Human rights
Does mental health care measure up?
Are people living with mental illness guaranteed the best available mental health care? Evidence suggests that they do not enjoy the same rights, in terms of self-determination and protection from exploitation and discrimination, as do people who do not suffer from mental illness. Some ethical codes do relate specifically to mental health - yet the transition from rhetoric to reality has so far been limited.
The United Nations (UN) Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care was adopted by the UN General Assembly in 1991. The principles stress the inherent humanity of people with mental illness. In addition, the 1996 World Psychiatric Association Declaration of Madrid sought to reverse the process of segregation and discrimination of people with mental illness. Both of these provisions combine rights to the freedom to access health and support services, and the need for protection from exploitation and discrimination.
Violations of even the most basic of human rights of mentally ill people still happen. Caged beds are used in several central and eastern European countries including the Czech Republic, Hungary, Slovakia and Slovenia - all members of the European Union since 2004. A report by the National Human Rights Commission in India exposed the gross violations of human rights in many mental hospitals. Basic human rights of people with mental illnesses are systematically disregarded in some countries: they have little power to resist or challenge the labels attached to them by others or to withstand the institutionalisation which severely limits their life opportunities.
Establishing and enforcing human rights are powerful tools in attempting to reduce stigmas attached to being mentally ill. Policy-makers need to:
- strengthen the self-advocacy arrangements of mental health service users, by offering financial support to self-help groups, which in the long term may allow service users to directly challenge discrimination
- recognise the magnitude of the public health impact of mental disorders and fund services accordingly: although mental and neurological disorders contribute to 12 percent of all diseases worldwide, services for the mentally ill attract less than two percent of health expenditure in developing countries
- develop robust independent organisational measures to inspect mental health facilities to ensure that they match or exceed minimum standards of care.
In the future it will be necessary to make legal challenges using, for example, disability, equal opportunity and civil rights legislation to establish test cases and legal precedents to ensure that established standards are met and kept to - for example mental health treatment and care should be as good as that for physical disorders in terms of the quality of staff training, staff to patient ratios and other performance indicators. The quality of service offered to people who are unwell or disabled should be equal whether they suffer from physical or mental disorders.
Thara Rangaswamy
Schizophrenia Research Foundation
R/7A, North Main Road
Anna Nagar (West Extension)
Chennai 600101
India
scarf@vsnl.com
www.scarfindia.org
Graham Thornicroft
Health Services Research Department
Institute of Psychiatry
King's College London
De Crespigny Park
London SE5 8AF
UK
g.thornicroft@iop.kcl.ac.uk
www.iop.kcl.ac.uk
See also
'World mental health: problems and priorities in low income countries', Oxford: Oxford University Press, by R. Desjarlais et al, 1995
'Reducing the stigma of mental illness', The Lancet 357: 1055 by N. Sartorius, 2001
Mental Disability Advocacy Centre campaign against the use of cage beds in Central and Eastern Europe and Central Asia www.mdac.info/cagebeds.htm
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