human rights and mental health service user participation

1

Participation and Human

Rights in Mental Health

A paper by

Liz Brosnan

Edited 12/10/2010

Participation, Mental Health and Human Rights

Liz Brosnan

Contents

Introduction ..................................................................................................................................................... 3

Human Rights Theory ...................................................................................................................................... 3

Disability and Human Rights ............................................................................................................................ 8

Human Rights and Mental Health ................................................................................................................... 9

Human Rights Based Approaches .................................................................................................................. 11

Conclusion ..................................................................................................................................................... 14

References ..................................................................................................................................................... 15


Liz Brosnan

"Participation and active involvement in the determination of one's own destiny is the

essence of human dignity" Mary Robinson

„[A]ctive and informed participation is an integral component of health systems, as

well as the right to the highest attainable standard of health. States have a human

rights responsibility to establish mechanisms that facilitate and enable participation in

health-related planning, policy-making, implementation, monitoring and

accountability. These mechanisms must be accessible to all those affected, including

disadvantaged individuals, communities and populations, as well as patients and

health workers.‟ Paul Hunt UN Special Rapporteur on the right

to the highest attainable standard of health (2002-2008)

Introduction

Marginalised and oppressed groups have much to gain from engaging with and becoming familiar

with human rights discourses. Since the Universal Declaration of Human Rights was adapted by the

UN assembly in 1948 much has been written about, and indeed tested in the courts, about what

human rights mean for marginalised and oppressed groups. The most recent Convention On the

Rights of People with Disabilities, signed into international law in 2008, in many ways illustrates the

extent to which human rights laws have evolved into instruments that can provide remedies for

failures of government to either positively or negatively provide for people's rights: perhaps more

importantly human rights discourses provide opportunities to help people improve their lives because

of the moral persuasion that can be used to effect change. This paper seeks to understand and

explain how the human rights frameworks can offer a different way for mental health activists to

engage with the system and influence improvements in how care is delivered. Before considering

what benefits there may be for advocates of change in adopting human rights-based approaches it

would be worthwhile to examine briefly some of the concepts and debates around what is meant by

human rights and how they have been understood by legal theorists. Some of the tensions and

paradoxes inherent in the discourses and practices of human rights are also discussed as they emerge

in the literature and empirical research.

Human Rights Theory


Liz Brosnan

Donnelly (2003) discusses the general principles of human rights in terms of their impact on

individuals and society. Rights holders can be said to be entitled to X, e.g. equal access to adequate

healthcare, while duty bearers have an obligation to provide or move towards providing X, in this

case, equal access to adequate healthcare. Rights are held by individuals and the individual can claim

their rights from the duty bearers and seek legal remedies if they are not forthcoming. Rights

empower, not just benefit, those who hold them because when they claim them things happen. The

ideal situation is when rights are the background upon which the state provides its services. It is

when the state does not provide, when a right is not respected, that human rights are most potent.

When a right is absent, claiming one is a powerful action, even if just at moral or symbolic level.

Donnelly describes a state of „objective enjoyment‟ of rights where the right, for instance to vote in

democratic elections, is offered by the state without any reference to its duties, therefore no action is

required by the rights holder to assert their right, (except to vote). This is the most favourable

position in terms of the rights holders as the right is enjoyed without effort, it is usually taken for

granted in these cases. It is when rights are not respected by states that rights holders may need to

take action to demand, to „assertively exercise‟ the right. This is where the power of human rights

law is most potent, in demanding that the state actively respect a duty they have towards fulfilment

of a right.

Under the Universal Declaration model of Human Rights as described by Donnelly (2003), there are

some core features of human rights which are understood as given in the discussions of them and the

ways they might be used. Human rights are considered to be equal, each right is of equal stature, no

one right is of more importance than another: they are inalienable, they cannot be taken away from

any person: and they are universal, every human being has the same rights, they apply to everyone

by virtue of being human. As well as being as „moral rights of the highest order‟, which „imply a

manifesto for political change‟, Donnelly argues that human rights rest on an a priori moral (and

international legal) entitlement. They can be used through moral arguments to secure legal

entitlements. Donnelly also emphasizes that human rights form part of an independent and

indivisible whole, not a menu, prohibiting states from deciding which rights they will recognize or

which they would ignore. Therefore social economic rights are on an equal basis with civil and

political rights.

