People Who Position Paper:
Children and Youth - Human Rights and Behavioral Interventions

People Who supports the Convention on the Rights of the Child (Convention) which spells out the basic human rights that children everywhere – without discrimination – have: the right to survival; to develop to the fullest; to protection from harmful influences, abuse and exploitation; and to participate fully in family, cultural and social life and to have love and respect.

The Convention offers a vision of the child as an individual and as a member of a family and community, with rights and responsibilities appropriate to his or her age and stage of development. By recognizing children's rights in this way, the Convention firmly sets the focus on the whole child. It also asserts that children have a right to express their views and to have their views taken seriously and given due weight (UNICEF). Articles 12, 13, 14, 19. 20, 23, 29 are especially significant to children and youth with psychiatric disabilities. Overall, People Who supports interpretations of the Convention that are consistent with the emerging norms in disability and human rights.

"Youngsters can only be understood by considering the complex, interlocking web of caregivers, family, neighborhood, and community that surrounds them and that changes over time." (Beardslee, p 83)

In the 21st century, "homes are more chaotic and disorganized, and the children appear to be suffering from more powerfully disruptive mental illnesses and living through a worse set of adversities – being abused, not being able to understand the dominant culture, having the family break down, and often being victimized by violence. There is now compelling evidence that rates of depression among young people are increasing significantly – both within (the US) and abroad." (Beardslee, p 237)

Children and youth face factors – exposure to violence, discrimination and prejudice, social isolation, and poverty - that may predispose them to behaviors that are different. (Beardslee, p 240)

Even though most of the members of People Who are adults, all of us have ourselves been children and youth, and some of us have childhood experiences with mental health services. We believe that "Nothing About Us Without Us" also means "Nothing About Youth Without the Youth; Nothing About Children Without the Children." People Who believes in the social model of difference, sees the child as an individual and as a member of the family , and knows that the whole family needs supports.

We are concerned at the increasing understanding of difference as a medical condition with a biological explanation, and the using of standards from the developed world that are based on privileged gender and race.

Children deserve more than a quick pharmaceutical fix. Legal and illegal drugs can decrease thinking capacity, and deprive liberty by subjugating the mind for the benefit of the social comfort of others. Above all, since scientists have discovered that the brain undergoes surprisingly dramatic anatomical changes between the ages of 3 and 15 ( Suplee, Dekaban), care must be taken when recommending drugs so as to not interfere with development. Additionally, medications often have very different effects on children than adults and most psychotropic drugs are not tested on children at all, but only adults. We urge extreme caution.

Children and youth deserve the opportunity to learn self-understanding, responsibility, and accountability. To prevent escalation, children and youth who are having difficulties functioning in their adult world deserve round-the-clock access in the community to supports of their own choosing. These supports must embrace an active partnership with the child or youth, a dialogue than ensures full understanding of any proposed interventions, the chance to question, to know the plan and how to evaluate it, and real choices between or including talking, medication, conditioning, and other interventions. These supports must be culturally and linguistically synchronous. These supports must develop strengths, competencies, and resilience. Children deserve the chance to learn self-management. Drugs can assist, and more likely, depending on the drugs, can interfere with children learning their own coping strategies.

Children and youth deserve a full medical work up to rule out the many medical conditions that can cause different behavior, and an exploration of their social environment, for instance for allergies to foods. pets, toxins, other environmental sensitivities, and individual sensitivities to sound, light, smells, touch which might so overload as to cause unusual behavior and reactions.

Children and youth, like all of us, live in a context. That context can be disabling. The behavior that calls the child or youth to the attention of others can best be understood in the social context of that child or youth - the family, the school, the community.  People Who believes we must rule out other context determinants (NASMHPD) before prescribing medication, and work within the context to ensure that the child has a regular schedule, sufficient sound sleep, good nutrition, regular exercise. In particular, the transition from child to youth to adult may be especially challenging for those children who have been raised outside of a family home. 

Children and youth must speak for themselves with whatever supports they need to enable their self-expression and self-determination. People Who believes that the family must be the spokesperson when they can demonstrate that the child or youth is unable to communicate effectively, even with supports. In case of conflict of interest between the child and the family, the spokesperson should be a competent adult chosen by the child and trusted by both.

Children and youth deserve help connecting with those in their own age group who have similar social problems as well as the opportunity to meet adults diagnosed with psychiatric disabilities who can act as role models and mentors.

Public health strategies for improving the life quality of children and youth are adequate nutrition and protection from harm for mother and fetus, early years parenting support, quality day care, nurse home visits, neighborhoods that are integrated communities, and good schools (Beardslee).

References

William Beardslee, Out of the darkened room, 2002. Boston: Little Brown.

Convention on the Rights of the Child http://www.unhchr.ch/html/menu3/b/k2crc.htm

Dekaban, A.S. and Sadowsky, D., Changes in brain weights during the span of human life: relation of brain weights to body heights and body weights, Ann. Neurology, 4:345-356, 1978)

NASMHPD: Studies consistently confirm a 50-80% prevalence rate of sexual and physical abuse among persons who later acquire diagnoses of mental illness.  http://www.nasmhpd.org/trauma.htm , www.peoplewho.org/abuse

Suplee, Curt, Washington Post, March 9, 2000; A01

UNICEF http://www.unicef.org/crc/crc.htm

2003, People Who