The Convention on the Rights of Persons with Disabilities (CRPD) is a human rights treaty that will forever change psychiatry as we know it. A convention is defined 'an agreement between states for regulation of matters affecting all of them.' The CRPD may even mean the end of biological psychiatry with its human rights violations and medicalization (labeling as a disorder) of difficulties inherent to life. Worldwide, 1 in 4 people have a disability. It is therefore likely that the implementation of this UN agreement will have profound effects—if not directly on your rights, at least on the rights of someone you know personally.

When we hear the word 'disability,' we often think of people in wheelchairs or mentally impaired. However, the concept goes far beyond that.

With the proviso that "disability is an evolving concept," the Convention on the Rights of Persons with Disabilities counts among persons with disabilities "those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others." Disabled people include people with

• Physical disabilities (such as people who need to get around in wheelchairs or are blind or deaf)
• Intellectual disabilities (denoting intellectual impairment or learning disability as caused by birth defects).
• Cognitive disabilities (involving conscious intellectual activity such as thinking, reasoning or remembering as in dementia).
• Psychosocial disabilities (mental disabilities or mental health problems).

The first three categories above are better known than the last (psychosocial disabilities). That category merits explanation. In a joint report, the Office of the High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO) define people with psychosocial disabilities as “persons who, regardless of their self-identification, experience discrimination and societal barriers based on actual or perceived mental health diagnosis or subjective distress. This term aims to reflect a social rather than a medical approach to mental health conditions and experiences, placing the focus on the attitudinal and environmental barriers that restrict their equal participation in society.” In other words, a psychosocial disability already exists as soon as a person with mental health problems encounters a social environment that creates barriers to his equality with others.

What does that mean practically? Anyone with what psychiatrists call a "mental disorder" can be classified as having a psychosocial disability. After all, they are called 'disorders' because they create barriers for the person that reduce their chances of getting a good education, work, housing and marriage, to name just a few aspects of life. As a result, they no longer have equal opportunities, and this hinders their rights.

In chapter eight of The Hidden Horrors of Psychiatry, you will read in detail about this convention and its consequences. Here, however, you will already find some aspects of it.

The purpose of the CRPD is: "To promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity." Unlike a Declaration, such as the Universal Declaration of Human Rights, which is not legally binding but can have political consequences, the UN Convention on Disability is legally binding under international law. In other words, when a country ratifies (officially endorses) the Convention, it commits to adapt its national legislation accordingly. The United Kingdom has ratified the CRPD in 2009. Until this date in 2023, the United States of America has failed to do so.

To date, mental health problems have been approached from the medical model. This model views disability as a defect, disease or disorder in the individual. Only medical intervention would address this. There is heavy criticism of this model because it reduces a person to his or her disability, seeing the disability as the most important part of the individual. At the same time, it suggests that the person is incapable of doing anything about it themselves. The medical model, especially psychiatry's biological approach to 'disease' or 'disorder,' stigmatizes. As a result, it can trigger experiences and feelings of shame, guilt, hopelessness and sadness, an unwillingness to seek or accept help, discrimination and denial of human rights. Moreover, WHO noted that "violence, abuse and coercion are common in mental health and related services around the world." Among the examples given, WHO cited violence, rape, aggressive language and threats, humiliation and intimidation, neglect, forced confinement, treatment without consent, such as covert medication by hiding pills in food, and isolation and restraint.

The CRPD rejects the medical model and adopts the human rights model in its approach to people with disabilities. As a result, they are no longer mere objects of charity or medical treatment with all the abuses and violations of rights that this entails, but full and equal members of society who may, can and indeed must enjoy their rights and dignity. As a result, even people with psychosocial disabilities will no longer be viewed medically, but will receive appropriate assistance that puts their rights as human beings first. Not a psychiatrist, but they themselves will decide what is best for them.

As indicated above, once ratified, a country is required to adapt national legislation. Every year, implementation of the Convention must be reported to the Committee on the Rights of Persons with Disabilities, the supervisory body under the Office of the High Commissioner for Human Rights. For reporting in Great Britain, the UK Independent Mechanism (UKIM) has been appointed. This is an umbrella human rights organization made up of the Equality and Human Rights Commission, the Equality Commission for Northern Ireland, the Northern Ireland Human Rights Commission and the Scottish Human Rights Commission. However, this institution did not exactly meet with cooperation. It signaled either ignorance or an indifferent attitude within the government and relevant agencies, making a major change a while away.

However, there are other aspects that stand in the way of implementing the full intent of the UN Convention on Disability. A 2022 letter from the Netherlands Institute for Human Rights to the Dutch House of Representatives shows that this human rights agency does not understand the scope of the UN Convention on Disability. When considering non-physical disabilities, Human Rights Board limits the convention to people with intellectual and cognitive disabilities. It excludes people with psychosocial disabilities—probably the largest group. As a result, reporting to the regulator will be incomplete and inaccurate.

Moreover, the WHO has someone in the person of Tevfik Bedirhan Üstün who undermines the UN Convention on Disability. This Turkish psychiatrist has worked for decades on a different approach to disability, one based on the very medical model that the CRPD wants to get rid of. The treaty is a threat to Üstün's life's work, and he is trying to thwart it.

However, the lack of cooperation from the Dutch government and relevant officials, the incomplete understanding of the Netherlands Institute for Human Rights or the attempt by psychiatrist Üstün constitute no more than a delay of execution, because the treaty is binding. If the need arises, the required measures can be enforced through the International Court of Justice in The Hague.

However, it would be a joy if going to court proved unnecessary. This would benefit the rights of people with disabilities, the reason the convention was concluded in the first place.

Either way, because of its binding nature, the UN Convention on Disability will inevitably and forever change psychiatry as we know it today.