Another feature of rights that Donnelly outlines is the distinction between positive and negative

duties of states associated with every right. Traditionally, negative rights, where the State apparently


Liz Brosnan

desists from action, for example, prohibiting torture, or police brutality, were argued by conservative

legal theorists such as Cranston, (1964), and Bedau (1979), to be cost neutral therefore more likely to

be realisable than more costly measures, those seen to be positive rights implying duties of provision

on States, for example to provide adequate health care. However, the negative rights do imply action

on the part of the State, to train the police forces in antidiscrimination policies, in non-conflict

resolution etc. Complying with these negative duties is therefore a costly exercise as Holmes and

Sunstein (1999) have illustrated in the US context. And under the UN system, resource arguments

are not acceptable justifications for inaction: states are obliged to demonstrate that they are making

reasonable movement towards progressive realization of the rights. Technically this point is outlined

in the International Covenant on Economic and Social Rights (ICESCR) but it is accepted as

applying to States generally.

Claiming rights, and the complex question of what rights are justiciable, or amenable to legal

adjudication, is a complicated matter because it involves the interaction of the courts and other

branches of the state to resolve questions, in the Irish context, about conflicts between different

interpretations of constitutional text and judicial precedent. International human rights laws are yet to

be used as common practice by Irish judges in arriving at their decisions, in part because many such

laws have not been incorporated into Irish law by the Oireachtas. Because exercising rights through

legal action requires an interpretation by individual judges one would need to have an expectation of

a positive outcome, which is fairly remote given the conservative nature of the current Supreme

Court in Ireland. By conservative I mean that the Court understands its role in narrow terms, failing

to move beyond a restricted, traditional, liberal interpretation of the constitution, indeed often

arguing to protect the State against citizens‟ rights. As we can see later, it is questionable if it is

worth getting a result that sets back the social progress of a movement towards realising rights,

especially for marginalised and oppressed groups. While many successes have been achieved in

different jurisdictions in human rights advocacy, for example in the US in relation to racism, by the

1980s Critical Race scholars were writing about the rolling back of gains made earlier, Delgado and

Stefancic(1998). There appeared to be a promising direction in Irish law in a series of cases in the

1980s and 90s to pursue the state‟s obligation to provide for the needs of troubled children and the

right to education, resulting in decisions by several Justices to hold the State to account for failures to

provide for vulnerable children‟s rights. In July 1998, Justice Kelly issued an order to force the

Minister for Health to provide sufficient accommodation for the children appearing before him in

order to vindicate their constitutional rights, and he concluded his statement „It is no exaggeration to


Liz Brosnan

characterise what has gone on a scandal…. I have come to the conclusion that the response of the

Minister to date falls far short of what this Court was reasonably entitled to expect concerning the

provision of appropriate facilities for young people with difficulties of the type with which I am

dealing.‟ (Kelly 1998, cited in O Sullivan 2009 p 253-4). However this direction of ruling on the

side of the rights of the individual against the State was firmly stalled by Supreme Court majority

decisions using the reasoning of judicial separation from the Executive branch of the State, Whyte

(2006), and Mullally (2004).1

Before leaving this brief discussion of human rights, it is worth noting two other themes of critique

in the scholarship around human rights. Firstly, a significant critique analyses the discourses within

which rights are framed. Siobhan Mullally (2004) reviews various debates within feminist

scholarship which critique the separation of the „ethic of care‟ from the „ethic of justice and rights‟ in

order to argue for a normative reconstruction of the legal sphere to include a „politics of recognition‟

of diversity and discrimination of women bound by networks of reciprocal obligations. The concept

of the „ethic of care‟ was first articulated by Carol Gilligan (1982), who described a style of moral

reasoning that considers the individual in relation to others and the interdependent relationships we

all have. This moral code of caring and the maintenance of relationships is juxtaposed to the

prevailing ethic of justice and rights which sees the individual as separate and autonomous, with

relationships being either hierarchical or contractual. Neta Ziv also points to the individualist -

liberal conceptualisation by which rights correspond to the fulfilment of responsibilities, with the

individual assumed to be autonomous and independent, achieving choice and participation through

maximising the opportunities available. She points out how social rights are termed as freedoms,

„freedom from want for a decent standard of living,‟ or „freedom for decent work without

exploitation‟, reflecting the managerial mindset of liberalist doctrines, Ziv (2007 p 370). This

approach fails to recognise the concept of capabilities, people's abilities to pursue freedom, the

constraints in particular on people with disabilities and others in need of protection from harm or

material deprivation. Amartya Sen (1992) has developed a concept of justice that critiques this

liberal notion, calling for recognition of the actual power or ability of the person to do certain things

that can improve their situation or overall well-being. Ziv has developed Sen‟s concept of justice as

