Mental health

What is mental health?

The WHO defines mental health as a state of well-being enabling individuals to realize their abilities, cope with the normal stresses of life, work productively and fruitfully and make a contribution to their communities.

What is mental disability?

Mental disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others. It may be caused by the experience of temporary or long-term mental health problems, which has the of limiting the capacity to perform one or more essential activities of daily life. Mental disability can be caused or aggravated by the economic and social environment.

Why is mental health a human rights issue?

Individuals with psychiatric disorders are one of the most marginalized and vulnerable groups in society, thus susceptible to human rights abuse of the worst kind including inhuman and degrading treatment.  The problem is that 40% of countries do not have a mental health policy and mental health budgets of most countries account for less than 1% of their health expenditures[1]. Furthermore, WHO’s spending on mental health has consistently remained below 1% of total programme spending[2]. The disturbing state of mental health calls for a human rights framework to solidify the human right to mental health.

What is the right to mental health?

The right to mental health entails:

• The duty of the government, within the limits of its available resources, to ensure the conditions necessary for the mental health of individuals and populations.
• High quality and least restrictive mental health care as part of the health and social care system.
• Mental healthcare care includes the analysis and diagnosis of a person’s mental condition, and treatment, care and rehabilitation for a mental illness or a suspected mental illness.
• Satisfaction of the preconditions for mental health.

What is a human rights based approach to the right to mental health?

A human rights based approach is the integration of human rights norms and principles in the design, implementation, monitoring, and evaluation of mental health-related policies and programmes. It includes the following:

• Use legal sources as the authority for standards on the right to mental health norms and principles.
• Use these standards to create specific obligations.
• Establish a human rights framework upon which the right to mental health can operate.
• Adopt a violations approach towards non-compliance with the right to mental health.
• Create mechanisms of accountability at the national and international levels.
• Gather detailed information on the impact of domestic mental health policies to evaluate extent of compliance.
• Focus on vulnerable groups, for example, women and children with psychiatric disorders.
• Incorporate the principle of non-discrimination into mental health legislation.

How and why does the right to mental health relate to other human rights?

Human rights are indivisible, interconnected and interrelated. This is of particular significance since the right to mental health requires the satisfaction of the preconditions for mental health. It is therefore contingent on the observance of other human rights, for example, the freedom from inhuman and degrading treatment, the right to housing, food and education.

What are the legal obligations arising from the right to mental health?

Using General Comment 14 from the CESCR, the general obligations of respect, protect and fulfill are applicable to the right to mental health. In addition, mental health care must meet the four standards of available, accessibility, acceptability and quality. It is expected that these obligations will be achieved progressively and dependent on financial resources.

Obligation to Respect:

• Governments must refrain from interfering directly or indirectly with the enjoyment of the right to mental health.
• Refrain from applying coercive medical treatment.
• Abstain from enforcing discriminatory practices as a government policy.

Obligation to Protect:

• Governments must take measures to prevent third parties from interfering with the right to mental health.

Obligation to Fulfil:

• Governments must give sufficient recognition to the right to mental health in the national political and legal systems, preferably by way of legislative implementation.
• The public health infrastructure should provide for the promotion and support of the establishment of institutions providing counselling and mental health services.
• To undertake actions that create, maintain and restore the mental health of the population.

The core obligations as essential requirements are immediate obligations and non-compliance cannot be justified by resource constraints:

• Governments must implement a national public mental health strategy, addressing the mental health concerns of the whole population.
• The strategy and plan of action shall be devised, and periodically reviewed, on the basis of a participatory and transparent process.
• To monitor the right to mental health including the use of mental health indicators and benchmarks.
• Particular attention must be given to all vulnerable or marginalized groups.
• Ensure access to essential primary health care including essential medicines.
• Ensure non-discrimination in access to mental health care services.
• Address the root causes of discrimination on the grounds of mental disability or health status, which has the intention or effect of nullifying or impairing the equal enjoyment or exercise of the right to health.
• To ensure the promotion and support of the establishment of institutions providing counselling and mental health services.
• Mental health care facilities must be affordable for all and of good quality.

Notes

[1] WHO, World Health Report 2001: Mental Health: New Understanding, New Hope, 2001, p.3

[2] Lancet Global Mental Health Group, Scale up Services for Mental Disorders: A Call for Action, 2007, p.9