venerdì 18 febbraio 2022

Reimagining Crisis Support: Matrix, Roadmap and Policy by Tina Minkowitz


Reimagining Crisis Support: Matrix, Roadmap and Policy aims to shift the conversation about personal crisis from one based in mental health discourse to one based in a social model of disability and human rights.

The book's primary thesis is that crisis support can be reimagined as support for decision-making

and maintaining an independent life in the community - as provided for under Articles 12 and 19 of 

the Convention on the Rights of Persons with Disabilities.  Community-based, non-discriminatory

conflict resolution and violence prevention are complementary to crisis support but are distinct as

they involve more than one person's needs and interests at the same time. 

The book explains its key premises and sets out some elements of decision-making support for

personal crisis, then explores the Matrix of rights and implementation measures set out in the

Convention that provide a scaffolding for a social, human rights-based approach to crisis support.

It then provides a Roadmap of aspirational transformations and strategies that are needed to

create the conditions in which reimagined crisis support can be meaningfully realized.

These range from large-scale social justice aims such as Democratize Knowledge and 

Strengthen Communitarian Practices to Tools such as 'Pilot projects' and 'Evaluate existing

support practices'.

A section on Policy addresses key issues for translating the model presented into national policy.

This should be read in conjunction with the chapter on Implementation: Legislative Reform that

is included in the Matrix section.

This book is intended for diverse audiences from policymakers to grassroots activists.

It is grounded in both a US context (inevitably as the personal informs the political) and wider 

perspectives from global networking. 

Table of Contents:



Basic Premises

Crisis support



De-medicalized, de-judicialized crisis support and response to conflict

Personal support; 

Conflict de-escalation and responding to violence; 

Suicide and self-harm

Decision-making support for personal crisis

Matrix: Human rights underlying this framework

Legal capacity


Living independently in the community

Other substantive rights:

Right to housing and subsistence;

Right to freedom of expression and communication;

Right to practice art, music, science, spirituality, religion and other aspects of culture; 

Right to sexuality, relationships, parenting, family; 

Right to safety from violence and abuse;

Right to bodily comfort and health; 

Right to advocacy and political participation;

Right to education and right to work

Duties toward others Implementation:

Legislative reform

Legal capacity reform; 

Right to live independently in the community; 



Implementation: Reparation

Roadmap: What will it take to put into practice?

Democratize Knowledge

Build Community Accountability 

Law and morality; The role of the state; Community accountability – starting from within

Strengthen Communitarian Practices

Solidarity economy; Care and forbearance; What is value


Principles of de-medicalization and de-judicialization; Pilot projects; Advocacy/shield programs; 

Evaluate existing support practices

Link our diverse stories

Policy implications

Appendix I: Mind-Maps

Appendix II: Key Points of Positive Policy

Appendix III: Discernment as Process, not precondition



Videos from launch event June 18, 2021

Excerpts from the book were read and a panel of survivor and disability movement colleagues

were invited to discuss the book.  Panelists were Beatriz Pérez Pérez, Hege Orefellen, Lu Han,

Risnawati Utami and Amalia Gamio.  The event was held in English and Spanish with translation,

and was recorded in both languages.  

English language video:

Spanish coming soon


An excerpt from Reimagining Crisis Support: Matrix, Roadmap and

Policy, by Tina Minkowitz (c) 2021

I began talking about the need to de-medicalize crisis support in September 2018 after learning

from lawyer Alberto Vásquez that the Peruvian legal capacity reform, which remains the clearest

and most advanced in its fidelity to the Convention on the Rights of Persons with Disabilities, left

only one basis for involuntary mental health interventions outside the context of criminal 

proceedings – as involuntary hospitalization in situations characterized as a medical emergency.  

The application of the CRPD to medical emergencies is itself a dimension of legal capacity reform

 that has to be fulfilled.  The standard of ‘legal capacity at all times’ and ‘best interpretation of will

 and preferences’ (when it is not feasible to determine the person’s will) could suffice for actual

 medical emergencies – say, when a person is unconscious and could bleed to death, to justify

 lifesaving treatment notwithstanding the non-manifestation of consent or refusal.  

But in the context of psychiatry I was concerned that the CRPD would be incorrectly applied, in 

particular that the obligation to respect a person’s manifestation of will at all times including in

 situations of emergency or crisis would be ignored, and the criterion of ‘best interpretation’ 

invoked when it was not warranted.  

The framing of crisis as a medical emergency implies a need for urgent medical intervention and 

assumes the appropriateness of such intervention.  For this reason, especially in light of the legacy

 of psychiatry as segregation and coercive control, it was highly likely that psychiatrists would view

 situations where the person is unclear or ambivalent about what they need, struggling to express

 new and difficult feelings and perceptions, or reacting strongly against the presence of a 

psychiatrist or mental health worker, as a failure to manifest their will, and that they would proceed

 with medical intervention as the default course of action without ascertaining that the person

 welcomes such a response.  Forced interventions would thus be likely to continue, requiring

 case-by-case redress after the fact.  

