Mental health and human rights

Citation

Knifton, L. (2013), "Mental health and human rights", Journal of Public Mental Health, Vol. 12 No. 4. https://doi.org/10.1108/JPMH-10-2013-0067

Mental health and human rights

Article Type: Guest editorial From: Journal of Public Mental Health, Volume 12, Issue 4.

We are delighted to have collaborated with the World Health Organisation (WHO) mental health policy team in the development of this special edition of the Journal of Public Mental Health. As part of their global mental health strategy the WHO have developed QualityRights – a human rights toolkit that aims to transform public policies and shape services to address human rights abuses and social inequalities. In support of this, our articles each focus upon the human rights of people who experience mental illnesses. Our call for papers generated tremendous interest internationally. In this edition we present very different articles. Some are conceptual and enrich our theoretical perspectives, others enhance our understanding of the practicalities of addressing human rights.

Our opening commentary by Funk and Drew, from the WHO policy team, provides a compelling case for adopting a human rights approach in mental health. They describe human rights abuses and violations as commonplace including physical, sexual and emotional abuse. They then describe the process for developing the QualityRights approach, which aims to empower service users, promote recovery-oriented practices, shape human rights in public policies and healthcare, and embolden social reform movements. One core principle is the commitment to bringing together service users with state and non-state partners to achieve change. This focus upon collaborative approaches to enhancing human rights directly challenges the deep-seated social stigmas attached to mental illness and the public and institutional discrimination that ensues (Corrigan et al., 2004).

This special edition begins with three major research papers.

In our opening paper Pelletier et al. make a case for a new global model of public mental health based on the notion of health citizenship. Informed by the QualityRights ethos, they acknowledge power differentials and discuss how recovery, citizenship and wider health promotion must be linked. They impressively outline the importance of a dual focus on promoting individual and collective agency whilst influencing and involving wider social structures and communities. These ideas relate closely to those in other areas of public health for example the community-based participatory research approaches initially championed by Minkler and Wallerstein (2003).

Our next paper by Russo and Rose then examines the role of mental health service users/survivors in the process of human rights research. This is not only an integral dimension of the QualityRights toolkit but an ethical imperative more widely. This research draws from experience of mental health service users/survivors leading research on human rights in institutional settings across 15 countries and is especially valuable in this context. The paper highlights many areas that “insider” research may identify that is likely missed in monitoring visits.

Rosenthal and Ahern, from Disability Rights International, then shift our focus and broaden the debate beyond adult mental healthcare. They highlight the world-wide abuses that take place in institutions for children. More than this they draw on evidence to make a case that all institutions are detrimental for mental health and welfare. They argue that a human rights paradigm could be the catalyst to end institutionalisation for children.

These papers are powerful and provocative and will create significant debates. I am also conscious that there are many areas we could not begin to address here, especially how we ensure rights are upheld for those with mental health problems from communities who maybe further stigmatised due to migration status, gender, sexuality, poverty, ethnicity and so on (see Knifton, 2012).

We then end with three important case studies.

Nomidou piloted the toolkit in a Greek mental health clinic, comparing it with a physical health clinic in the same hospital. She undertook interviews with patients, relatives and staff alongside analysis of documentary evidence and group discussions. The findings highlight striking gaps in the promotion of human rights, social inclusion and autonomy and suggest that QualityRights may be a powerful resource to highlight abuses.

Appiah, a lawyer from Ghana, describes a human rights campaign and struggle over many years. Appiah describes how a social movement in Ghana has worked tirelessly to develop progressive human rights mental health legislation. What becomes clear is that change not only takes time but that social movements need to address multiple barriers and, at times, opposition and delay. The paper highlights the importance of alliance-building with media, political and legal systems – and this is seen in wider civil rights struggles. But I would also relate this to more general policy directions where we are understanding the significance of communities of practice (Wenger, 1999).

Finally Khaild et al. help us to think through how to develop the capacity of our workforce and civil society groups. They developed and delivered training for trainers for key human rights figures from Pakistan, Afghanistan, Libya, Morocco, Egypt, Sudan, Kuwait and Jordan. In their short paper they looked for ways to reduce the complexity of the toolkit, to focus on issues of quality, and to address cultural sensitivities. They note that training or support is as important as the resource if it is to be effective.

We hope that this special edition is provocative and challenging, but also that it provides practical ideas to advance equalities in mental health.

Lee Knifton
Senior Research Fellow, based at Strathclyde University, Glasgow, UK

References

Corrigan, P.W., Markowitz, F.E. and Watson, A.C. (2004), “Structural levels of mental illness stigma and discrimination”, Schizophrenia Bulletin, Vol. 30 No. 3, pp. 481-91

Knifton, L. (2012), “Understanding and addressing the stigma of mental illness with ethnic minority communities”, Health Sociology Review, Vol. 21 No. 3, pp. 287-98

Minkler, M. and Wallerstein, N. (2003), Community Based Participatory Research for Health, Jossey Bass, San Francisco, CA

Wenger, E. (1999), Communities of Practice, Cambridge University Press, Cambridge