psychiatric
drugs.
12 June 2006:
Roberto Melino, 24 years old, dies for a hearth attack; he entered voluntarily
the psychiatric ward of Empoli’s “San Giuseppe” hospital. As he tried to leave
the hospital, he was forced to stay by the doctors, and obliged to take high
doses of psychiatric drugs, in spite of his evident and serious breath
difficulties.
15 June 2008:
Giuseppe Uva, 43 years old, was brought inside a police station, because he was
driving in state of high alcoholic level. There he was subjected to
ill-treatments. After 3 hours he was forced to an obligatory hospitalization in
the Varese’s
“Circolo” hospital and was forced to take psychiatric drugs. He died because of
the stress provoked by the mix of alcohol and psychiatric drugs.
30 August 2010:
Lauretana La Coca, 32 years old, entered voluntarily in Termini Imerese’s
“Salvatore Cimino” hospital. After 10 days of hospitalization her condition got
worse, till she got into a comatose state and died.
Giuseppe D.: A
man, more than 70 years old, was interned in Reggio Emilia’s psychiatric
prison. His problem was that the neighbour’s daughter is a psychiatrist. His
lawyer took a legal action to the European Court of human Rights, but until now
there has been no answer, so the Pisa’s student group “Collettivo
Antipsichiatrico Artaud”, together with “Telefono viola” from Milan, decided to
release the documentation relating to this case in Internet, according with
Giuseppe D.’s will, his lawyer, and his relatives.
2 April 2010:
Eric Beamont, 37 years old, the 2 April 2010 was hospitalized in Lamezia. After
2 days he entered coma, so the doctors transferred him to the Catanzaro’s “Pugliese – Ciaccio” hospital,
where he died. There is the suspect that the death of Eric was caused from a
high dose of benzodiazepine. Diagnosis was: subarachnoid hemorrhage[i]
28
May 2015 Massimiliano Malzone died during a forced treatment.
11
July 2015 Amedeo Testarmata died during a forced treatment.
29
July 2015 Mauro Guerra died during a forced treatment.
5 August 2015 Andrea Soldi died during a forced
treatment...
Unfortunately in
this article we have not described isolated occurrences, but an emblematic situation of violation of human rights in
the Italian psychiatric institutions.
These are just some of the “incidents” that came to the
limelight, but many more of them are not known when they happen, because, for
example, people who live in loneliness are involved, or people whose relatives
have given their consent, or simply when people want to get rid of a person
perceived as annoying. We The Mad Hatter Association, constantly of forced
psychiatric treatments, during which treated people suffer heavy damages.
Forced treatments are often made on request of relatives, when patients refuse
to take any longer the psychiatric drugs, or when their behaviour is perceived
as disturbing. A friend of us (I.M.) tried to escape, but he was chased and
filled with drugs; shortly after he was found dead at the bottom of a ravine.
He was 40 years old. Another friend (A.S.) was walking on a path between fields
and was stopped by police, because he was known as a “mentally ill” person.
Then they called the psychiatrist on duty and told him: “He was walking near
the railway and could possibly have in mind to commit suicide”; so they locked
him up. I know this person, who often walks in the fields, where, however, it’s
easy to be located near the railway, because of the constitution of the territory.
He had never the intention of
committing suicide. Another acquaintance of us
died, throwing himself under a train, terrified by the fact that his mother,
according to the psychiatrist, would refer to forced psychiatric treatment for
him. Another one (U.S.)
has suffered of heavy harassment, after having reported his superior’s
embezzlement, noticed during his duties as a municipal technician. He was
subjected to forced psychiatric treatment, kidnapped by police in riot gear.
While he was sleeping, his door was smashed down, and he was thrown on the
ground face down and handcuffed. He says that at least they could have tried to
open the door, which was not locked. Now he is terrified and he even fears the
dark; he is forced to take psychiatric drugs.
We can not think of de-institutionalization before we have dismissed
the rules that allow forced psychiatric treatment, that allow to hold a person
against his will, without having committed any crime, without the right to an
equitable process, based on the alleged dangerousness and only because this
person was diagnosed with a mental illness.
