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The Practice of Freedom: Human Rights and the Global Mental Health Agenda

  • Roberto Mezzina
  • Alan Rosen
  • Michaela Amering
  • Afzal Javed
Chapter

Abstract

In the long history of human rights advocacy in psychiatry, the Convention on the Rights of Persons with Disabilities (CRPD) sets an important balancing point between the right to adequate care and all human rights and fundamental freedoms and draws on cross-cutting themes including empowerment, citizenship, recovery and community living as a viable alternative to institutional living. Coercion in care, such as restraints, seclusion, forced medications, locked inpatient units, warehousing and forensic institutions, must be curtailed. The optimal attainment of liberty and freedom in care processes entails change, substitution and systematization of availability of practical alternatives: open doors, open communities, open dialogues, free access, community engagement, advance directives, joint decision-making and co-production of policy with stakeholders and recovery orientation of all services. Absolutist and idealistic insistence on the abandonment of all forms of involuntary treatments straight away will not work, but CRPD has undoubtedly opened a new debate and is definitely setting a new horizon for psychiatry to approach. Deinstitutionalization is a necessary step, by substituting community for hospital care and voluntary for involuntary care wherever possible and changing legislations accordingly. Widening the new frontier involves creating a convergence of clinical and support services with strong advocacy for rights. There is an emerging evidence base for the proposition that optimizing human rights is inherently therapeutic and contributes to healing. In this framework, the WHO has launched The QualityRights Programme for improving quality of care and implementation of core articles of CRPD. An effective action includes challenging social exclusion and inequality, by acting on social determinants of health like quality and stability of home, work, income, supports, relationships and social participation. Political, legal and social action has to be combined with our own emancipation from institutional thinking and practices in mental health and social care, to vastly improve the prospects of a whole life and full citizenship and rights for persons with psychosocial disabilities.

Keywords

Human rights CRPD Psychosocial disabilities Deinstitutionalization Alternatives to coercion Empowerment Freedom Emancipation Involuntary care 

References

  1. 1.
    Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A. No health without mental health. Lancet. 2007;370(9590):859–77.CrossRefGoogle Scholar
  2. 2.
    Rosen A, Rosen T, McGorry PD. The human rights of people with severe and persistent mental illness: can conflicts between dominant and non-dominant paradigms be reconciled? In: Dudley M, Gale F, Silove D, editors. Mental health and human rights: vision, praxis, and courage. Oxford: Oxford University Press; 2012. p. 297–319.CrossRefGoogle Scholar
  3. 3.
    Cook JA, Jonikas JA. Self-determination among mental health consumers/survivors: using lessons from the past to guide the future. J Disabil Policy Stud. 2002;13(2):87–95.CrossRefGoogle Scholar
  4. 4.
    Barry A. The importance of mental health advocacy. Psychosoc Rehabil J. 1983;VI(4):35–41.Google Scholar
  5. 5.
    Tucker S. Psychosis and the therapeutic community: beyond the user movement? Ther Commun. 2001;22(3):233–47.Google Scholar
  6. 6.
    Robertson G. Health and human rights series. Lancet. 2007;370:368–9.CrossRefGoogle Scholar
  7. 7.
    Mizrahi T. The right to treatment and the treatment of mentally ill people. Health Soc Work. 1992;17(1):7–11.CrossRefGoogle Scholar
  8. 8.
    Sedgwick P. PsychoPolitics. London: Harper Collins; 1982.Google Scholar
  9. 9.
    Rosen A, O’Halloran P, Mezzina R, Thompson KS. International trends in community-oriented mental health services. In: Mpofu E, editor. Community-oriented health services. Practices across disciplines. New York: Springer; 2014.Google Scholar
  10. 10.
    Gooding P. Change and continuity in mental health law: the long road to the United Nations Convention on the Rights of Persons with Disabilities and its implications for mental health and the Law Today. Web JCLI. 2014;20(3).Google Scholar
  11. 11.
