Natalie Drew, Michelle Funk, Caroline Kim, Crick Lund, Alan J. Flisher, Akwasi Osei, Sheila Ndyanabangi, Joshua Ssebunnya and John Mayaye
The purpose of this paper is to provide detailed assessments of the mental health laws of Ghana, South Africa, Uganda and Zambia.
Abstract
Purpose
The purpose of this paper is to provide detailed assessments of the mental health laws of Ghana, South Africa, Uganda and Zambia.
Design/methodology/approach
The mental health laws of four countries were assessed both by country partners and staff of WHO, Geneva, using the World Health Organization (WHO) Checklist on Mental Health Legislation, which examines the level of coverage of key issues in mental health laws.
Findings
The older laws of Ghana, Uganda and Zambia do not address fundamental human rights of people with mental health conditions. South Africa's more recent Mental Health Care Act (2002) incorporates critical human rights standards, though certain provisions fail to adequately safeguard against potential violations. For mental health legislation to maintain currency with human rights standards it must be regularly reviewed and updated.
Originality/value
The findings highlight the urgent need to revise the mental health laws of Zambia, Uganda and Ghana, and to plan ways to address the gaps identified in the relatively new South African mental health law. The entry into force of the United Nations Convention on the Rights of Persons with Disabilities in 2008 signals a new era in how mental health legislation is to be drafted. The identification of gaps in national laws, as has been undertaken by the four countries, is an important first step towards putting in place legal frameworks to promote the rights of people with mental health conditions in line with current international human rights standards.
Details
Keywords
Michelle Funk, Natalie Drew and Martin Knapp
This paper, which builds on the findings of WHO's Report on Mental Health and Development, aims to highlight the health, social, economic, and human rights effects of unaddressed…
Abstract
Purpose
This paper, which builds on the findings of WHO's Report on Mental Health and Development, aims to highlight the health, social, economic, and human rights effects of unaddressed mental disorders in low and middle income countries (LMICs) and to propose effective strategies to address mental disorders and their impacts as part of an overall development strategy.
Design/methodology/approach
The paper first reviews the findings of relevant research on mental disorders and poverty and then proposes solutions that can be adopted by countries to promote development.
Findings
This evidence of strong links between poverty and mental disorder supports the argument that mental disorders should be an important concern for development strategies. Mental disorders have diverse and far‐reaching social impacts, including homelessness, higher rates of imprisonment, poor educational opportunities and outcomes, lack of employment and reduced income. Targeted poverty alleviation programmes are needed to break the cycle between mental illness and poverty. These must include measures specifically addressing the needs of people with mental health conditions, such as the provision of accessible and effective services and support, facilitation of education, employment opportunities and housing, and enforcement of human rights protection.
Originality/value
The paper highlights that four out of every five people suffering from mental disorders are living in LMICs. Many LMICs have identified mental health as an important issue, yet lack the finances and technical expertise to address the problem. Having mental health on the agenda of development organizations will be a critical step for overcoming the negative development consequences of mental disorders.
Details
Keywords
The purpose of this paper is to assess the quality of healthcare offered by a Greek Public Psychiatric Clinic. Special attention is paid to the degree to which the Clinic promotes…
Abstract
Purpose
The purpose of this paper is to assess the quality of healthcare offered by a Greek Public Psychiatric Clinic. Special attention is paid to the degree to which the Clinic promotes human rights, social inclusion, and autonomy.
Design/methodology/approach
The paper opted for an exploratory study using the open-ended approach of grounded theory, including 21 depth interviews with patients, staff members and patients’ relatives, documentation review and observation by an independent assessment team consisting of the author, a sociologist with mental disabilities, and a psychologist using the World Health Organization QualityRights tool kit which uses the Convention on the Rights of Persons with Disabilities (CRPD) as its frame. The data complemented by a group discussion with employees in another Clinic of the same hospital.
Findings
The paper provides empirical insights about how the steps taken by the Psychiatric Clinic to address several of the themes drawn from the CRPD require either improvement or initiation to comply fully with the convention's themes, and how this compares unfavorably with the Urology Clinic.
Research limitations/implications
Sample size and restriction of the data to only one mental health facility limit the generalizibility of the results. Staff who reported professional burnout and cuts in wages may have been be susceptible to recall bias due to current negative mood. Respondent patients may also have failed to disclose their true experiences due to fear of punishment.
Originality/value
The paper uses a new methodology and instrument to assess current practice in mental health facilities in relation to international human rights standards emanating from the CRPD as well as the degree of parity between mental health and general health services.
