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. 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.
Confidentiality
“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 about 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.
Follow-through needs to happen
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 on 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?
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.
There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.
You bring up some very important points. The police should not be the default crisis intervention. I’ve had cops involved in crisis intervention with me more than once and they just aren’t good at it. It shouldn’t be their job.
My one area of disagreement is that people with mental illness are not violent. They certainly can be. Psychosis can make people do some strange things out of fear.
Anyone can be violent, but most people with mental illness are no more likely to be violent than anyone else.
Going through some of my psychotic breaks I was highly arrogant, but violent, no. That being said, a real arrogant psychotic can scare the hell out of someone who lacks good training in psychiatry. But, violence is the exception rather than the rule.
The only psychotic symptom that’s demonstrated any increased risk for violence is command auditory hallucinations to harm others.
Good to know!
I don’t feel in general that people with mental illnesses (especially the most severe of them) are able to access their human rights on an equal scale to those without a mental health condition. There is far too many obstacles in getting that done.
Yeah, there’s certainly a lot to try to overcome.
I actually didn’t know a) that this UN position existed and b) that it has existed for 30 years.
I stumbled across it by accident.
This is a very good follow up to your post on the stigma within mental illness. We sure have a loooong way to go but the more we can openly share our experience, speaking from a place of understanding and empathy, the better the chances are to change these systems. We know that when in our actute times of crisis, we hurt ourselves more than anything or anybody. That’s the truth that needs to be heard and accepted. The way fear in others can manipulate the conversations is frankly dangerous to all, especially the mental health community.
Sharing our stories is so important.
💯 it’s about continuing to open the conversations. Listening to one another other than talking at one another.
For sure.
I appreciate you breaking down these discrepancies. I agree, lots of work to do!
Yup.
The interesting thing about this is the underlying assumption that all mental illnesses/neurodivergence is wrong and must be corrected. We do like to pretend we’re all, or should be, the same. The points you make about the difference between the talk and the walk are spot on.
That’s a very good point.
These are all important points regarding human rights. Essential. I see people fall through the “cracks” in the system. Always treating a person with dignity is important, as is respecting the right to choose care and confidentiality in that care. I think the thing that is most difficult (and painful) is ~people sometimes get dismissed (at least here in my country) as their assigned label. A few identified services provided (boxes checked) and then they are alone again. A very difficult balance around individual rights, genuine capacity to choose, and a system that doesn’t seem to go an extra inch.
Yes, a person is a whole person, and focusing on solely one labelled aspect of them will never be enough to see the whole picture.
It is very true.
The short answer is a resounding NO. Not in my experience, anyway.
Sounds about right.