    Drew N, Funk M, Tang S, Lamichhane J, Chávez E, Katontoka S, Pathare S, Lewis O, Gostin L, Saraceno B. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet. 2011;378(9803):1664–75.  https://doi.org/10.1016/S0140-6736(11)61458-X. Epub 2011 Oct 16CrossRefPubMedGoogle Scholar
  12. 12.
    World Health Organization. WHO QualityRights Tool Kit. http://www.who.int/mental_health/publications/QualityRights_toolkit/en/. Retrieved 14 Feb 2016.
  13. 13.
    Convention on the Rights of Persons with Disabilities, United Nations General Assembly Resolution, 13 December 2006, A/RES/61/106. http://www.ohchr.org/OHCHR/English/Human%20Rights%20Bodies/CRPD.
  14. 14.
    Parker C. Forgotten European, forgotten rights. The human rights of persons placed in institutions. OHCHR, Regional Office for Europe; 2011.Google Scholar
  15. 15.
    Schulze M. Understanding the Convention on the rights of persons with disabilities. Lyon: Handicap International; 2010. http://hiproweb.org/uploads/tx_hidrtdocs/HICRPDManual2010.pdfGoogle Scholar
  16. 16.
    Cohen Y. Seven years after ratification of the UNCRPD: are there any advances for patients with mental health conditions? Eur Psychiatry. 2016;33:S39–40.CrossRefGoogle Scholar
  17. 17.
    Sabatello M, Schulze M, editors. Human rights & disability advocacy. Philadelphia: University of Pennsylvania Press; 2014.Google Scholar
  18. 18.
    Hoffman S, Sritharan L, Tejpar A. Is the UN Convention on the Rights of Persons with Disabilities impacting mental health laws and policies in high-income countries? A case study of implementation in Canada. BMC Int Health Human Rights. 2016;16:28.  https://doi.org/10.1186/s12914-016-0103-1.CrossRefGoogle Scholar
  19. 19.
    World Health Organization. Mental Health Action Plan 2013-2020. 2013. N LM classification: WM 101. ISBN 978-92-4-150602-1.Google Scholar
  20. 20.
    World Network of Users and Survivors of Psychiatry. Implementation manual for the United Nations Convention on the Rights of Persons with Disabilities. 2008.Google Scholar
  21. 21.
    Steinert C, Tilman Steinert T, Erich Flammer E, Susanne Jaeger S. Impact of the UN Convention on the Rights of Persons with Disabilities (UN-CRPD) on mental health care research—a systematic review. BMC Psychiatry. 2016;16:166.  https://doi.org/10.1186/s12888-016-0862-1. PMCID: PMC4937523CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    United Nations. Report of the Special Rapporteur on torture and other cruel, in human or degrading treatment or punishment. Juan E Méndez. 1.2.2013. 2016. https://www.hrdp.org/files/2013/10/28/A.HRC_.22_.53_Special_Rapp_Report_.2013_.pdf. Accessed 18 May 2016.
  23. 23.
    Committee on the Rights of Persons with Disabilities. Eleventh session, 31 March–11 April 2014. General comment No. 1 (2014) Article 12: equal recognition before the law. 2014. http://www.ohchr.org/OHCHR/English/HumanRightsBodies/CRPD.
  24. 24.
    Javed A, Amering M. Mental health and human rights: working in partnership with persons with a lived experience and their families and friends. Indian J Psychiatry. 2016;58(3):250–2.  https://doi.org/10.4103/0019-5545.192002. PMCID: PMC5100114CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Freeman MC, Kolappa K, de Almeida JMC, Kleinman A, Makhashvili N, Phakathi S, et al. Reversing hard won victories in the name of human rights: a critique of the general comment on article 12 of the UN Convention on the Rights of Persons with Disabilities. Lancet Psychiatry. 2015;2:844–50.  https://doi.org/10.1016/S2215-0366(15)00218-7.CrossRefPubMedGoogle Scholar
  26. 26.
    Committee on the Rights of Persons with Disabilities. Guidelines on article 14 of the Convention on the Rights of Persons with Disabilities. The right to liberty and security of persons with disabilities. Adopted during the Committee’s 14th session, held in September 2015. 2015. http://www.ohchr.org/OHCHR/English/HumanRightsBodies/CRPD.