1 Decisions in Sinnott v Minister for Education [3] and TD v Minister for Education [4] in which a majority of

the Supreme Court judges decided that the executive branches of government could not be held to account

for failures to provide educational rights to children by the judicial branch are discussed in some detail by

Gerry Whyte (2006) in (2006) 13(1) DULJ 1 Article: THE ROLE OF THE SUPREME COURT IN OUR DEMOCRACY: A

RESPONSE TO MR JUSTICE HARDIMAN : GERRY WHYTE


Liz Brosnan

it operates in relation to the human rights of people with disabilities, developing the question of an

ethics of care which regards people as interdependent, with everybody likely to require and be reliant

on others for care and support at different stages in their lives. While individuals are rights holders,

the practice of human rights and in particular human rights-based approaches are realised and

exercised in webs of social relationships (Nedelsky 1993; Minow 1987; Minow & Shanley 1996).

White and Tronto (2004) offer a valuable contribution to framing a substantive argument for the

inclusion of recognition of the role caring plays in society and its relationship with rights and justice

considerations. They highlight many of the important consequences of this omission and indeed

point to failures of rights discourse as meaningful for vulnerable groups without a re-ordering of the

political and social priorities to account for this invisible aspect of how our lives are lived in relation

to others.

Another theme within critical legal scholarship is illustrated by Pieterse. He points out „the

transformative potential of rights is significantly thwarted by the fact that they are typically

formulated, interpreted, and enforced by institutions that are embedded in the political, social, and

economic status quo‟, Pieterse (2007 p 797). Critical legal scholars have demonstrated how liberal

rights discourse has been used to „silence challenges by vulnerable sectors of society to existing

social power structures and, second, to thwart state efforts at social redistribution‟, Pieterse (2007 p

800). He illustrates how the South African Constitutional Court, in many ways a shining example of

judgments positively influencing socioeconomic policies, interpreted the human rights obligations in

terms of the State‟s abstract procedural duties to progressively realise rights rather than immediately

enforce concrete entitlements. In other words by showing it was developing policies to improve

access to health rights, the State could argue it was meeting its duties to respect human rights. And

the Applicants could die, or remain homeless, meanwhile.

Yet although critical legal scholarship may question the advances made and the real danger of

appropriation by liberal discourse or dominant interest groups, Patricia Williams offers a powerful,

eloquent and moving defence of human rights and their role in the emancipation and empowerment

of dispossessed groups like African Americans. Her argument is incontestable.

„'Rights' feels so new in the mouths of most black people. It is still so deliciously empowering

to say. It is a sign for and a gift of selfhood that is very hard to contemplate reconstructing

(deconstruction is too awful to think about!) at this point in history. It is the magic wand of

visibility and invisibility, of inclusion and exclusion, of power and no-power. The concept of

rights, both positive and negative, is the marker of our citizenship, our participatoriness, our

relation to others‟.


Liz Brosnan

Williams (1987 p 431)

I would argue this is how most people with disabilities feel about the newly won recognition for their

rights in law with the CRPD.

Disability and Human Rights

The social model asserts that disability is a product of disabling environments, rather than an

inherent attribute of a person (Oliver, 1990; Oliver and Barnes, 1998). The social model was a major

development of the Disability Movement which challenges the paternalistic and reductionist

conception of people enshrined in the medical model of disability, providing an intense sense of

liberation from attention on individual deficits of disabled people. Space does not permit adequate

discussion of the immense importance of this development here, much has been written about its

enormous impact in changing the paradigms and discourses around disability. Its influence is

obvious within the Convention on the Rights of People with Disabilities which for the first time

adopts a social model of disability in international law. There is however an inherent tension

between asserting the importance of environmental restrictions on individuals and recognising the

costs for disabled people of asserting and exercising their rights. For instance, Ruth Baily (2010) has

described how recognition of the effort the disabled person must make with and through their bodies

is not addressed in the social model of disability, and she theorises about recognition of „doing

impairment‟, or „doing energy management‟, actual daily practices by people which allow them

participate in daily activities taken for granted by able-bodied people. This recognition of the reality

of „doing the body‟, or indeed the broader concept of the ethics of care are sharp critiques of the

dominant language and discourses around disability and human rights.

