Last week, the Government held an event to mark the occasion of T&T's June 25 ratification of the Convention on the Rights of Persons with Disabilities (CRPD). The United Nations Chief of the Secretariat for the CRPD and UN/Focal Point on Disability, Akiko Ito, was in T&T for the event and spoke with mental health disability columnist and advocate Caroline C Ravello in a wide-ranging conversation on the convention.
Ms Ito, who is also a departmental focal point for women at the UN Department of Economic and Social Affairs (Desa) first visited T&T in 2009 to organise a workshop on disability and held high praise for what she deemed "the progress and surge in interest that T&T is making in promoting the rights of persons with disabilities."
A level playing field
Akiko Ito says she feels privileged to have seen and overseen the subject of disability for over 20 years and to be involved from the beginning of the work on this convention, which she says "was designed not just as a human rights instrument but one to transform societies."
The CRPD and its Optional Protocol was opened for signature in March 2007; there were 82 signatories to the convention, 44 signatories to the Optional Protocol, and one ratification of the convention. According to the UN Enable Website, this was the highest number of signatories in history to a UN convention on its opening day.
"I see now the coming together of what we saw then as fundamental and we are at the stage where States need to concretise the ideas that were envisaged many years ago," Ito says."Back in 2001, 2002, 2003, the international community struggled to get the specifics correct to establish a proper foundation for what was lacking.
"These rights," Ito says, "are not new rights but present the levelling of the playing field for the (equal) rights of persons with disabilities to live lives of dignity."At the outset, in December 2001, the authors were mandated to consider proposals for a comprehensive and integral international convention to promote and protect the rights and dignity of people with disabilities, based on the holistic approach of social development, human rights and non-discrimination.
Invisible disabilities
Bringing the issue of invisible disabilities to the fore and the fact that in T&T there remains an unfortunate slant where the disability community, policymakers, and media continue to highlight physical disabilities to the disregard of mental and psychosocial disabilities, Ito said it was a universal problem.
"It is actually not just T&T, but in general, in all of the world we tend to focus on physical disabilities. And at the UN for the past several years, especially since the convention was adopted, we have placed a specific focus on invisible disabilities.
"This is something that we have been working on during the past several years," Ito says, "through organising of panel discussions in conjunction with Conference of State parties (COSP) and highlighting psychosocial disabilities on globally-designated days."
To ensure inclusion of mental and psycho-social disabilities, Ito says COSP, as a major global meeting keeps the elevated focus on mental health and psychosocial wellbeing. She says the UN works with experts in mental health and psychosocial wellbeing from different countries.Ito also spoke of the University of Tokyo's focus on disability on mental health wellbeing.
She said: "I have also learnt that in my country there will be established a global institute with a focus on mental health and mental wellbeing and development. That is currently being established and would serve as an access point for global resource.""But in order for any focus to be effected and effective to make real change on the ground, legislative change is necessary."
Ito says in T&T as elsewhere, legislation or the process to develop legislation will require different expertise. And that as a society, we have to determine our priorities for each year and use the designated days for observations/events not just for general awareness but with specific focus, meaningful political affirmation and commitment and important pledges to specific actions.
The UN, Ito says, is also committed to working in conjunction with World Autism Day, the WHO focus on mental health day, the international day for Down's syndrome and others as entry points to ensure that mental and developmental disabilities remain on the forefront of every discussion on the rights and dignity of those living globally with disabilities.
"We at the UN recognise that mental health is one of the most neglected yet essential development issues however. And that no umbrella programme can meet the diverse needs of the disability community nor can they properly address the invisibility of those with invisible disabilities," says Ito.
On constitutional reform
On highlighting that T&T's Constitution makes the point of discriminating against just one groupof people with disabilities–the mentally ill–disqualifying a person for such a status from serving in the Senate or the Parliament, Ito says ratification of the CRPD places the onus on government to institute necessary reform and to take all appropriate measures to revise obsolete legislation.
Ito says that T&T deserves the best standard in law and no less than the highest standard should be looked at if constitutional reform is required.
"Government is obligated to harmonise legislation. If constitutional reform is required, a task force to review constitutional implications locally would be the expectation. In some cases you need an expert to work with government and again the UN through its local office would co-opt WHO experts, experts in Geneva, or elsewhere at the request of the State.
On lack of financial commitment
Presented with the fact that out of a budget of $2.8 bn allocated for health only $6M actually goes to cover "all other mental health expenditures" outside the work at the St Ann's Psychiatric Hospital, Ito said profoundly "governments must consider that the investment in persons with disability is an investment in the whole society."
In order to impress on government that the ratio is terribly skewed and mis-informed or under informed so we can move away from the culture of merely "celebrating and observing" moments in the name of mental/psychosocial disabilities, Ito says will require evidence-based informing of policy-making.
"There are any approaches to agenda budgeting for disability for example from gender perspective, using and developing budget analysis utilising the information of the statistical office, or deferring to the WHO for evidenced-based work to provide to government officials and expert committees with the best advice."
more info
WHO statistics
Of the $2.8B allocated to the MoH (in 2006) only $103M or four per cent of health care expenditures were devoted to mental health or care of the mind.Of the $103M for mental health, 85 per cent ($97.5M) were allocated to the St Ann's facility; a mere $6M covers "all other mental health expenditures."The biggest share of mental health expenditures is for payment of salaries/wages.
Bridging gap between policy and practice
On bridging the gap between policy and practice, Ito says States cannot assume they have the right answer but must bring stakeholders together: NGOS, individual advocates, community based groups, all must interact at the highest level to talk about needs and obstacles and come up with an action plan.
"At the Convention's Conference of State Parties where more than 1,000 delegates are in attendance, we ask governments to tell us what you have done, what you can do, what you intend to do," Ito says."At that meeting we do not necessarily want to discuss hindrances."
"We want to know about specific actions by States to bring people together and how best the UN can provoke that to happen."
Purpose of the convention
The purpose of the convention is to promote, protect and ensure the full and equal enjoyment of all human right/cuts and fundamental freedoms by people with disabilities, and to promote respect for their inherent dignity.People with disabilities include 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.