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 Table of Contents    
GUEST EDITORIAL  
Year : 2016  |  Volume : 58  |  Issue : 3  |  Page : 250-252
Mental health and human rights: Working in partnership with persons with a lived experience and their families and friends


1 The Medical Centre, Nuneaton, CV11 6AS, UK
2 Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

Click here for correspondence address and email

Date of Web Publication12-Oct-2016
 

How to cite this article:
Javed A, Amering M. Mental health and human rights: Working in partnership with persons with a lived experience and their families and friends. Indian J Psychiatry 2016;58:250-2

How to cite this URL:
Javed A, Amering M. Mental health and human rights: Working in partnership with persons with a lived experience and their families and friends. Indian J Psychiatry [serial online] 2016 [cited 2021 Jun 24];58:250-2. Available from: https://www.indianjpsychiatry.org/text.asp?2016/58/3/250/192002


The concept of human rights increasingly defines the discourse on ethical, moral, and legal frameworks of nations as well as international organizations. Their international and universal character was set out in the 1948 Universal Declaration of Human Rights and reinforced consistently ever since. At the same time, discussions on differences regarding their interpretation and application involve all of us on a daily basis on a political, professional, and personal level.

Although human rights are promoted in a wider perspective and all population groups fall under their protection, there are on-going discourses around the world over the human rights needs of individuals diagnosed with psychiatric disorders and those experiencing mental health problems. Reports have confirmed the severity of human rights violations among this group almost in all cultures and countries though there are variations in frequency, intensity or severity. The practices and policies to follow human rights also change from one country to another with a number of concerns for disparities.


   Recent Historic Firsts Top


In recent years, several historic firsts occurred, which have a strong bearing on the current developments in mental health and human rights:

  • For the first time in history, the human rights for persons with disabilities were specifically formulated in the 2006 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). This was deemed necessary because persons with disabilities have been denied their human rights on many levels and in all cultures and societies despite the fact that all prior human rights legislation, of course, applies to persons with disabilities in the same way as to every human being. This process of assessing the human rights situation of a particular group of people responding to the documented need for extra attention can be understood in analogy with the formulation of the UN-Convention on the Elimination of All Forms of Discrimination against Women in 1979 or the UN-Convention on the Rights of the Child in 1989
  • For the first time in history persons with a lived experience of disability were part of the negotiating process at the United Nations. This brought about a plethora of novel experiences and “New Diplomacy” strategies with remarkable successes and only partly overcome stumble blocks [1]
  • For the first time in history persons with a lived experience of disabilities from mental health problems (psychosocial disabilities) joined the movement of disability activists and were equal partners in the process of drafting the UN-CRPD. As a result, the convention obliges states to involve persons with disabilities in policy development. Therefore, from now on, people with a lived experience background will as rights-holders be part of the activities of international and national monitoring bodies with regard to UN-CRPD as well as all negotiating processes of international, national or local policies that concern their care and their lives in their communities.


Furthermore, the UN-CRPD has a place in history with an exceptionally fast ratification process. By June 2016, 165 States Parties have ratified the UN-CRPD, thereby making it applicable in their countries. The consequent changes in policy and practice of mental health care concern high-as well as low- and middle-income countries.[2] As a majority of people will be experiencing some form of disability either personally or as a family carer or friend at some point in time in their lives and disabilities from mental health problems affect millions of people all around the globe the significance of the claims and consequences of a successful meeting of the obligations of this particular UN-Convention can hardly be overestimated.


   The Un-Convention on the Rights of Persons With Disabilities Top


The UN-CRPD includes freedom rights, such as the right to be free from exploitation, violence and abuse and requests nondiscrimination in terms of capacity and equal recognition before the law. The first of many to follow comments by the UN Convention on the Rights of Persons with Disabilities (CRPD), a body of independent experts which monitors implementation of the convention by the States Parties, concerned a most controversial issue for psychiatry. In 2014, the committee set forth an interpretation of Article 12 on equal recognition before the law, which requests the replacing of all substituted decision-making regimes with supported decision-making alternatives. At the same time – in another historical first the UN Rapporteur on torture and other cruel, inhuman or degrading treatment – an independent expert appointed by the UN Human Rights Council – voiced serious concerns about discrimination against people with psychosocial disabilities and the domestic legislations and practices in many parts of the world. The comment was widely contested as was the report. Efforts toward a realistic way forward include calls for a broad discussion including mental health practitioners and a wide range of service user groups and family carers as well as specific interventions such as reform of guardianship laws or the promotion of advance directives in mental health care. The latter have received special attention in India as they were introduced in 2013 as part of the Mental Health Care Bill.[3]

The concept of nondiscrimination also informs another essential part of UN-CRPD provisions, which formulate core entitlement rights, for example, Article 19 on Living Independently and Being Included in the Community stating that “States Parties to this convention recognize the equal right of all persons with disabilities to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment by persons with disabilities of this right and their full inclusion and participation in the community.” The UN Committee on the Rights of Persons with Disabilities held a Day of General Discussion specifically on Article 19 of the CRPD in April 2016.

Our work with the World Association of Psychosocial Rehabilitation (WAPR) along with its joint work with WHO in line with the WHO Community-based Rehabilitation Guidelines [4] and the WHO QualityRights Tool Kit [5] also directs our attention especially to the following UN-CRPD articles pertinent to the core tasks of psychosocial rehabilitation:

  • Article 24 - Education
  • Article 25 - Health
  • Article 26 - Habilitation and rehabilitation
  • Article 27 - Work and employment
  • Article 28 - Adequate standard of living and social protection
  • Article 29 - Participation in political and public life
  • Article 30 - Participation in cultural life, recreation, leisure, and sport
  • Article 31 - Statistics and data
  • Article 32 - International cooperation.