Kayness and French are part of a substantial body of writers whose work that focuses on the right of

disabled people to participate, pointing out the central importance of the concept of citizenship in

contemporary theories of disability and disability rights. Claiming citizenship, and the dignity and

equality it entails, is fundamental to overcoming dehumanisation and exclusion. For persons with

disability, the effective denial of citizenship through failure to accommodate affects of impairment,

means a denial of the opportunity to participate in everyday activities but also in public policy

formulation and decision-making which affects their lives. The effective exclusion of persons with

disability from public policy formulation and decision-making processes is a profound distributive

injustice, denying them the opportunity to argue for their needs and rights in the contest for social


Liz Brosnan

resources, and for the reform of oppressive laws. This „wrong‟ is intensified by the exercise of overt

and covert executive power over the lives of many people with disability by means of compulsory

assistance (or coercive treatment), or, more subtly, through effective control over the social resources

that sustain people with disability. This history of disempowerment and paternalism has resulted in a

deep suspicion of administrative power and the demand for radical participation, which is

encapsulated by the credo „nothing about us without us‟: now a universal claim of the disability

rights movement internationally and a fundamental principle of equality (Kayness and French 2008).

Human Rights and Mental Health

Early recognition of disabled people, including people with mental illness, in human rights law

tended to be paternalistic, and legitimise segregation through specialised services and institutions.2

While the 1991 adoption by the UN General Assembly of the Principles for the Protection of Persons

with Mental Illness and the Improvement of Mental Health Care (Principles) was the first time

mental health conditions were included in human rights discourses they were controversial as they

enshrined the paternalistic medical model. The Principles established mental health care standards

and procedural guarantees for the protection of people with mental illness against human rights

abuses in mental health facilities, such as excessive or prolonged use of physical restraint or

involuntary seclusion, sterilisation on the grounds of mental illness, psychosurgery and irreversible

treatment. However, the continued focus on treatment and protection has meant the Principles have

been critiqued by many legal theorists, (Rosenthal and Rubinstein 1993, Gendreau 1997, Harding

2000) and rejected by service user activists for their perpetuation of a medical model of disability.

Harding (2000) critiqued the Principles in several ways: they lacked formal international treaty

status; there was no requirement on States to adopt them as minimum standards; in relation to

consent to treatment they removed rights rather than protect them; and finally the failure to provide

for a redress or any form of monitoring inspection and supervision by an independent international

body.

2 There is an active debate as to whether mental health conditions should be considered a disability. Many mental

health service users do not want to identify as having disability particularly as the condition is usually episodic, but most

accept that mental illness causes impairments, and accept the benefits that accrue from the protection of rights

afforded by the CRDP.


Liz Brosnan

The Convention of the Rights of People with Disabilities (CRPD) covers mental health conditions,

which is a core strategy of the disability movement: the inclusion of all people with disabilities in

policies and frameworks rather than developing impairment specific frameworks or principles.

Kayness and French (2008 pp 29 -30) reviewed the process of the drafting of the CRPD and their

account of the negotiations and compromises the activist must engage in when seeking to influence

policy or laws is illuminating. Consider Article 17. It was perhaps the single most contentious

Article negotiated by the Ad Hoc Committee, and, in large part as a consequence of this, its text is

the most limited of the substantive human rights Articles. The Article is confined to a simple

statement of principle with no specific application of this principle to the human right violations it

purports to address. Due to irreconcilable differences and implacable opposition to prohibiting the

use of compulsory treatments in the field of mental health, the Ad Hoc Committee abandoned an

earlier proposal that would have required the strict regulation of compulsory treatment. The

International Disability Caucus (IDC) and World Network of Users and Survivors of Psychiatry

(WNUSP) sought the ultimate goal of the CRPD „outlawing‟ all forms of compulsory assistance, but,

when this proved impossible to achieve, they adopted the alternative lobbying stance that there ought

to be no reference to compulsory treatment in the CRPD as this would provide it with legitimacy.

