In 1991, the United Nations General Assembly passed a set of principles for the protection of persons with mental illness and the improvement of mental health care. A PDF version is embedded below. The international community will talk the talk when it comes to human rights and mental illness, but they’re still a long way from walking the walk. This post takes a look at some of the principles that stood out for me.
Mental illness and basic human rights
One of the fundamental freedoms identified is “All persons have the right to the best available mental health care.” This is interesting wording. Does the prayer camp in Ghana where someone is chained to a tree count as the best available care if nothing else is available?
“All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person.” I wonder if that extends to the people kept in chains in hospitals in Somalia? Or patients who are in the NHS’s Serenity Integrated Mentoring system that can get turned away from A&E following a suicide attempt? Or someone whose heart attack is written off by ER docs as “just anxiety” that’s “all in your head.”
“There shall be no discrimination on the grounds of mental illness.” It’s a nice thought, but far from reality.
Determination of mental illness
There were a couple of statements under this principle that caught my eye.
“A background of past treatment or hospitalization as a patient shall not of itself justify any present or future determination of mental illness.” I’m not sure here if they’re implying past diagnosis when they mention past treatment/hospitalization, but having a wrong diagnosis can certainly follow you around like a skunky smell.
“No person or authority shall classify a person as having, or otherwise indicate that a person
has, a mental illness except for purposes directly relating to mental illness or the consequences
of mental illness.” The wording of this is a bit odd, but I think what they’re getting at is that outside of health care, it’s nobody’s business whether you have a mental illness or not. That would be great, but people will make it their business whether you want them to or not.
“The right of confidentiality of information concerning all persons to whom these Principles apply shall be respected.” This seems obvious, but one area where confidentiality can go out the window is when police get involved. With them being the de facto emergency mental health service in many places, health-related info, including suicide attempts, ends up in police files. That can sometimes make its way into background checks for employment purposes. Sayonara, confidentiality!
In the US, many states require information about things like involuntary admissions to hospital to be passed on to the FBI’s background checks system that’s used for firearms purchases. Ah, the good old mentally ill = violent stereotype.
Rights and conditions in mental health facilities
“Every patient in a mental health facility shall, in particular, have the right to full respect for his or her… privacy.” I’m not sure what aspect of privacy we’re talking here, but it’s definitely not one of the words that springs to mind when I think of psych wards.
“… Freedom of communication, which includes freedom to communicate with other persons in the facility; freedom to send and receive uncensored private communications; freedom to receive, in private, visits from a counsel or personal representative and, at all reasonable times, from other visitors; and freedom of access to postal and telephone services and to newspapers, radio and television.” Ah, 1991. Things have changed a bit since then. What this makes me think of is the issue of cell phones on psych wards. Some wards have across the board bans on patients having cell phones on them. I don’t think that’s appropriate, as access to one’s social support network is important, whether that’s through postal services in 1991 or WhatsApp messages in 2021.
It’s nice that they’re trying, and at least the UN is working on decreasing the use of chains in places like Somalia. But, like with the Declaration of Human Rights, the UN can develop the framework, but countries have to get their shit together for the follow-through. Given the many shit-storms going in the world, this is probably a low priority, but we’ll keep talking about it anyway.
Do you think people with mental illness (or other disabilities) are able to exercise their human rights in the same way as the average person?
You can find more on mental illness stigma on the Stop the Stigma page.