Human Rights and Mental Health Service User Participation

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Participation and Human Rights in Mental Health
A paper by Liz Brosnan

Edited 12/10/2010


Participation, Mental Health and Human Rights Liz Brosnan


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

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Participation, Mental Health and Human Rights 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)

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

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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
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Participation, Mental Health and Human Rights 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
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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

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

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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‟.
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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

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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.


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.

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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

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

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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.

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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
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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.

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.‟

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Amnesty (2005) Our Rights, Our Future. Human Rights Based Approaches in Ireland: Principles, Policies and Practice, Dublin: Amnesty International, Ireland. Bailey, Ruth (2010) Doing Impairment: Towards a Non Normative, Socially Shaped Understanding of Impairment. Paper presented at BSA Annual Conference „Inequalities & Social Justice‟, 7-9 April 2010, Glasgow Caledonian University. Bourdieu, P. and Terdiman, R (1987) The Force Of Law: Toward A Sociology Of The Juridical Field, Hastings Law Journal 805 Burns, J. K. (2009) 'Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability', Health and Human Rights, 11(2), 19-31 Butler, F. (2005) Improving Public Services: Using a Human Rights Approach, London: Institute for Public Policy Research. Delgado, Richard and Jean Stefancic (1998) „Critical Race Theory: Past, Present and Future‟, Current Legal Problems 51, 467-91. De Wispelaere, J. and Walsh, J. (2007) 'Disability Rights in Ireland: Chronicle of a Missed Opportunity', Irish Political Studies, 22(4), 517 - 543. Donnelly, Jack (2003) Universal Human Rights in Theory and Practice, 2nd edition Cornell University Press: Ithaca, N.Y.; London. Dhanda, A. (2008) 'Constructing a New Human Rights Lexicon: Convention on the Rights of Persons with Disabilities', International Journal On Human Rights, 8, 42-59. Ellis, J. A. (1988) Chronicling a Movement for Civil Rights, Law & Society Review, 22, 5, 1027-1032 Harding, T.W. (2000) Human Rights Law in the Field of Mental Health: A Critical Review, Acta Psychiatr Scand, 101,24-30 Holmes, S. & Sunstein, C. R. 1999. The Cost of Rights: Why Liberty Depends on Taxes, New York, W. W. Norton & Co. Kayess, R. & French, P. (2008). Out of Darkness into Light? Introducing the Convention on the Rights of Persons with Disabilities. Human Rights Law Review, 8, 1-34. McMillan, F. V., Browne, N., Green, S. and Donnelly, D. (2009) 'A Card Before You Leave: Participation And Mental Health In Northern Ireland ', Health and Human Rights, 11, 61- 72. Minkowitz, T. 2007. The United Nations Convention of the Rights of Persons with Disabilities and the Right to Be Free from Nonconsensual Psychiatric Interventions. Syracuse J. Int’l L. & Com., 34, 405-428.
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O‟Sullivan, E. (2009) Residential child welfare in Ireland, 1965-2008: an outline of policy, legislation and practice: a paper prepared for the Commission to Inquire into Child Abuse. Available on accessed 22 Sept 2010. Pieterse, Marius (2007) „Eating Socioeconomic Rights: The Usefulness of Rights Talk in Alleviating Social Hardship Revisited‟, Human Rights Quarterly 29, 796-822. Potts, H. (2008) Participation And The Right To The Highest Attainable Standard Of Health, Colchester, Essex,: Human Rights Centre, University of Essex Stammers, N. (1999) 'Social Movements and the Social Construction of Human Rights', Human Rights Quarterly, 21(4), 980-1008. Thomas, C. (2004) How is disability understood? An examination of sociological approaches, Disability and Society 19/6, 569–583. Williams, P. J. (1987) 'Alchemical Notes: Reconstructing Ideals From Deconstructed Rights', Harvard Civil Rights-Civil Liberties Law Review, (Spring), 401-438 Whyte, G., (2006) The Role of the Supreme Court in our Democracy: A Response to Mr Justice Hardiman, Dublin University Law Journal 28, 1-26 Ziv, Neta (2007) „The Social Rights of People with Disabilities‟ in Daphne Barak-Erez, and Aeyal M. Gross (eds.) (2007) Exploring Social Rights: Between Theory and Practice (Oxford: Hart), pp. 369-395.

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