Details
Keywords
The purpose of this paper is to discuss human rights assessment and monitoring in psychiatric institutions from the perspectives of those whose rights are at stake. It explores…
Abstract
Purpose
The purpose of this paper is to discuss human rights assessment and monitoring in psychiatric institutions from the perspectives of those whose rights are at stake. It explores the extent to which mental health service user/psychiatric survivor priorities can be addressed with monitoring instruments such as the WHO QualityRights Tool Kit.
Design/methodology/approach
The paper is based on the outcomes of a large-scale consultation exercise with people with personal experience of detention in psychiatric institutions across 15 European countries. The consultation took place via one focus group per country and extended to a total of 116 participants. The distinctive characteristic of this research is that it imparts an insider perspective: both the research design and the qualitative analysis of the focus group discussion transcripts were done by a social researcher who shared the identity of service user/survivor with the participants.
Findings
The paper highlights human rights issues which are not readily visible and therefore less likely to be captured in institutional monitoring visits. Key issues include the lack of interaction and general humanity of staff, receipt of unhelpful treatment, widespread reliance on psychotropic drugs as the sole treatment and the overall impact of psychiatric experience on a person's biography.
Research limitations/implications
Because of the way participants were recruited, the research findings do not offer a representative picture of the human rights situation in particular countries. They point clearly, however, to new directions for human rights research in the psychiatric context.
Originality/value
This paper demonstrates the indispensability of experiential knowledge for not only securing and improving but also extending the understanding of human rights standards in psychiatry.
Details
Keywords
Jean-Francois Pelletier, Denise Fortin, Marc Laporta, Marie-Pascale Pomey, Jean-Luc Roelandt, Pauline Guézennec, Michael Murray, Paul DiLeo, Larry Davidson and Michael Rowe
– The purpose of this paper is to update the Global Model of Public Mental Health (GMPMH) in light of the WHO QualityRights project.
Abstract
Purpose
The purpose of this paper is to update the Global Model of Public Mental Health (GMPMH) in light of the WHO QualityRights project.
Design/methodology/approach
Being able to refer to international conventions and human rights standards is a key component of a genuine global approach that is supportive of individuals and communities in their quest for recovery and full citizenship. The GMPMH was inspired by the ecological approach in health promotion programs, adding to that approach the individuals as agents of mental health policies and legislation transformation. The GMPMH integrates recovery- and citizenship-oriented psychiatric practices through the Ottawa Charter for Health Promotion (WHO, 1986).
Findings
Updating the GMPMH through the WHO QualityRights Toolkit highlights the need for a new form of governance body, namely the Civic Forum, which is inclusive of local communities and persons in recovery. People with mental health disabilities, intellectual disabilities, and substance use conditions can be “included in the community” (UN Convention on the Rights of Persons with Disabilities, Article 19) only if the community is informed and welcoming, for instance through a Civic Forum and its organizing Local Council of Mental Health.
Research limitations/implications
Transition from social marginalization to full citizenship represents a daunting challenge in public mental health care. An approach that focuses primarily on individuals is not sufficient in creating access to valued roles those individuals will be able to occupy in community settings. Instead, public intervention and debate are required to promote and monitor the bond of citizenship that connects people to their communities.
Originality/value
The GMPMH is the result of a conceptual cross-breeding between recovery and health promotion (WHO, 1986). The GMPMH is an offspring of the ecological approach in health promotion programs, adding to that approach individuals as agents of mental health transformation. It refers to international conventions and human rights standards as a central component of a genuine global approach. A community-based participatory research design is well suited, which includes a Civic Forum for local communities to become involved and supportive of service users in their quality and human rights assessments.
Details
Keywords
Eric Rosenthal and Laurie Ahern
– The purpose of this paper is to emphasize the human rights imperative to end the segregation of children in orphanages and other residential institutions.
Abstract
Purpose
The purpose of this paper is to emphasize the human rights imperative to end the segregation of children in orphanages and other residential institutions.
Design/methodology/approach
The paper draws on international human rights standards under the UN Convention on the Rights of Persons with Disabilities and other treaties, as well as documentation gathered by Disability Rights International (DRI) over the past 20 years.
Findings
DRI has found that institutionalization of children exposes them to high risk of physical, sexual and emotional abuse. Even clean and well-staffed orphanages are psychologically damaging. Well intentioned but misguided donors often perpetuate institutionalization by investing in the building or rebuilding of institutions instead of investing in community-based alternatives.
Originality/value
Through the Worldwide Campaign to End the Institutionalization of Children, DRI is calling for a moratorium on all new placements of children in orphanages. No new institutions should be built. Research shows that children thrive in a family or family-like environment, and all children are capable of being supported to live in the community.