The so called “Basaglia law” the
law nr. 180 from 13.5.1978, then joined and actually regulated by Law 833/1978
articles 33, 34, 35, 64, establishes the “Accertamenti e Trattamenti sanitari
volontari e obbligatori” (“Forced health verifications and treatments”). In
1978 the law nr. 180 imposed the asylums’ closure, and the elimination of
dangerousness or/and public scandal as criterion for forced treatment. But in
the most Italian province, asylums didn’t close. So it was necessary to make
another law, (because these asylums were too expensive), the law n. 724 from
23.12.1994, art. 3 paragraph 5, which dispose that these asylums had to be
closed within the 31.12.1996; again disregarded, differed until the end of 1999. In 1996 the asylum
inmates in Italy
were 11.516 in
62 public asylums and 4.752
in private asylums.
According to this art. 180 law, forced treatment and included forced
hospitalization, are possible if there are the following conditions: 1) a person “suffering mental illness”
requires urgent medical treatment; 2) refuse the
treatment; 3) it’s not possible to take adequate measures outside the
hospitals. Forced treatments has a maximum
duration of seven days, but can be renewed if necessary and then extended if it
persists for a reasoned clinical need (it’s not an exception that the duration
is extended for months and years). For forced treatments and the consequently
limitation of personal freedom, there must be a request signed by two
physicians, an administrative validation from the Mayor is required, followed
by the validation of a judicial review by the Tutelary Judge.
Legislation of forced psychiatric treatment provides ample scope
for arbitrariness and it is in strong contrast to the human rights regulations,
that aim at preserving even people with disabilities from inhuman and degrading
treatments. For those who commit a crime, it is expected that the judicial
authority, within certain specific procedural rules, sanctions or imposes restrictive
measures. We constantly deal with innocent people in forced psychiatric treatment, who
can no longer find a way out of the psychiatric institution.
“I have to confess”, said a psychiatrist, “to have a person completely
in my power, made me feel a kind of sadistic shiver”.
In Italy the CRPD was ratified in 2009, but just at
now we have not a law against torture, torture is not a crime, torture is not forbidden in Italy. So,
those who torture does not violate the law. In the meantime a lot of
intermediate psychiatric institutions (also called little asylums) were built.
They are public or private and reimbursed from the State. A very great business
is behind. Some other examples: Lazio Region President Polverini’s decree on
Lazio hospital system: the number of beds in Psychiatric Institutions raise
from 369 up to 629; more 70%. 50 beds for the public structure and 210 for the
private structure trigger the chronicization circuit.
260 beds =
90.000 life days subtracted to the people at the cost of 10.000.000 €.
Didn’t the
Basaglia Law foresee the closing up of madhouses?
-
Professor
Antonucci, what is, to date, the status of implementation of the law 180?
- Apart from
some single exceptional case, what proposed Franco Basaglia is not realized,
but it continues a job that Basaglia obviously would not approve: authoritarian
interventions, taking people by force and bring it in psychiatric clinics,
which are the continuation of the asylum. The asylum was established by the authoritarian
intervention: I take a person against his will, then I submit her to a series
of forced interventions, which are the essence of the mental hospital”. (http://www.psicoterapia.it)
The deplorable situation of the six Forensic
Psychiatric Hospitals recently became more visible, after
surprise-inspections of a parliamentary committee. The videos of the visits,
showed by the national television, and the press releases can be found on the
web. A parliamentary report had already been made in June 2010, but the
photographs show a situation that until now has not yet changed. People held
for decades for minor offenses, whose penalty would have expired long time
since, if not repeatedly and automatically renewed.
Here
below we report some data extracted from the text of the parliamentary relation
on the June 2010 inspection of the 6 Italian psychiatric prisons (forensic
institutions) still active (Senator Ignazio Marino, physician ,was Chair of the
Investigative Committee on the National Health Care System). After the 1978 “Basaglia law”, madhouses had
to be closed, but the 6 psychiatric prisons mentioned above keep doing the same
job. Senator Marino was also concerned about the increasing of electroshock
(from 9 institutions allowed to give electroshock before 2008, now we have more
than 90 psychiatric institutions who dispense ECT).
The
regulations and logics that manage these psychiatric prisons (forensic
institutions) (in Italian OPG-Ospedale Psichiatrico Giudiziario), are the same
inherited by the fascist Rocco Code (1934). 40 % of the 1500 actual convicted
should already have been released, for detention terms expired, but they see
their penalty end terms deferred in order of their supposed social dangerousness.