  27. 27.
    Rosen A. What does co-design, co-production & co-delivery mean to me? In: Proceedings, from madhouse to co-design: placing consumers and carers at the centre in mental health system design, development, delivery and evaluation, Angliss Conference Centre, Melbourne, 22 Mar 2016.Google Scholar
  28. 28.
    McSherry B. Australia’s international human rights obligations. University of Melbourne, Mental Health Commission of NSW; 2014.Google Scholar
  29. 29.
    World Health Organization. User empowerment in mental health—a statement by the WHO Regional Office for Europe. With the support of the European Commission Health and Consumers Directorate-General. 2010.Google Scholar
  30. 30.
    Miller V, Rosen A, Gianfrancesco P, Hanlon P. Australian National Standards for mental health services: a blueprint for improvement. Int J Leadersh Public Serv. 2009;5(3):25–42.CrossRefGoogle Scholar
  31. 31.
    United Nations. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. In: Thirty-fifth session, Human Rights Council, 6–23 June 2017. http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/35/21. Accessed 6 June 2016.
  32. 32.
    CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.Google Scholar
  33. 33.
    Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099–104.CrossRefGoogle Scholar
  34. 34.
    World Health Organization and Calouste Gulbenkian Foudation. Social determinants of mental health. Geneva: World Health Organization; 2014. Accessed 14 Aug 2017Google Scholar
  35. 35.
    International Mental Health Collaborating Network. Whole life whole systems whole community approach. 2015. http://www.IMHCN.org.
  36. 36.
    Mezzina R. Paradigm shift in psychiatry: processes and outcomes. In: Ramon S, Williams JE, editors. Mental health at the crossroads. The promise of the psychosocial approach. Aldershot: Ashgate; 2005.Google Scholar
  37. 37.
    Rotelli F, Mezzina R, De Leonardis O, Goergen R, Evaristo P. Is rehabilitation a social enterprise? Initiative of support to people disabled by mental illness. Geneva: World Health Organization, Division of Mental Health; 1994. http://www.triestesalutementale.it/english/doc/rotelli-et-al_xxxx_rehabilitation.pdf.Google Scholar
  38. 38.
    FRA—European Union Agency for Fundamental Rights. Involuntary placement and involuntary treatment of persons with mental health problems. Luxembourg: Publications Office of the European Union; 2012. ISBN 978-92-9192-949-8.  https://doi.org/10.2811/87077.CrossRefGoogle Scholar
  39. 39.
    Basaglia F. Institutions of violence. In: Hughes NS, Lowell A, editors. Psychiatry inside out. Selected writings of Franco Basaglia. New York: Columbia University Press; 1987. p. 59–85.Google Scholar
  40. 40.
    Mezzina R. Creating mental health services without exclusion or restraint but with open doors—Trieste, Italy. La santé mentale en France et dans le monde. Inf Psychiatr. 2016;92(9):747–54.Google Scholar
  41. 41.
    Ridente G, Mezzina R. From residential facilities to supported housing: the personal health budget model as a form of coproduction. Int J Ment Health. 2016;45:1–12.CrossRefGoogle Scholar
  42. 42.
    De Leonardis O. Il Terzo Escluso. Milan: Feltrinelli; 1997.Google Scholar
  43. 43.
    Mezzina R, Borg M, Marin I, Sells D, Topor A, Davidson L. From participation to citizenship: how to regain a role, a status, and a life in the process of recovery. Am J Psychiatr Rehabil. 2006a;9:39–61.CrossRefGoogle Scholar
  44. 44.
    Mezzina R, Davidson L, Borg M, Marin I, Topor A, Sells D. The social nature of recovery: discussion and implications for practice. Am J Psychiatr Rehabil. 2006b;9:63–80.CrossRefGoogle Scholar
  45. 45.
    Le Boutillier C, Leamy M, Bird VJ, Davidson L, Williams J, Slade M. What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance. Psychiatr Serv. 2011;62(12):1470–6.CrossRefGoogle Scholar
  46. 46.
