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Global Mental Health > Human rights > Flashcards

Human rights Flashcards

1
Q

What are human rights?

A

> Rights irrespective of:

  • nationality
  • gender
  • ethnicity
  • religion
  • language
  • disability

> Often expressed and guaranteed by law

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2
Q

What is the influence of international human rights laws on governments?

A

They give obligations to governments:
- to refrain from certain acts

  • to take action promote and protect the rights of individuals and groups
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3
Q

What is the influence of national policies and legislation?

A

They can act to:
- promote rights of individuals

  • or deprive them of their rights
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4
Q

What was the aim of the study on the ‘Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis’ (Drew et al., 2011)?

A

To understand the range of human rights abuses faced by people with mental illness

  • interview 51 people with mental and psychosocial disabilities in 18 LMICs
  • review a wide range of reports and publications
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5
Q

What were the findings of the global study on ‘Human rights violations of people with mental and psychosocial disabilities’ (Drew et al., 2011)?

A

Human rights violations are near universal experience amongst people with mental illness globally

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6
Q

What are the five key rights violations in people with mental disorders found in the global study on ‘Human rights violations of people with mental and psychosocial disabilities’ (Drew et al., 2011)?

A
  1. Restriction of:
    - civil, cultural, economic, political and social rights
  2. Difficulty getting work despite being well-qualified
  3. Lack of disability or social security benefits available
  4. Denial of right to marry and have children
  5. Denial of decision to divorce unless made by a guardian
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7
Q

What characterises the human rights violation concerning mental health services in LMICs?

A

Lack of access to mental health services
- in many LMICs, they are concentrated in urban areas

  • > up to 90% of people with severe mental illness in rural areas are unable to access any biomedical care
  • when care is available, people can’t afford it
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8
Q

What characterises the human rights violation concerning abuse?

A

Reports of abuse in residential facilities and places of detention
- overcrowded and unhygienic conditions

  • insufficient food
  • pervasive tobacco smoke
  • outbreaks of preventable communicable diseases
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9
Q

What type of abuse has been reported in psychiatric institutions?

A

> Physical, emotional and sexual abuse

> Arbitrary detention

> Psychiatric confinement without justification

> Seclusion and restraint

> Unmodified electroconvulsive therapy (ECT)

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10
Q

What characterises the human rights violation concerning legal capacity?

A

Restriction on the exercise of legal capacity

  • guardian or third person can sometimes make decisions on residence, money, personal affairs, health treatment
    (e. g. compulsive treatment)
  • there are few formal mechanisms for the individual to appeal
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11
Q

Which institutions compose the international human rights system?

A
  1. United Nations
  2. Regional systems
    - > address human rights violations experienced by people globally
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12
Q

What are the five key principles to international human rights law?

A
  1. Universality
  2. Inalienable
  3. Indivisible, interrelated, interdependent
  4. Non-discrimination
  5. Rights and obligations
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13
Q

What is the principle of universality in international human rights law?

A

International human rights apply to everyone irrespective of political, economic, or cultural system

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14
Q

What is the principle of inalienability in international human rights law?

A

International human rights can’t be taken away

  • unless according to due process
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15
Q

What makes international human rights indivisible, interrelated and interdependent?

A

Improvement of one right facilitates advancements of others

-> deprivation of one right adversely affects the others

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16
Q

What is the principle of non-discrimination in international human rights law?

A

International human rights are non-discriminating by any category
- including sex or ethnicity

-> cross-cutting principle

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17
Q

What are the obligations in international human rights law?

A

Obligation on governments to both:
- refrain from acts that infringe rights
AND
- take action to promote and protect these rights

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18
Q

What are the three main legally binding instruments in the UN human rights system?

A
  1. International Bill of Rights
  2. International United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2006)
  3. Regional systems
    - including African Human Rights system
    - and European Human Rights system
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19
Q

What composes the International Bill of Rights?

A
  • Universal Declaration of Human Rights (1948)
  • International Covenant on Economic, Social and Cultural Rights
  • International Covenant on Civil and Political Rights (1966)
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20
Q

What characterises the Convention on the Rights of Persons with Disabilities (CRPD)?

A

> Came into force in 2008

> Ratified by 174 countries

> Reflects the social model of disability

> Applicable to all types of disabilities, including psychosocial

> Developed with significant input form those with disabilities

-> Paradigm shift in seeing people with disability as rights-holders

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21
Q

What does “people living with psychosocial disabilities” refer to in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

Refers to people living with mental illness

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22
Q

What is the advantage of using the terms “people living with psychosocial disabilities” in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

Helps frame mental illness in the social model of disability

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23
Q

What are the eight key rights for persons with psychosocial disabilities in the Convention on the Rights of Persons with Disabilities (CRPD)?