WAPR in their general board meeting at the 2015 World Congress in Seoul approved a policy document and statement supporting UN-CRPD guidance and urged its incorporation, also in daily practices in the field of rehabilitation.[6]


   Working in Partnership Top


The UN-CRPD highlights the role of barriers that hinder the full and equal enjoyment of all human rights by persons with disabilities on different levels. Its focus on nondiscrimination and social inclusion goes hand in hand with the participatory process of its drafting. Consequently, it makes the consultation of its constituency mandatory: No policy development, no amendment of legislation or elaboration of new regulations shall be undertaken without including experts in their own right: Persons with a lived experience of mental health problems and services. Specific examples concern the obligations to “closely consult with and actively involve persons with disabilities, including children with disabilities, through their representative organizations in the development and implementation of legislation and policies to implement the present convention, and in other decision-making processes, concerning issues relating to persons with disabilities (Article 4 (3)) as well as in the mandatory monitoring process CRPD (Article 33 (3)).”

WHO in its Mental Health Action Plan 2013-2020 relies on human rights as one of six cross-cutting principles formulating that “mental health strategies, actions and interventions for treatment, prevention and promotion must be compliant with the convention on the rights of persons with disabilities and other international and regional human rights instruments”[7] and proposes actions for collaborations with users and family carers and to ensure the involvement of people with a lived experience through formal mechanisms giving them the “authority to influence the process of designing, planning and implementing policies, laws and services.”[7]

World Psychiatric Associations (WPA's) recommendations for the international mental health community on best practices in working with service users and carers,[8] state that “based on the understanding that recovery from mental illness includes attention to social and economic inclusion as well as adequate access to a balanced system of hospital and community mental health care, the WPA recommends to the international mental health community the following approach for collaborative work between mental health practitioners, service users, and family/carers.” The first of the ten recommendations concerns the notion that “Respecting human rights is the basis of successful partnerships for mental health.” Recommendations include the call to include users and carers in the development of policy and practice as well as to promote and support the development of service users' and family carers' organizations and were validated by a consequent amendment of the WPA Madrid Declaration on Ethical Standards for Psychiatric Practice in 2011.[9]

The Trialog movement, which originated in Germany almost 30 years ago [10] and is meeting growing international interest during recent years,[11] is an exercise in communication between service users, families and friends and mental health workers on equal footing. Trialog groups teach many of the skills we will need to make use of the mandated communications and collaborations between mental health-care users and user activists, family carers and friends, and mental health professionals and policy makers outside and beyond traditional clinical and pedagogic encounters, which are needed to strengthen a rights-based approach in the field of mental health and further civil society involvement. Trialogues are indicative of our capacity to acquire the expertise to learn from each other and to gain from serious discussions of adverse issues as well as the great possibilities of cooperative efforts and coordinated action.


   Conclusion Top


The current literature clearly demonstrates the increased incorporation of human rights in supporting people with mental health problems and disabilities. This does and will further strengthen the programs addressing issues related to abuse and violations of rights in our field. These efforts should be expanded to ensure global coverage and support systems that address the needs of persons with mental health problems and their families and friends in an even more open, transparent way. While the concepts of health are getting refined, mental health will continue to be an integral component of general health with widespread consequences for human rights violations, including discrimination, in this area.

 
   References Top

1.
Sabatello M, Schulze M, editors. Human Rights and Disability Advocacy. Pennsylvania, USA: University of Pennsylvania Press; 2013.  Back to cited text no. 1
    
2.
Poreddi V, Ramachandra, Reddemma K, Math SB. People with mental illness and human rights: A developing countries perspective. Indian J Psychiatry 2013;55:117-24.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Ratnam A, Rudra A, Chatterjee K, Das RC. Psychiatric advance directives in India: What will the future hold? Asian J Psychiatr 2015;16:36-40.  Back to cited text no. 3
[PUBMED]    
4.
WHO (2010) Community-Based Rehabilitation Guidelines; 2010. Available from: http://www.who.int/disabilities/cbr/guidelines/en/. [Last retrieved on 2016 Feb 14].  Back to cited text no. 4
    
5.
WHO (2012) WHO QualityRights Tool Kit; 2012. Available from: http://www.who.int/mental_health/publications/QualityRights_toolkit/en/. [Last retrieved on 2016 Feb 14].  Back to cited text no. 5
    
6.
World Association of Psychosocial Rehabilitation; 2016. Available from: http://www.wapr.info. [Last retrieved on 2016 Feb 14].  Back to cited text no. 6
    
7.
WHO (2013) Mental Health Action Plan 2013-2020; 2013. Available from: http://www.who.int/mental_health/action_plan_2013/bw_version.pdf. [Last retrieved on 2016 Feb 14].  Back to cited text no. 7
    
8.
Wallcraft J, Amering M, Freidin J, Davar B, Froggatt D, Jafri H, et al. Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers. World Psychiatry 2011;10:229-36.  Back to cited text no. 8
[PUBMED]    
9.
WPA Madrid Declaration on Ethical Standards for Psychiatric Practice. Available from: http://www.wpanet.org/detail.php?section_id=5 and content_id=48. [Last retrieved on 2016 Feb 14].  Back to cited text no. 9
    
10.
Amering M, Mikus M, Steffen S. Recovery in Austria: Mental health trialogue. Int Rev Psychiatry 2012;24:11-8.  Back to cited text no. 10
[PUBMED]    
11.
Mental Health Trialogue Network, Ireland. Available from: http://www.trialogue.co. [Last retrieved on 2016 Feb 14].  Back to cited text no. 11
    

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Correspondence Address:
Afzal Javed
The Medical Centre, Manor Court Avenue, Nuneaton, CV11 6AS
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.192002

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