    Anthony W. Recovery from mental illness. The guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. 1993;16:11–23.Google Scholar
  47. 47.
    Wallcraft J. Consumer models of recovery: can they survive operationalism? World Psychiatry. 2012;11(3):166–7.CrossRefGoogle Scholar
  48. 48.
    Wallcraft J, Amering M, Freidin J, Davar B, Froggatt D, Jafri H, Javed A, Katontoka S, Raja S, Rataemane S, Steffen S, Tyano S, Underhill C, Wahlberg H, Warner R, Herrman H. Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers. World Psychiatry. 2011;10(3):229–36.CrossRefGoogle Scholar
  49. 49.
    Thornicroft G, Alem A, Antunes Dos Santos R, Barley E, Drake RE, Gregorio G, Hanlon C, Ito H, Latimer E, Law A, Mari J, Mcgeorge P, Padmavati R, Razzouk D, Semrau M, Setaya Thara R, Wondimagegn D. WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry. 2010;9:67–77.CrossRefGoogle Scholar
  50. 50.
    Zero Project—for a world without barriers. https://zeroproject.org/.
  51. 51.
    Mezzina R. Community mental healthcare in Trieste and beyond. An “open door-no restraint” system of care for recovery and citizenship. J Nerv Ment Dis. 2014;202:440–5.CrossRefGoogle Scholar
  52. 52.
    Muusse C, van Rooijen S. Freedom first. A study of the experience with community-based mental health care in Trieste, Italy, and its significance for the Netherlands. Utrecht: Trimbos–instituut; 2015.Google Scholar
  53. 53.
    Zinkler M. Germany without coercive treatment in psychiatry—a 15 month real world experience. Laws. 2016;5:15.  https://doi.org/10.3390/laws5010015.CrossRefGoogle Scholar
  54. 54.
    Commission of the European Communities. Green paper. Improving the mental health of the population. Towards a strategy on mental health for the European Union. Brussels; 2005. COM(2005)484 final.Google Scholar
  55. 55.
    The Danish Institute for Human Rights. The 10 greatest challenges. https://www.humanrights.dk.
  56. 56.
    Szmukler G. UN CRPD: equal recognition before the law. Vol 2. 2015. www.thelancet.com/psychiatry.CrossRefGoogle Scholar
  57. 57.
    Morrissey F. The United Nations Convention on the Rights of Persons with Disabilities: a new approach to decision-making in mental health law. Eur J Health Law. 2012;19(5):423–40.CrossRefGoogle Scholar
  58. 58.
    Szmukler G, Daw R, Callard F. Mental health law and the UN Convention on the Rights of Persons with Disabilities. Int J Law Psychiatry. 2014;37(3):245–52.  https://doi.org/10.1016/j.ijlp.2013.11.024. Epub 2013 Nov 23CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Porxas Roig MA. The paradigm shift on disability and its particularities to persons with mental illness. Rights!; 2016.Google Scholar
  60. 60.
    Council of Europe: Parliamentary Assembly Recommendation n. 2091. Recommendation 2091. The case against a Council of Europe legal instrument on involuntary measures in psychiatry. 2016.Google Scholar
  61. 61.
    Council of Europe, Committee of Ministries. Ministers’ Deputies CM documents CM/AS(2016)Rec2091-final. 10 Nov 2016.Google Scholar
  62. 62.
    Kelly BD. Mental health, mental illness, and human rights in India and elsewhere: what are we aiming for? Indian J Psychiatry. 2016;58(Suppl 2):S168–74.  https://doi.org/10.4103/0019-5545.196822.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Battams S, Henderson J. The right to health, international human rights legislation and mental health policy and care practices for people with psychiatric disability. Psychiatry Psychol Law. 2012;19:314–24.  https://doi.org/10.1080/13218719.2011.561771.CrossRefGoogle Scholar
  64. 64.
