Mental health and human rights inevitably linked

The link between human rights and mental health is a crucial one. Moreover, it is one that continues to grow in importance. By Justin Frewen and Dr. Anna Datta.

A range of international human rights agreements and principles provide minimum standards as to how states should respect the rights of their citizens. Every person, irrespective of their race, gender, ethnicity, nationality, religion, mental health or any other aspect of their status is entitled to full enjoyment of their human rights.

Ireland has signed up to and ratified a number of international human rights covenants. Conventions such as the International Covenant on Civil and Political Rights (ICCPR) and International Covenant on Economic, Social and Cultural Rights (ICESCR) bind the Irish government to certain minimum standards in the delivery of mental health services. Furthermore, human rights entitlements encompass social determinants such as education, employment and housing.

(Picture: John Moloney, Minister with special responsibility for Equality, Disability Issues and Mental Health)

The Irish mental health policy document - A Vision for Change - stresses that the human rights of mental health service users “must be respected at all times”. The Mental Health Commission (MHC) Customer’s Charter also asserts that its operations are guided by international human rights law principles and standards.

However, there is growing disquiet that Ireland is failing to honour its international human rights commitments to mental health service users. This situation is aggravated by a shortfall in the required investment, increased pressure on available resources aggravated by the current recession and the high levels of stigma and prejudice confronting mental health service users.

Funding

Funding continues to remain a major stumbling block. As Amnesty highlight, Ireland has an obligation to make progress towards realising its human rights commitments, which means “that Ireland must be doing better today than it was doing five years ago... Even in a recession, Ireland has a duty to make progress towards realising this right.”

This principle of 'progressive realisation' acknowledges it may not be possible to fully implement all Treaty rights immediately. However, states must demonstrate their genuine commitment and active efforts to introduce these rights over a period of time by allocating the maximum resources available.

Convention on the Rights of Persons with Disabilities

Many in the mental health sector and wider disabled community are very concerned that the Irish government has failed to ratify the Convention on the Rights of Persons with Disabilities (CRPD), which is necessary for it to achieve legal status domestically.

The CRPD marks a paradigm shift whereby disabled people, including mental health service users, are regarded as rights holders. As rights holders, mental health service users should no longer be treated as objects of charity and/or medical treatment. Instead they are entitled to make their own decisions based on the principle of free and informed consent as well as being facilitated to participate as active members in society. The CRPD is animated by a social model which recognises that “disability resides in society, not in the person”.

It is essential the Irish government ratifies the CRPD and its Optional Protocol without further delay.

Human Rights Soft-Law

In addition, there is also important non-binding soft law, such as the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (MI Principles). These principles were adopted in 1991 by the UN General Assembly and outline minimum human rights standards in mental health practice.

Soft-law is non-compulsory and incurs no legal obligations. Nevertheless, it plays a significant role in promoting human rights, as with general international acceptance they acquire a certain normative power. Given their potential mutability, soft law standards can be improved over time and may serve as a draft of an actual international human rights convention further down the road. Finally, soft law can function as a blueprint for crafting national legislation.

Community-based Mental Health Care

Of particular concern is the failure to develop appropriate community-based treatment and care facilities. Article 19 of the CRPD articulates the right of disabled people, including those with a mental health issue, to live independently and be included in the community. According to MI Principles, mental health service users should, as far as possible, have the right to receive treatment and be cared for in their local community. A Vision for Change also advocates improved community care

However, progress towards developing adequate community services has been painfully slow. Funds, which might have been used to develop these services, have been diverted towards other uses. Therefore, Ireland suffers from a troubling lack of community-based services.

Participation

Rule 15 of the 1993 UN General Assembly “Standard Rules on Equalization of Opportunities for People with Disabilities” (Standard Rules) states, “people with disabilities” should be directly involved in preparing, monitoring and evaluating national legislation concerning them. This Standard Rule applies to mental health service users also.

Mental health service users, together with their family members, care providers, and other relevant stakeholders should be empowered to participate fully in the design, implementation and evaluation of mental health policy, programs and activities. This right to participation should be recognised as a matter of law.

The introduction and enactment of appropriate legislation could play a major role in realising human rights norms by creating a legal structure to facilitate their implementation and enforcement.

For further information on the human rights issues relevant to mental health, visit Amnesty International at http://www.amnesty.ie/amnesty/live/irish/action/default.asp?page=32840&rec=20&pos=1

This is an edited version of a piece that was originally in the Irish Medical Times