Human Rights in Mental Healthcare: High Time to Scale it up
The world has become more aware of the burden of Mental health (MH) conditions, thus the research to investigate the epidemiology, diagnoses, and treatments of these conditions as well as the funding and investments in improving MH services are increasing than ever before (1). It seems that MH is coming out of the shadows after centuries of stigma and discrimination. However, not only are these efforts far below the actual global burden of the MH conditions but also certain aspects of the matter are still left behind the curtains and not touched upon as much. One such aspect is the human rights in MH which is by itself an important, and yet controversial issue. Despite the undeniable recent improvements in this area and increased awareness of all stakeholders regarding the importance of respecting the human rights of people with mental health conditions and psychological disabilities, there is still a huge gap to fill.
When talking about human rights in MH, the first thing that comes into mind is the respect for basic human rights of people with MH conditions in inpatient psychiatric services, i.e. proper treatment, no chaining or beating, and allowing proper clothing, time off unit and using cellphones like other patients on medical floors. In addition, human rights advocates believe that mental health professionals should defend human rights at the populations level as well. Respecting rights can potentially enhance peace within societies and produce a way to create a fairer society for future generations, while violation of human rights are psychological traumas that can potentially be conducive to an increased occurrence of MH conditions. While everyone agrees on the mentioned areas of human rights activism in MH, there are more controversial notions like coercive measures in psychiatry, and medical decision-making capacity assessment that involve choice and dignity versus beneficence in patients with mental health conditions and are more controversial in this field.
Legally allowed coercive measures can barely pass the scrutiny of modern life human rights standards. One such measure is guardianship (conservatorship or curatorship) that is defined as removing one’s right to autonomy and self-determination by appointing a protector to manage the financial (guardian of property), medical and/or even daily life affairs (guardian of person) of someone whose decision-making capacity is deemed to be impaired due to a mental or neurological disability. Other measures such as substitute decision-making, preventive confinements, involuntary treatments, and community treatment orders are also allowed in MH acts of almost all jurisdictions to ostensibly protect patients and the public from possible harm to self or others; i.e. suicide, homicide, violence, and aggression (2). However, the limited research in this area is still inconclusive and generally fails to show that these coercive measures have been achieving any clinically significant reductions in harm at the population level (3). On the contrary, these approaches can potentially lead to arbitrary decisions in removing the rights of vulnerable and marginal people by giving huge power to clinicians that some of whom might still think somewhat paternalistic in their medical practice approaches. Moreover, these coercive approaches are often seen as a form of abuse by service users and can bring about a negative experience that might influence future voluntary use of MH services (4).
There is a strong relationship between MH and human rights. It is high time that we scaled up research in this area to provide a solid foundation for health policymakers in revising MH acts in accordance with the national and international human rights charters.
By Artin A. Mahdanian, MD, MSc, FRCPC
McGill University, Montreal, QC, Canada
1. Murphy J, Qureshi O, Endale T, Esponda GM, Pathare S, Eaton J, et al. Barriers and drivers to stakeholder engagement in global mental health projects. Int J Ment Health Syst. 2021;15(1):30.
2. Canvin K, Bartlett A, Pinfold V. Acceptability of compulsory powers in the community: the ethical considerations of mental health service users on Supervised Discharge and Guardianship. J Med Ethics. 2005;31(8):457-62.
3. Puras D, Gooding P. Mental health and human rights in the 21st century. World Psychiatry. 2019;18(1):42-3.
4. Funk M, Drew N. Practical strategies to end coercive practices in mental health services. World psychiatry : official journal of the World Psychiatric Association (WPA). 2019;18(1):43-4.