    Kleintjes S, Lund C, Swartz L, Flisher A, MHaPP Research Programme Consortium. Mental health care user participation in mental health policy development and implementation in South Africa. Int Rev Psychiatry. 2010;22:568–77.  https://doi.org/10.3109/09540261.2010.536153.CrossRefPubMedGoogle Scholar
  65. 65.
    Gordon S, O’Brien A. New Zealand’s mental health legislation needs reform to avoid discrimination. N Z Med J. 2014;127(1403).Google Scholar
  66. 66.
    Funk M, Drew N, Robertson P. Mental health, human rights and legislation. A global human rights emergency in mental health. Geneva: World Health Organization; 2017.Google Scholar
  67. 67.
    World Health Organization. Mental health atlas. 2014. ISBN 978-92-4-156501-1. http://www.who.int/mental_health/evidence/atlasmnh/. Accessed 11 May 2017.
  68. 68.
    World Health Organization. Quality Rights Programme. http://www.who.int/mental_health/policy/qualityrights/en.
  69. 69.
    World Health Organization. Mental health included in the UN sustainable development goals. 2017. http://www.who.int/mental_health/SDGs/en/.
  70. 70.
    Seikkula J. Becoming dialogical: psychotherapy or a way of life? Aust N Z J Fam Ther. 2011;32(3):179–93.Google Scholar
  71. 71.
    Amering M. Trialogue: an exercise in communication between users, carers, and professional mental health workers beyond role stereotypes. In: Gaebel W, Rössler W, Sartorius N, editors. The stigma of mental illness—end of the story? Cham: Springer; 2016. p. 581–90.Google Scholar
  72. 72.
    World Psychiatric Association. Madrid Declaration on ethical standards for psychiatric practice. 1996. Retrieved 14 Feb 2016.Google Scholar
  73. 73.
    World Association of Psychosocial Rehabilitation. 2016. www.wapr.info . Retrieved 14 Feb 2016.Google Scholar
  74. 74.
    Amering M, Schmolke M. Recovery in mental health. Reshaping scientific and clinical responsibilities. London: Wiley-Blackwell; 2009.Google Scholar
  75. 75.
    Killackey E, Harvey C, Amering M, Herrman H. Partnerships for meaningful community living: rehabilitation and recovery-informed practices. In: Tasman A, Kay J, Lieberman J, et al., editors. Psychiatry. 4th ed. Chichester: Wiley-Blackwell., Chapter 97; 2015. p. 1959–82.Google Scholar
  76. 76.
    Szmukler G. The UN Convention on the Rights of Persons with Disabilities and UK mental health legislation. Br J Psychiatry. 2014;205(1):76.  https://doi.org/10.1192/bjp.205.1.76.CrossRefPubMedGoogle Scholar
  77. 77.
    Fulford KWM. Ten principles of values-based medicine. In: Radden J, editor. The philosophy of psychiatry: a companion. New York: Oxford University Press; 2004.Google Scholar
  78. 78.
    Woodbridge K, Fulford W. Whose values? A workbook for values-based practice in mental health care. London: Sainsbury Centre for Mental Health; 2004.Google Scholar
  79. 79.
    Thornicroft G, Tansella M. Better Mental Health Care. Cambridge: Cambridge University Press; 2009.Google Scholar
  80. 80.
    Zhok A. La sinistra dei diritti a costo zero. L’Espresso. 2017;LXIII:76–7.Google Scholar
  81. 81.
    World Health Organization. Psychosocial rehabilitation. A consensus statement. 1996. http://apps.who.int/iris/bitstream/10665/60630/1/WHO_MNH_MND_96.2.pdf.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Roberto Mezzina
    • 1
  • Alan Rosen
    • 2
    • 3
  • Michaela Amering
    • 4
  • Afzal Javed
    • 5
  1. 1.Dipartimento di Salute MentaleWHO CC for Research and Training, DSM – ASUITsTriesteItaly
  2. 2.Illawarra Institute of Mental Health, University of WollongongWollongongAustralia
  3. 3.Brain and Mind CentreUniversity of SydneySydneyAustralia
  4. 4.Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
  5. 5.The Medical CentreNuneatonUK

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