It was clear that the challenge to a medical narrative had to be incorporated into the CRPD

 normative framework.  It could not be left to a debate about the type of services to be offered.  

The stimulus to take on the topic of crisis support in greater depth was a conversation I had with

 Israeli human rights advocate Sharon Primor at a conference in Hong Kong in April 2019.  Our

 dinner companions enjoyed watching us spar, as she challenged me to set out positive policy as

 an alternative to forced psychiatry.  I started to write a list of the needs in crisis situations and the 

kinds of responses that would have to be in place for comprehensive policy to take the place of 

the medical coercive psychiatric system.  I posted some notes on (under the title

 ‘Towards Positive Policy’) as a draft for people to comment on, and out of this developed the 

skeleton concept of de-medicalized crisis support based on Article 12 (support for decision-making) and Article 19 (support for practical necessities of living in the community).  

The premise of de-judicialization came a few months later during a conversation with Michelle 

Funk of the World Health Organization and Catalina Devandas, Special Rapporteur on the Rights

 of Persons with Disabilities, about what a legislative framework might look like for de-medicalized

 crisis support.  It became clear to me that there cannot be any legislative framework that treats

 crisis support as a mandated action in response to defined situations; to do so would carry over

 the managerial approach of mental health legislation that is incongruent with providing support as

 act of respect and solidarity among fallible individuals who are all vulnerable in their shared

 humanity.  Crisis support needs to be made available as a positive entitlement of the individual,

 in the same manner as other disability-related support such as personal assistance, to bring to

 full fruition the social model of disability for people with psychosocial disabilities. 

This paper presents a framework for crisis support based in the social model of disability, and 

then branches out into exploration of broader social change and actions that can help to bring 

about this crisis support – de-medicalized and de-judicialized – on the ground.   It began as 

narrative of an initial graphic representation that one colleague calls a mind map, which was to be

 developed into a hyperlinked website with text and references on the various components.  

The two-part mind map, which differs in some particulars from the outline of this paper, is attached

 here as Appendix I. 

The concept in skeleton form is found in the paper, ‘Positive policy to replace forced psychiatry, 

based on the CRPD’, and was presented in an even more pared-down version in a one-page

 intervention at the 2019 CRPD Conference of States Parties; the latter is also attached, as is a

 related essay, ‘Discernment as process, not precondition’.  

I use the term ‘crisis’ as a shorthand, understanding that it is problematic – similar to ‘psychosocial

 disability’, it can be misunderstood as a euphemism for the old paradigm of mental illness.  I use

 the term in two ways.  First, it allows me to think about the complex social situation that is 

happening when anyone thinks about invoking psychiatric commitment, with the differing

 motivations and perceptions of all concerned.  That starts from the problem I am aiming to 

solve - what is going on when this happens and what can we do instead?  How can we divert the

 good motivations into a different channel, while rejecting the violence, segregation and making

 anyone an outcast from community or intersubjective relations?  This is a social crisis that has 

personal as well as political dimensions for everyone involved.

Second, sometimes though not always the person who is targeted for such intervention has been

 experiencing her own sense of urgency and distress.  Understanding this urgency and distress as

 crisis allows us to reframe it apart from the question of whether anyone is trying to violate her

 human rights.  This is a personal crisis that has social and political dimensions.  

In view of the social and interpersonal dimensions of crisis, whether we start out understanding it

 from the social or the personal point of view, community is both the background of any crisis and

 a participant in it.  This does not mean that the community around a person has any ownership of

 her personal crisis or her decisions.  It means that there is potentially a restorative or

 transformative justice need in relation to the social (including interpersonal) and political 


Justice and healing cannot be led by mental health professionals.  On the contrary, that sector 

needs to make reparations for its profound violation of the fabric of community through its violent 

practice of psychiatric commitment and forced intervention with drugs and electroshock, practices

 that subjugate and terrorize its victims and render society as a whole vulnerable to its political and

 ideological influence.  The first step is to end the violations and step aside; the mental health 

sector cannot be either directly or indirectly in charge of a new paradigm.    

This paper is itself a bridge between different ways of engaging with the traumatic events that led 

me to bear witness as a survivor of psychiatric violence – from law and policy generated

 deductively from the necessity for abolition, to a more situated practice that ultimately blends 

seamlessly with a need for radical change in all areas of society.  This is in one sense 

intersectional but in another an expression of an underlying universality that converges from many


I have written most of the paper during the globally shared yet vastly disparate and isolating world

 of the COVID-19 pandemic and, in the US, an uprising against racist police violence and other 

systemic racism, known as the Movement for Black Lives.  Crisis support has received attention 

since it is apparent that police responses to someone experiencing personal crisis can be

 life-threatening.  The concept of social-model crisis support presented here dovetails with that

 serendipitous national conversation that draws on theory and practice of the prison abolition 

movement and psychiatric survivor movement, as well as with the human rights framework for 

robust equality that is set out in the CRPD.

