Global Mental Health : An in-depth analysis of the global situation with regard to Human Rights
Mental health concerns continue to be largely neglected, despite the high prevalence of mental disorders in society. Mental health is integral to living a healthy and balanced life. According to the preamble of the 1946 constitution of the World Health Organization (WHO), mental health is “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” This definition implies that mental health is reliant on a wide array of supports and resources that facilitate individual engagement at the highest level of gainful employment and in other community roles.
Mental Health is important because it impacts our thoughts, behaviour, and emotions. Poor mental health can even lead to mental illnesses. One in five Americans has experienced some form of mental illness, with one in twenty-five experiencing serious mental illness, such as bipolar disorders or schizophrenia. Suicide accounts for over 800000 deaths globally each year, with 41000 in the U.S. alone. It is one of the leading causes of death worldwide for 15-29-year-olds. More than 450 million people suffer from mental disorders. In light of these hard facts, mental health disorders need to move out of the realm of being stigmatized. Furthermore, this article discusses the relationship between Mental Health and Human Rights and also focuses on the current mental health legislation in India. In addition, this article shows how the human rights of the mentally ill remain violated, and how it contributes to global economic loss.
The Intersection of Mental Health with Human Rights
The concept of human rights is a relatively recent notion that arose in mainstream discourse after World War II, the founding of the United Nations in 1945, and the adoption of the Universal Declaration of Human Rights by the UN General Assembly in 1948, it has entered into everyday parlance. Human Rights are about being treated fairly and treating others fairly irrespective of caste, color, creed, or whether the person is mentally healthy or not. In addition, Human dignity appeared with great force in the aftermath of World War II, and since then the global community has accepted it as the pillar on which human rights are based. Indeed, international human rights law has been specifically based since 1948 on the premise that citizens should have equal fundamental rights. It is the basic rights and freedom to which all humans are entitled. Human dignity forms a priori justification for the existence of human rights, and in turn, human rights become a means of realizing human dignity. Therefore Human dignity is one of the human rights. In order to protect these human rights across the globe a United Nations body i.e. The United Nations Human Rights Council (UNHRC) was founded in 2006.
The Office of the United Nations High Commissioner for Human Rights (OHCHR) declares that “the right to health is a fundamental part of our human rights and of our understanding of a life in dignity”. The UNHRC helps the Member States and non-member states to promote and protect the right to the highest attainable standard of physical and mental health (right to health). The relationship between mental health and human rights is an integral and interdependent one. For example, Human Rights violations such as torture and displacement and coercive treatment practices negatively affect mental health and can hinder human rights. Any person with a mental illness shall have the right to exercise all legal, political, economic, social, and cultural rights as recognized in the Universal Declaration of Human Rights. Mental illness was not specifically stated in the list of factors that were not to form the basis of discrimination; it certainly belongs to the term 'other status.' In 1991, the UN made this more explicit in its Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care it was important not only for its concrete provisions but also for its recognition of a particular need to protect the rights of persons with mental illness, especially persons with persistent mental disorders whose rights have been largely ignored in the past. So, the advancement of human rights will directly benefit mental health.
Mental Illness: The Brutal truth of maltreatment and Human rights violations.
The most striking inequity in global mental health is the disparity visible in the provisions of care and respect meted for the human rights of people living with mental disorders between rich and poor countries. The maltreatment of the mentally ill in many low-income countries is widely reported within psychiatric hospitals, informal healing centers, and family homes according to an ethnographic study of responses to mental illness in rural Ghana. Chaining and beating of the mentally ill were found to be commonplace in homes and treatment centres in the communities studied, as well as the with-holding of food ('fasting'). In Africa, people are locked away in traditional mental hospitals, where they are continuously shackled and routinely beaten because of the belief that mental illness is evil and that the afflicted are possessed by bad spirits. Children are tied to their beds, lying in soiled beds or clothing, and receiving no stimulation or rehabilitation for their condition. Countries continue to lock up patients in 'caged beds' for hours, days, weeks, or sometimes even months or years. A couple of patients have lived in these devices for nearly 24 hours a day for at least the last 15 years."