A
  1. Freedom from discrimination
  2. Right to the highest attainable standard of physical and mental health and to rehabilitation
  3. Legal capacity and informed consent
  4. Right to liberty and security of the person
  5. Right to freedom from torture of cruel, inhuman or degrading treatment or punishment
  6. Right to independent living in the community
  7. Right to education, employment, social support and housing
  8. Civil and political rights
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24
Q

What is the aim of the right to ‘freedom from discrimination’ in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

To enjoy the same rights regardless of disability

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25
Q

What is the aim of the ‘right to the highest attainable standard of physical and mental health and to rehabilitation’, in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

To have the right to:
- accessible, acceptable and good quality health services

  • individualised treatment
  • support to grain maximum possible level of independence
26
Q

What is the aim of the right to ‘legal capacity and informed consent’ in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

To have the right to undertake court proceedings and to make their own decisions

  • right to recognition everywhere as persons before the law
27
Q

What does the right to ‘legal capacity and informed consent’ in the Convention on the Rights of Persons with Disabilities (CRPD) promote?

A

Promotes the (self) decision-making model

  • in contrast to substituted decision-making model (guardian making decision on behalf of individuals with mental illness)
28
Q

What is the implication of the ‘right to independent living in the community’ in the Convention on the Rights of Persons with Disabilities (CRPD) for governments?

A

Governments should take steps to facilitate the full inclusion of people with disabilities in society

29
Q

What do the civil and political rights in the Convention on the Rights of Persons with Disabilities (CRPD) include?

A

Right to vote and stand for elections

30
Q

What are the two official monitoring bodies for human rights?

A
  1. Committee on Rights of Persons with Disabilities

2. UN’s Human Rights Council

31
Q

How does the Committee on Rights of Persons with Disabilities monitor human rights?

A

The committee has a constructive dialogue with governments and NGOs
- which have to submit progress reports

  • countries can agree to optional protocol allowing individuals to make complaints about alleged abuses to the committee
32
Q

How does the UN’s Human Rights Council monitor human rights?

A

Through Special Rapporteurs: Independent experts

  • who monitor and report on thematic human rights issues: disability, torture, right to health
33
Q

What is the consequence of the historical acceptability for people with mental illness to be detained and treated against their will?

A

Most mental health laws across the world have provision for involuntary detention in certain circumstances:

Presence of mental illness
+
Individual is danger to themselves or others
OR need for treatment of mental illness

34
Q

What is the current state of mental health laws on detention?

A

Mental health legislation has tried to establish a balance between:
- individual freedom
AND
- need to protect society

However, there’s emphasis on protection of society

35
Q

What does the ‘right to liberty and security of the person’ in the Convention on the Rights of Persons with Disabilities (CRPD) specify?

A

Simply having a disability, or mental illness, should not justify a person being detained against their will

36
Q

What is the issue with the ‘right to liberty and security of the person’ (Article 14) in the Convention on the Rights of Persons with Disabilities (CRPD) before the 2015 update?

A

Ambiguity:
- this article doesn’t specify the circumstances in which it would be considered lawful, or not arbitrary, to deprive someone with a disability of their liberty

37
Q

What were the new guidelines in September 2015 on the ‘right to liberty and security of the person’ (Article 14) in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

Clarifications: there are no circumstances in which it is acceptable to involuntarily detain a person on basis of mental disorder EVEN if they pose a danger to themselves or others
- as this would be discriminatory and amounts to arbitrary detention

-> generally supported by disability and user groups

38
Q

What are the criticisms of the the 2015 new guidelines on the ‘right to liberty and security of the person’ (Article 14) in the Convention on the Rights of Persons with Disabilities (CRPD)?

A

Avoiding involuntary detention and treatment of people with mental illness in all circumstances could lead to threat to individual rights:

  • right to health
  • right to liberty
  • right to life
  • rights of family and public
39
Q

What is the ambiguity in the consequences of the inability to involuntarily detain and treat on the right to health?

A

Inability to involuntarily detain and treat may result in:

  • not receiving treatment that may improve health of individual
  • > knock-on effect on other rights (e.g. right to work)

BUT expressed opinions whilst ill-health may not reflect individual’s true will and preference

40
Q

How does the inability to involuntarily detain and treat threaten the right to liberty?

A

Inability to involuntarily detain and treat may result in:
- untreated illness -> longer periods of inpatient care later on

  • detention trough criminal justice system
  • physical restraint by family members in LMICs
41
Q

What is the ambiguity of the inability to involuntarily detain and treat on right to liberty?

A

For some people, being involuntarily admitted for a short period may be the ‘way in’ to accessing treatment

  • particularly for those who’ve had long periods of untreated illness, and those with severe mental illness
42
Q

How does the inability to involuntarily detain and treat threaten the right to life?

A

Inability to involuntarily detain and treat may result in:
- suicide

  • untreated physical illness resulting in premature mortality

(in Ethiopia, main causes of death, including suicide, are entirely preventable issues)

43
Q

How does the inability to involuntarily detain and treat threaten the rights of family and public?