 Decision-Making Support

An excerpt from Reimagining Crisis Support: Matrix, Roadmap and 

Policy, by Tina Minkowitz (c) 2021

CRPD considers both guardianship regimes and forced treatment regimes in mental health to be

 restrictions of legal capacity that take away a person’s right to engage the legal system by her 

own will and choices, and allow others to make choices that profoundly affect the person’s life:

 even decisions about her own body like ingesting psychotropic drugs or undergoing sterilization 

or electroshock.  These regimes include the deprivation of liberty using the power of involuntary 

admission to hospitals and institutions delegated to medical personnel or to courts, or by 

accepting the consent of guardians or family members to represent that of the person concerned, 

whose own decision is denied legal validity.  All these practices violate the right to legal capacity.

In contrast, CRPD sets out a positive entitlement of support for exercising legal capacity that 

allows people to seek help with making decisions, understanding information or communicating

 their choices, without having anyone else take over for them or act against their will. 

This support regime is one way to address the needs people may have in crisis situations.  

In crisis, it can be hard to make decisions because we feel like the stakes are high, there may be 

no answer that feels good or right or safe, and we don’t know which way to move.  A crisis by

 definition entails a dilemma, and usually requires both immediate and longer-term 

decision-making, including both discernment and action.  Support for discernment and for taking 

action, dealing with both immediate and longer-term needs, is a non-medical way to conceptualize

 an important part of the needs that emerge in crisis situations, for the purpose of developing 

policy and programs for de-medicalized, de-judicialized crisis support. 

This type of support is informal in the sense that it does not need to involve formal registration of

 supporters or a written agreement setting out the scope of support.  In a crisis, what’s important is

 meeting the person where she is, both literally and figuratively, engaging with her ethically, and

 respecting her choices.  Ethical guidelines for crisis supporters, and holding them accountable for

 acts of abuse or bad faith, are the appropriate safeguards; legal formality serves no purpose and

 is likely to be counterproductive.  Formalizing a legal agreement in the midst of a crisis itself is 

inadvisable, and while a formal agreement could be used for pre-planned crisis support, this might

 lead to a managerial approach and discourage flexibility and attunement to the present moment.  

Support for making decisions takes many forms.  It includes prayer and divination, not only linear 


Support can also be a personal practice of befriending oneself.  None of us exist in total

 isolation — even a hermit has a history and culture, even a person who has lost her memory had

 past experiences.  Solidarity is always necessary in crisis at least to the extent of respecting a

 person’s chosen solitude, and potentially checking in to assist with basic needs if that is 


Practical Support

An excerpt from Reimagining Crisis Support: Matrix, Roadmap and 

Policy, by Tina Minkowitz (c) 2021

Crisis support includes support for the practical aspects of managing life when you might be 

emotionally very sensitive, focused inward, or simply kept busy with the demands of a fraught 

situation.  Housing or food insecurity, domestic violence, sexual violence or exploitation, job loss, 

end of an intimate relationship, deaths and illnesses of close people, precarity of income, confront

 people with practical needs that can lead to a life crisis.  A crisis that starts from within (e.g. crisis 

of purpose and meaning, eruption of past trauma, or a source within or beyond the self that may

 never be fully known) can have implications for practical life that are far-reaching.

Practical crisis support could involve help with household tasks and navigating the community 

(the kind of tasks typically done by a personal assistant), navigating service systems and financial

 and legal issues (the kind of tasks done by knowledgeable advocates), and/or emotional support

 to get through the days and to confront difficult tasks.  It could include going to a crisis respite

 center or a spiritual or healing retreat, or otherwise finding a place to go that feels safe, 

comfortable and nurturing.  

Navigating legal and financial issues or service systems during a crisis overlaps with support for 

exercising legal capacity in those areas.  Transactional support for exercising legal capacity in

 relation to a discrete legal act or proceeding, including support during police investigations and

 criminal trials, should be available with the flexibility to meet needs of people in crisis, in case it is 

not possible or desirable to postpone the matter.

Emotional support and support to prevent isolation overlap with support for healing and for

 discernment about any aspect of a crisis (which similarly falls under the right to legal capacity). 

 Someone experiencing crisis may want to be left alone, may want someone around all the time,

 or some combination.  Preventing isolation means respecting the person’s wishes about the 

degree of contact and connection, so that community remains available to them; respecting 

chosen solitude while maintaining awareness and solidarity in case they reach out. 


Tina Minkowitz is a theorist and practitioner of international human rights law from a survivor of 

psychiatry perspective. She contributed significantly to the drafting of the Convention on the 

Rights of Persons with Disabilities and to its subsequent interpretation and application, which is 


From 2002-2015, she represented the World Network of Users and Survivors of Psychiatry in 

various capacities. Currently she is President of the Center for the Human Rights of Users and 

Survivors of Psychiatry,, which she founded in 2009.

For additional writings, see 


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