Nine people each cell, dirty bathrooms
and bed sheets; dirty nurses’ gowns as well. In Barcellona Pozzo di Gotto (Messina), 329 convicted
are overcrowded in cells built in 1914. Dirt everywhere. One patient was found
naked, tied up to his bed, with a haematoma on his head. Aversa, built in 1898. 320 people locked up
six by cell, in inhuman conditions.
NAS
(Antisofistication and health nucleus of Carabinieri (Police)) reported and
denounced all this to the Public Prosecutor’s Office, but this office is often
made by the same persons that sentence patients to life.
In
the Secondigliano OPG, the psychiatric prison is interior to the jail. Here
stays since 25 years a patient who was sentenced two years. Burns and black
eyes are not reported on the clinical diary. Feet and hands go gangrenous.
In
Montelupo Fiorentino OPG they are 170 in a very scruffy building. In Reggio
Emilia OPG they are 274 where they should be 132. 3 showers serve 158 patients.
One is tied up to his bed since 5 days for disciplinary reasons. 3 in 9 meters square. “The OPG
(psychiatric prison) are one of the “silence zones”, explains Alberto, of the
Pisa Antipsychiatric Collective dedicated to Antonin Artaud, “and they show the
political use of psychiatry. The consume of psychiatric drugs is more and more
pushed, the electroshock comes back “in fashion”, perhaps to “heal post partum
depression”. And a law lies in ambush in order to bring the forced
hospitalization terms from 7 to 30 days”. After the scandal came to light, on 17 January 2012 the Senate Judiciary Committee
unanimously approved the definitive closure of the OPG by 31 March 2013. The closure was extended until March 31, 2015. After the
closure of the facilities in 2015, according to Law Decree n. 211/2011,
converted into Law no. 9/2012, have been replaced by residences for Execution
of Security Measures (R.E.M.S.). We have to closedown the Forensic Psychiatric Hospitals, instead of
changing the name of them. If we don’t shut dawn these places once and for all,
we cannot talk about de-institutionalization. Close them not in order to
transfer their users to other psychiatric institutions, but to give these
people a life dignity.
A research (source: British Medical Journal) conducted in
6 European countries (Italy, Spain, England, Netherlands, Sweden, Germany),
that have closed asylums in the 70s, saw that between 1990 and 2003 an increase
in the number of beds in forensic psychiatric hospitals, in psychiatric wards,
in so-called safe houses. Supported housing is seen as an alternatives to
asylums, as a sign of de-institutionalization, but they are rather a form of
institutionalization. Also forced
treatments are increasing. It is not clear the reason why the number of
beds in Forensic
Psychiatric Hospital
increased, since there is no correlation between crimes like homicides and
de-institutionalized persons.
It would be important to spread the awareness that forced
treatments, like the restraint is an anti-therapeutic act, that makes cures
more difficult, rather than to facilitate them. Physical restraint is not
exercised only in the field of psychiatry. The areas of operation where should
be discussed the problem of legitimacy, usefulness and appropriateness of
physical restraint, do not consist only in hospitals, but also in nursing homes
for the elderly, therapeutic communities for drug addicts and nursing homes for
people with disabilities related to congenital or early acquired disabilities.
An improvement in psychiatric nursing practice, characterized by the
renunciation of physical restraint, would be a strong signal in order to spot
out the problem also in other operating environments, urging those who work in
this field to act with similar treatment practices, rather than restrictive
ones.
Referring
to the psychiatric drugs there are rules of the Convention on Human Rights,
which require user’s fully informed consent, before administering, even if he’s
disabled. Most psychiatric drugs are prescribed for a long time, sometimes for
life, without informing the user on their effects, and without any help in the
resolution of his real and existential problems. Psychiatric drugs can cause
neurological diseases, that sometimes become irreversible. Akathisia, dyskinesia, are very unpleasant
effects and can throw a person in despair. Often the user is encouraged to
continue taking the drugs even when he asks to withdraw them, and it is almost
impossible to find professionals who help and give directions for withdrawal. Peter
Breggin, a psychiatrist, working with institutions as WHO (World Health
Organisation) and FDA (Food and Drug Administration), wrote hundreds of pages
on the harmful effects of psychiatric drugs. Peter Lehmann, who tested
the effects of drugs on himself during his hospitalization in a psychiatric
clinic, has published and continues to publish the results of his research for
which he uses pharmaceutical and medical literature. The effect of psychiatric
drugs is known, but the billion-dollar business behind it is too big to lose
it. Peter Lehmann is the first survivor of psychiatry to be awarded with
the honorary degree, conferred him by the clinical psychology faculty of the
Aristotele’s University of Thessaloniki, for his work as researcher and
activist in the field of mental health.