This is how the human rights of mentally ill people remain violated and they are socially stigmatized and discriminated against. According to Article 12 of the Convention on the Rights of Person with Disabilities, discrimination on the basis of mental illness is not permitted and people being treated for mental illness must be accorded the right to recognition as a person before the law”.
Health services have also not responded sufficiently to the burden of mental illness. As a result, the disparity between the need for care and its availability is wide throughout the world. Mental health conditions contribute to poor health outcomes, premature death, human rights violations, and global and national economic loss and up to 85 percent of people with severe mental health issues receive no treatment in low and middle-income countries, according to WHO. In response to this situation in March 2016, Portugal and Brazil, together with 73 States issued a joint statement to highlight the centrality of mental health for the full realization of the right to health. The statement also highlighted the importance of adopting a human rights perspective to ensure respect for the dignity of all human beings, and the full enjoyment of human rights without discrimination
The WHO recently implemented a special initiative for mental health over 5 years (2019-2023), WHO aims to raise US$ 60 million. The initiative seeks to ensure universal health coverage involving access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people. It will advance mental health policies, advocacy, and human rights, and scale up quality interventions and services for individuals with mental health conditions, including substance use and neurological disorders. These initiatives promote and protect the rights of the mentally ill.
Current Mental Health Legislations in India:
After the mental health care home fire of Erwadi in 2001 where patients who were chained faced death continues to be a constant reminder of society's apathy towards mentally ill people. A need was felt for effective legislation that secured the rights of people with mental illness. An attempt to protect the rights of the mentally ill can be seen in the Mental Healthcare Act, 2017. The act aims at providing mental health care and services to the mentally ill while promoting and fulfilling the rights of such persons during mental health care services. The act is patient-centered and based on the rights. There are various rights such as the right to community living given under section 19(1), right to confidentiality under section 23, right to access medical records under section 25, right to protection from cruelty and inhumane treatment given under section 20(2), and right to equality and non-discrimination under section 21 clause 4, they are all ensured by the law that makes it a progressive act in the right direction. Previous laws like the Mental Health Act, 1987 did not cover all such aspects which have been covered under the present Act. Lack of access to healthcare, superstition, lack of awareness, stigma, and discrimination are the most common problems in mental health awareness faced in India. The 1987 act does not direct any provision to address these factors. It provides nothing for prevention and early intervention. In recent years India has enacted many modern, progressive pieces of legislation that have had an indirect effect on the mental health of its people. For instance, in 2016 the RPDA Rights of Persons with Disabilities Act replaced the Persons with Disability Act 1995. The RPDA received the assent on 27 December 2016 and like IMHA Indian Mental Health Act 2017 it explicitly states that its purpose is to give effect to the UN-CRPD (United Nations Convention on the Rights of Persons with Disabilities). These legislations are progressive because the RPDA complements the proposed IMHA and legally underpins many of the social and economic rights of individuals with mental illness. In particular, they stress on ‘respect for inherent dignity’, ‘individual autonomy’ including the right to make one’s own decisions, non-discrimination; equal opportunities; affordability; respect for difference, and acknowledgment as part of human diversity and equality of people with disabilities. However, there are some limitations to the IMHA 2017, the new act attempts to shirk its responsibilities and shifts the burden upon families. This is likely to result in numerous unintended and mostly negative consequences. It breaches its own stated principles of equality therefore the act ends up discriminating against the mentally ill.
Mental health problems and mental illness often appear in adolescence or early adulthood and can have a lasting impact on one's life, disrupt school, work, and family relationships. Despite many initiatives by the World Health Organization human rights of mentally ill people have not been protected yet and influenced their reintegration in the community. Therefore, the need of the hour is to give attention to mental health legislation aside from making efforts in educating and shaping community attitudes towards mental illness as well as advocating the human rights of people with mental illnesses. Efforts to promote the human rights of those with mental illnesses must engage with the experience of mental illness within the affected communities in order to grasp the discrimination faced by them.
Title image source : TIME Magazine
This article has been written by Komal Soni , second year law student at Himachal Pradesh National Law University, Shimla.