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 theProtection of Persons with Mental Illness and the Improvement of MentalHealth Care was adopted by the UN General Assembly in 1991. The principlesstress the inherent humanity of people with mental illness. In addition, the1996 World Psychiatric AssociationDeclaration of Madrid sought to reverse the process ofsegregation and discrimination of people with mental illness. Both of theseprovisions 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 humanrights of mentally ill people still happen. Caged beds are used in severalcentral and eastern European countries including the Czech Republic, Hungary,Slovakia and Slovenia - all members of the European Union since 2004. A reportby the National Human Rights Commission in India exposed the gross violationsof human rights in many mental hospitals. Basic human rights of people withmental illnesses are systematically disregarded in some countries: they have littlepower to resist or challenge the labels attached to them by others or towithstand the institutionalisation which severely limits their lifeopportunities.

Establishing and enforcing human rights arepowerful tools in attempting to reduce stigmas attached to being mentally ill.Policy-makers need to:

• strengthen the self-advocacy arrangements of mental health serviceusers, by offering financial support to self-help groups, which in thelong term may allow service users to directly challenge discrimination
• recognise the magnitude of the public health impact of mentaldisorders and fund services accordingly: although mental and neurological disorderscontribute to 12 percent of all diseases worldwide, services for thementally ill attract less than two percent of health expenditure indeveloping countries
• develop robust independent organisational measures to inspectmental health facilities to ensure that they match or exceed minimumstandards of care

In the future it will be necessary to makelegal challenges using, for example, disability, equal opportunity and civilrights legislation to establish test cases and legal precedents to ensure thatestablished standards are met and kept to - for example mental healthtreatment and care should be as good as that for physical disorders in terms ofthe quality of staff training, staff to patient ratios and other performanceindicators. The quality of service offered to people who are unwell or disabledshould be equal whether they suffer from physical or mental disorders.