Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability

Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Health and Human Rights 01/2009; 11(2):19-31. DOI: 10.2307/25653100
Source: PubMed


Mental disability and mental health care have been neglected in the discourse around health, human rights, and equality. This is perplexing as mental disabilities are pervasive, affecting approximately 8% of the world population. Furthermore, the experience of persons with mental disability is one characterized by multiple interlinked levels of inequality and discrimination within society. Efforts directed toward achieving formal equality should not stand alone without similar efforts to achieve substantive equality for persons with mental disabilities. Structural factors such as poverty, inequality, homelessness, and discrimination contribute to risk for mental disability and impact negatively on the course and outcome of such disabilities. A human rights approach to mental disability means affirming the full personhood of those with mental disabilities by respecting their inherent dignity, their individual autonomy and independence, and their freedom to make their own choices. A rights-based approach requires us to examine and transform the language, terminology, and models of mental disability that have previously prevailed especially within health discourse. Such an approach also requires us to examine the multiple ways in which inequality and discrimination characterize the lives of persons with mental disabilities and to formulate a response based on a human rights framework. In this article, I examine issues of terminology, models of understanding mental disability, and the implications of international treaties such as the United Nations Convention on the Rights of Persons with Disabilities for our response to the inequalities and discrimination that exist within society--both within and outside the health care system. Finally, while acknowledging that health care professionals have a role to play as advocates for equality, non-discrimination, and justice, I argue that it is persons with mental disabilities themselves who have the right to exercise agency in their own lives and who, consequently, should be at the center of advocacy movements and the setting of the advocacy agenda.

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Available from: Jonathan Kenneth Burns
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    • "Addressing the social disadvantage relating to compromised mental health has been a key focus of European and UK health policy for some time (Knapp et al. 2007, Jané-Llopis & Anderson 2005, Sayce 2001, McKeown & Jones in press) and in these times of austerity remains a crucial concern (McDaid & Knapp 2010). Widespread stigma and discrimination exacerbate negative experience of mental ill-health and contribute to inequalities of access to health care services across the board (Wahlbeck & Huber 2009, McDaid 2008); this can be plausibly framed as a human rights issue (Burns 2009). "
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    ABSTRACT: This paper offers a critique of austerity policies in a context of mental health and contemplates some activist inspired remedies. These policies of austerity powerfully stalk the globe, preying on the poor, weak and vulnerable, redistributing their meagre assets wholesale to the pockets of the rich and super-rich whilst simultaneously stigmatising and blaming the victimised for their predicament. In times like these, mental distress escalates, social solidarity is purposively and divisively undermined and psychiatric services mop up their share of the dispossessed and can be seen to function as a safety valve on protest and dissent. Wherever such power is exercised, however, there is also resistance. Here we present an argument for the value of alliances between organised mental health care workers in trade unions and self-organised survivor groups. Despite significant barriers to success, we remain optimistic that efforts in this direction offer the ideal means of resisting austerity policies and could also herald a democratic transformation of the social relations of care. Austerity: policy 'madness' Let us be clear, there is no uncomplicated, economically rational justification for the UK coalition government's politics of austerity. The irrationality of these policies in economic terms suggests the architects of austerity are simply confused, completely cynical or
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    • "This development is in line with South Africa’s obligations as a signatory to the United Nations Convention on the Rights of Persons with Disabilities. The Convention obligates civil society and other government sectors to work toward aligning societal mores, legal frameworks, national policies, organisational policies and procedural guidelines, professional curricula, clinical practice guides, research foci and funding policies to effect the systemic changes alluded to above [43]. "
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    ABSTRACT: Background This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. Method Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people’s organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Results Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. Conclusion A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
    Full-text · Article · Mar 2013 · BMC International Health and Human Rights
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    • "Without such evidence it is not possible to influence policy and practice so that evidence-based and appropriate services can be designed and offered to these populations (Dogra et al., 2012). However, it must be stated, while health care professionals do, indeed, have a role to play as advocates for equality, non-discrimination, and justice, it is those with mental disabilities themselves who should be setting the advocacy agenda, as they have the right to exercise agency in their own lives (Burns, 2010). "
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    ABSTRACT: Goals: The geo-political and socio-economic landscape of Europe has undergone significant changes since the World Wars creating challenges for both health policy makers and health service providers. This paper aims to review immigration trends in Europe and identify problems and needs of immigrant and ethnic minority children and youth with respect to mental health services. Methods: Published reports and studies on mental health of immigrant and ethnic minority youth are reviewed and discussed. Results: Data show immigrant and ethnic minority youth in the European Union consistently experience discrimination, marginalization and stigmatization, which increases their risk for mental health problems. The stigmatization of mental health problems within their groups decreases their propensity to seek mental health services or to respond to interventions when they are offered. Conclusions: The most vulnerable population with respect to having poor health profiles and outcomes are immigrants and ethnic minorities ; within these groups are many children and young people with mental health problems. In societies with higher rate of immigration such as Europe it is important that mental health services are both accessible and culturally sensitive. Using various evidence based interventions in appropriate setting would improve mental health of these children and prevent developing serious mental health disorders. Are mental health services and interventions geared to meet the needs of these population groups in a culturally sensitive and appropriate way?
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