A
person who starts to take drugs, in most cases will be induced to take them for
life, because they create addiction problems. The psychiatric user develops a
very strong dependence toward the psychiatric service too. For the
psychiatrists, lack of compliance is in fact intended in it self an aggravation
of the disease. Then the conditioning that takes place, goes in the direction
of dependence from psychiatric services, of becoming “childish” and “chronic
patient”.
Although
in almost all European countries asylums and psychiatric hospitals have been
eliminated or substantially reduced, this does not mean that in the new
post-asylum structures, asylum-dispositifs have been eliminated. People are,
with few exceptions, completely sedated by psychiatric drugs, even though
apparently there are implemented programs such as art therapy. The intake of
psychiatric drugs is induced also in order to make the user unconscious.
Erwin
Redig,
a German psychiatric survivor, says: “There are people putting us under
pressure to force us to take them (psychiatric drugs). If we do not take them,
our changes embarrass them. If this is
our case, we must make clear to ourselves that we are swallowing drugs for
other people’s welfare, because they find us unpleasant if we do not”.
“The
dispositif of discomfort-complex, that operates in a small residence, acts more
broadly in the society”. Neuroleptic drugs affect thinking, block the flow of
thoughts, and make people flatten. I relate the words of a healthcare
professional: “As soon as psychiatric drugs are given to people, they literally
get extinguished. To what extend is it fair to cancel the person?” Although in
the European countries, the asylum psychiatry and the psychiatric
hospitalization of users have given way to communities, the psychiatric
institution culture has not changed. The patterns of asylum residentiality are
still active. But most of all it is still alive an asylum mentality, therefore
it is important for everyone to be aware how much everybody’s mentality is
crucial in creating or not creating devices that belong to psychiatric institutions;
operating devices that constitute a widespread operating module. “Residential
Intermediate Structures”, foreseen in Italy by the 1983 law, should have
had the provisional nature as their specificity; therefore they should not
constitute either a definite admission or a final place for forced
hospitalization; they should have been transitional housing, that could
break prejudice and exclusion logics. In March 1999, by a special decree, to
the Italian Regions was imposed the definitive closure of the asylums, under
threat of strong economic sanctions, because despite the birth, on paper, of
the new “local services”, mental hospitals were still crowded with patients.
Named by the
derogatory title of “asylum residuals”, for these people that nobody wanted,
residential structures accounted for an illusion of freedom; they founded
themselves to be again in a mental institution. “Many patients”, writes one of
them in an autobiography, “have never been so well in terms of comfort, but
nevertheless they are in a state of fearful desolation”.
An induced need
of security, the defence from a potentially dangerous mind sick person that at
any time, during an outbreak, could commit heinous actions against others or
against himself; shortly, on the basis of this need and of this false
scientific fundamentals, we build the myth of the need of post-asylums
psychiatric institutions. If we don’t get reed of the psychiatric prejudice,
the “mental health” institution remains. There are many alternatives pursued by
individuals, associations or institutions, but they are deliberately ignored.
The responsibility for solving the problems of institutionalization, is not up
only to psychiatrists or to mental health professionals, but to the whole civil
society. Everybody contributes to the asylum mentality. Users as well, who have
internalized the psychiatric diagnosis and can no longer live without it.
Mary Nettle,
chairman of Enusp until 2010, expects an increasing involvement of users
and survivors of psychiatry in researches about psychiatry; while they often
are excluded or not paid on the pretext that they are not professionals.
Although
many examples exist that prove that you can accompany a person in
troubles out of his problems, through dialogue and support in the resolution of
the objective and material difficulties, and helping him to get awareness of
his own rights, these experiments and their positive results continue to be
deliberately ignored.
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