A

Inability to involuntarily detain and treat may result in:
- danger to others

  • in Ethiopia and other LMICs, rights of individual are seen in unison with rights of family (when family = caregiver)
44
Q

What is argued against the inability the idea that the inability to involuntarily detain and treat is a threat to the rights of family and public?

A

-Some propose that human rights law should protect the rights of the individual with disability exclusively

45
Q

What is the state of physical restraint of people with psychosis in community settings, in rural Ethiopia (Asher et al., 2017)?

A

> Psychiatric nurse-led outpatient clinic in district available

> BUT due to long distances AND lack of public transports to access healthcare facilities:
- family carers are the most common form of care in this settings

-> most people with schizophrenia in this setting are care for by their family

46
Q

What are the patterns fo restraint found in the qualitative study on physical restraint in rural Ethiopia (Asher, et al., 2017)?

A

> Common experience and practice between individuals and caregivers

> Most often, family members carried out restraint with support from community

> Individuals sometimes restrained on the journey to health facility

> Wider community either condones or actively helps the restraint

> Some experienced long-period restraint (months to years)

> Caregivers reported short periods of restraint, depending on illness

47
Q

What is the reported impact of restraint on the individual, in the qualitative study on physical restraint in rural Ethiopia (Asher, et al., 2017)?

A
  • Physical injuries

- Psychological impact

48
Q

What are the underpinning reasons for caregivers to restraint a person with mental illness?

A

> Heavy caregiver burden and lack of support
- reporting of getting ill through caring, feeling hopeless

> Restraint as pragmatic action to manage illness

> Lack of accessible and affordable treatment

> Background of pervasive stigma
(“e.g. people with mental illness are “always dangerous”, “insignificant”, “hacking usual needs”

49
Q

hat is the impact of restraining a person with mental illness on the caregiver?

A

Restraining is distressing for the caregiver

50
Q

What are the four specific reasons for restraint?

A
  1. Means to access healthcare or medication
  2. Protection of person with schizophrenia
  3. Protection of other pope and property
  4. Punishment
51
Q

How is restraining seen as a mean to access healthcare or medication?

A

> Ease of journey to health centre or psychiatric hospital
- forceful healthcare attendance was ultimately beneficial

> Forceful administration of medication when refused
(considered by caregivers as last resort)

> All participants felt that increased access to healthcare would be a way to reduce the need for restraint

52
Q

How is restraint seen as a way to protect individuals with mental illness?

A

> Tendency of individual with mental illness to wander off for days

> Fears from caregivers about individual getting lost, into fights, accidents and suicide

53
Q

How is restraint as protection for other people and property?

A

> Fears that individual with schizophrenia would be dangerous
- mix between reported specific incidents and hypothetical fears

> Significant pressure form wider community for family to protect others
- by restraining the family member with mental illness

54
Q

What is the community’s perspective on restraining for the protection of other people and property?

A

“if a crazy person is not tied up, […] and if he causes damage on another person, […] a complaint might come to the people, they might be held accountable for it”

55
Q

How is restraining used as punishment?

A

Restraint explicitly as punishment for bad behaviour only mentioned by a minority of participants

56
Q

What are the reported human rights violations associated with restraint in community settings in rural Ethiopia?

A
  • Dignity
  • Right to be free from exploitation, violence and abuse
  • Equality
  • Family life, education, employement
  • Right to liberty
57
Q

Who uses physical restraint and involuntary detention of individuals in Ethiopia compared to other settings?

A
  • Ethiopia: done by family members / community

- Done by mental health professionals under mental health laws

58
Q

Who is responsible for the ‘assessment’ of the level of danger posed by an individual to themselves and others in Ethiopia compared to other settings?

A
  • Ethiopia: responsibility on family members / caregivers

- Responsibility on mental health professionals

59
Q

What is the expectation from general public that those responsible for an individual will protect the community, in Ethiopia compared to other settings?

A
  • Ethiopia: greater emphasis on collective rights than individual rights
  • Otherwise, policies, strategies and laws tend to focus on protecting the general public rather than promoting rights of people with mental disorders
  • > explains the ongoing use of mental health laws for detention on basis of individual being assessed as danger to others
60
Q

What is the approaches to reduce resting in LMICs?

A

> Acknowledge that increased access to mental healthcare might raise fresh issues around individual’s role in deciding what care they receive

> Human rights should be protected and promoted by governments

> Scale up accessible and affordable community-based mental healthcare

> Integrate mental healthcare into primary care (mhGAP)

> Antipsychotic medication in conjunction with additional support

> Support for caregivers

> Encourage uptake of treatment

> Educate the wider community and reduce stigma

> Train family members to identify triggers of difficult behaviour AND techniques to de-escalate violence

61
Q

What is the key for the success of unchaining programmes?

A

Availability of accessible community-based mental health care

62
Q

What is the purpose of WHO’S Quality Rights Toolkit?

A

To ensure that inpatient and outpatient mental health services meet the highest human rights standards

Global Mental Health (14 decks)

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