One of the most critical areas of human rights violation for people with disability, the use of coercive

State power for the purpose of „treatment‟, therefore remains without any specific regulation. This

issue of positive rights to treatment: to be able to access the choice in the form of treatments

available, to have appropriate care in the community, to have alternatives to medication only

treatments , and the corollary negative right, to be free from compulsory treatment are core human

rights issues within the mental health field.. 3

It is evident that much has been gained by the leverage of human rights in international and national

legal and policy domains of society. There are also significant criticisms of the limitations of human

rights discourse, including suggestions that the more powerful can appropriate rights talk to defend

their privileges or to assimilate and subsume social movements (Pieterse 2007). Patricia Williams

articulated clearly and passionately the power an appeal to human rights has for disposed people.

Neil Stammers argues for the need to examine the role and potential for social movements to

3 The issue of informed consent to treatment and use of non-consensual psychiatric treatments as a human rights

violation is argued by Tina Minkowitz in her paper discussing the international protections of human rights afforded

people with psychosocial difficulties under the CRDP. See

http://psychrights.org/Countries/UN/TMinkowitzOnNonconsensualPsychInterventions.pdf


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challenge and redefine how human rights can contest some of the power plays of dominant interest

groups. Substantial gains have been made by adapting a social movement/community development

approach to the use of human rights. A social movement has emerged around the Human Rights

Based Approach, which seeks to engage local people on the ground with the ideas of human rights

activism and it is worth looking at what has been achieved in this arena, in particular through the

work of the Participation and Practice of Rights Project in Belfast.

Human Rights Based Approaches

The right to participate in decisions which affect one‟s life is both an element of human

dignity and the key to empowerment – the basis on which change can be achieved. As such, it

is both a means to the enjoyment of human rights, and a human rights goal in itself. Amnesty

International (2006 p 48)

Human rights based approaches (HRBA) seek to ensure that human rights are a central plank

underpinning policymaking and political choices by ensuring that people have the political,

institutional and material resources to demand, exercise and monitor their human rights, and to

actively participate in decision-making processes. It requires the integration of minimum standards

into all plans, policies, budgets, processes and institutions. By definition HRBA is as concerned with

the process as the outcome. In the context of mental health services for instance, HRBA requires that

strategies and goals be explicitly based on the norms and values of international human rights law,

but also that those strategies be identified, applied and reviewed with active and informed

participation of the relevant communities, in particular those who use services. The use of human

rights language and participatory processes empowers rights holders, to both assert their human

rights and hold accountable those legally responsible for their delivery.

The five inter-connected principles, which have been internationally recognised as forming the core

of HRBA are: express application of the international human rights framework; empowerment;

participation; nondiscrimination and prioritisation of vulnerable groups; and accountability. I will

examine just one of these principles in more detail as it specifically relates to the emergent concept

of user involvement in mental health services.


Liz Brosnan

The active and informed participation of individuals, communities and populations is an integral

component of the right to the highest attainable standard of health (Hunt 2008). Helen Potts (2008)

points out that this includes participation in identifying overall health strategy, agenda-setting,

decision-making, prioritisation, implementation and accountability. She clearly distinguishes

participation in health policy development from education, informing or consultation, as none of

these concepts guarantees that the „voice‟ of individuals and groups will be heeded, or that there will

be follow through on any information gathered during the conduct of these activities. Potts describes

the learning from several projects that used HRBAs to look at participation in health policy

development in different countries. She argues that institutional mechanisms must be put in place to

ensure participation is fair. This must address three aspects: agenda setting; rule making and

facilitation; and discussion. Participation in the context of the right to health permits a preliminary,

predetermined agenda because a starting point is necessary in policy formation but fairness means

allowing everyone the same chance to put their concerns on the agenda. Rules must be established to

overcome the difficulties all participants can have as a result of personal, interpersonal and

institutional dynamics, setting out how discussions are managed and decisions reached. Appointing

an independent facilitator can also help ensure everyone has a chance to have their voice heard.

Transparent information on which to base decisions must be available. This means complex

epidemiological data or health management systems are explained in an accessible manner, free of

jargon, and that community perspectives and understandings of the health issues are available to

health services officials. Health service providers and government departments are firmly committed

to governance through policies and procedures, including ways to measure progress against these in

the form of indicators and benchmarks. Through the development of policies which use indicators

and benchmarks that make intuitive sense to people and are relevant to their concerns, they can show

how the „voices‟ of people and groups are listened to in the process and how the final decision are

made.

