The term ‘human rights’ refers to the fundamental rights and freedoms which every human being is entitled to irrespective of factors such as age, gender, race, sexual orientation, illness/disability, nationality, colour, religion, political opinion and ethnicity. A number of pressure groups, advocacy groups, social agencies and non-governmental agencies have committed themselves to promote and safeguard the human rights of different vulnerable groups in our society. One of these vulnerable groups is people experiencing mental health difficulties.
Situations that violate the human rights and freedoms of people with mental illness are very often forgotten and sidetracked, therefore they are subtlety or more overtly abused. In addition to the obvious suffering due to mental illness, there exists the hidden burden of stigma and discrimination faced by those with such illnesses. Throughout the world, stigmatisation of people with mental health problems has persisted throughout history, manifested by stereotyping, fear, embarrassment, anger and rejection or avoidance. Violations of basic human rights and freedoms and denial of civil, political, economic, social and cultural rights to those suffering from mental illness are a common occurrence both in institutions and in the community. Physical, sexual and psychological abuse is an everyday experience for many with mental health difficulties. In addition, they face unfair denial of employment opportunities and discrimination when accessing services, health insurance and housing policies. Much of this goes unreported and therefore people suffer in silence.
People with mental health difficulties are, or can be, particularly vulnerable to abuse and violation of rights. Legislation, policies and systems that protect vulnerable citizens (including people with mental illness) reflects a society that respects and cares for its people. These can be effective tools to promote access to mental health care as well as protect the rights of people with mental illnesses. However, the presence of mental health legislation and policies do not in themselves guarantee respect and protection of human rights. In some countries where legislation has not been updated for many years, mental health legislation has resulted in the violation, rather than the promotion, of human rights of people with mental illness. This is because much of the mental health legislation initially drafted was aimed at safeguarding members of the public from “dangerous” patients and isolating them from the public, rather than promoting the rights of people with mental illness as people and citizens. Other legislation permitted long-term custodial care of people with mental illness who posed no danger to society but were unable to care for themselves, and this too resulted in a violation of human rights.
Unfortunately, this practice could happen also today if people are held in institutions for issues related to their choice of lifestyles, housing, relationships and other personal and social reasons rather than because of the state of their mental health. Adequate and modern policies and legislation are the starting point for achieving respect for the human right of people with health difficulties but it is also important that there is public, political and professional will, education and information and adequate health and social care services with well trained professional staff. It is very basic and superficial when a country has policies and legislation which promote community care when in practice community services are inadequate, scarce, uncoordinated, understaffed or staffed by people who are not trained to deal with people with mental health difficulties in the community. In principle, the policy or legislation would be protecting the individual’s right to receive care in the community and in the least restrictive manner, but the system and the practices would be undermining the very same policy and legislation. Likewise, policies and legislations often respect the individual’s rights that medical and social care for people with mental illness is based on the values of empowerment, autonomy, informed choices and decisions, but in order to be able to achieve this in practice it is very important that there is investment in educating and training both the general public and mental health professionals in particular to achieve this change in mentality, as traditionally care for people with mental illness may be disempowering and patronising.
The lack of flexibility at the work place and the stigma and fears, which still exist in our society, most frequently results in the violation of people’s right to work. A number of people with mental illness are unemployed primarily because they do not find places of work that are flexible to their health needs and because the policies lack incentives for employers to be flexible when offering job opportunities to such individuals. As a result of high unemployment in this vulnerable group of people, most live on social benefits with all the limitations which living on a very basic income brings with it. As a result of this financial hardship most are unable to live comfortably and enjoy a good quality of life, another infringement of human rights. Notwithstanding this, not all people with a mental illness and who are unemployed are entitled to social benefits, as a number of them have no income because of specific living conditions such as living with parents. It is assumed that the individual can depend on his/her relatives’ financial assistance to meet his/her daily needs. Besides the financial burden on the whole family, this is often a humiliating experience for the person concerned. The right for every person to be protected by social welfare systems in times of distress is not respected in such cases. In some cases people are not even eligible for free medication because their diagnosis do not meet particular criteria. This, together with other practices such as that of not having the choice over which mental health professional to care for you, are a few of the flaws in the system which could jeopardize the individual’s right to adequate healthcare. Other legislation and policies, which we need to reconsider for the protection of this vulnerable group’s human rights, are those which jeopardize their right to family life since it is clearly stated in our laws that people with a particular mental illness cannot marry.
This is definitely not a complete analysis of the local situation with regard to the promotion and protection of the human rights of people with a mental illness. It is important to highlight the sufferings and injustices that people with mental illness often have to endure in silence as a result of certain legislation and policies that impact negatively on their daily life.
Human rights which need to be promoted and protected with regards to persons experiencing mental health difficulties:
• Right to employment
• Right to access for services
• Right not to be discriminated because of an illness
• Right to receive treatment in the community and in the least restrictive manner
• Right to community health and social care based on values of empowerment and informed choices
• Right to have an adequate standard of living
• Right to social benefits at times of distress, including free medication
• Right to a holistic approach to care and of one owns choice
• Right to marry and start a family life
Dolores Gauci is Chief Executive Officer
Richmond Foundation