Potts reports on the way the HRBA worked in several health related projects including one of the

Participation and Practice of Rights (PPR) projects in Belfast, which focused on the needs of

residents of the Seven Towers housing project. Another project of the PPR, a mental health focused

project, reported by McMillian et al (2009), worked with the Public Initiative for the Prevention of

Suicide–Greater Shankill Bereaved Families (PIPSGSBF) Rights Group to affect a change in policy

in Northern Ireland in how mental health services provide follow-up care. The background to this

project, concerned with reducing deaths by suicide, is a complex and weighty set of policy


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documents and government exercises which make frequent references to user involvement, which

however had not resulted in any changes for people on the ground. This group, in collaboration with

PPR, demonstrated how participatory processes, from the bottom- up, resulted in concrete, user

defined outcomes and indicators. These indicators were established using WHO designed

instruments and indicators to monitor governments‟ progress on international human rights

commitments. Local people, supported by the PPR, used these official measures, based on action

research carried out by the group themselves on the mental health needs of their communities to

place the spotlight back on the State. Their experiences and research helped them identify four core

concerns around mental health services in Northern Ireland: follow-up appointments: complaints,

information from General Practitioners, and service user participation. They developed six

indicators to hold the government to account for progressive realisation of these issues which they

saw as critical to realisation of their human rights. McMillian et al (2009) describe how the group

made significant progress on the first issue, specifically their campaign to have a “card before you

leave” appointment system for mental health patients implemented across the province so that people

would feel connected to and supported by the services. They took three key decisions after

consultation on their indicators with an international panel of mental health and human rights

experts. Firstly, by holding the Minister for Health directly accountable for delivery on their

indicators, he used his political authority to overcome the resistance of the Trust to making

progressive changes. As a result he announced the introduction of the „card before you leave‟ scheme

a few short months after the media campaign set up by the group, and made mental health follow-up

care one of his top 12 health priorities. The second key decision the group took was to avoid the

existing government structures for consultation as they had previous experience of the failures of

these existing mechanisms. McMillian et al define “existing consultative structures” as „those

structures, bodies, and forums designed and led by the government, which include mental health

service users as members and which have the express purpose of increasing “user involvement” in

policy processes‟, McMillian et al (2009 p 65). The group‟s issues and concerns had been frequently

raised through these fora in the past without result. Instead, the group sought a ministerial liaison, a

top level civil servant who had specific responsibility to deliver on their indicators. Finally they

decided not to rely solely on the Minister or the liaison official to deliver but also exerted outside

pressure through a successful media campaign and alliances with other community groups, including

international advocacy groups, trade unions etc.

An interesting aspect of this project was the rejection of the existing consultative structures.

McMillan et al describe some of the barriers to participation experienced by members of the


Liz Brosnan

PIPSGSBF Rights Group. These included having decisions made without them, being made to feel

stupid at meetings, the chair always filled by someone on the government side, having to constantly

repeat their stories, and no real information about obstacles presented. McMillan et al call for further

research on barriers such as these and whether they are representative of wider participation

processes. Top down consultative processes have often been criticised as failing to provide genuine

opportunities for participation, whereas the projects developed in partnership with PPR from the

ground up, building capacity in local groups through HRBA, supporting them in developing their

own user led benchmarks and indicators can be the beginnings of real participation for service users.

In addition this project demonstrated real power subversion by adapting the WHO measures and

indicators and using them to hold the government to account. There is a pressing need for more

examples of participation by people affected by mental health issues in projects which engage with

the language of human rights used to leverage change towards progressive realisation of improved

mental health services.

Conclusion

This paper has examined some of the issues and paradoxes of human rights discourses and practices.

Initial enthusiasm for the expectation that human rights law would lead to progressive realisation of

improvements in people‟s actual circumstances has been tempered by the reality of limited liberal

interpretations by courts and indeed outright subversion of rights talk by dominant interest groups,

including the state itself. This discourse was also shown to be limited by its failure to include the

standpoint of women, or other marginalised groups such as black or disabled people, for instance the

need to include an ethic of care and a concrete elaboration of people‟s realities and needs into

abstract human rights discourses. This has begun to happen by the use of HRBAs by social

movements, illustrated in the empirical discussion of the PPR projects in Belfast. Here people on the

ground showed the power of HRBAs, bypassing the established participation mechanisms, and using

official indicators drafted by the WHO and adapted by the local people to hold the government to

account to leverage some of the changes they decided could meet their needs. These examples of

human rights in action from the ground up demonstrate the continued power of human rights, (to use

Patricia Williams‟ words again) to be the„magic wand of visibility and invisibility, of inclusion and

exclusion, of power and no-power.‟


Liz Brosnan

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