Feature

Volume 3 Issue 11 - June 01, 2005

The Human Right to Mental Health

A world with rights is a world in which people are dignified objects of respect, both in their own eyes and those of others. And mental health interventions need to be seen as a right of the person, and not an additional ‘icing on the cake’ service, says Dr. Achal Bhagat, Director, Saarthak.

Mental Health has been largely seen as ‘icing on the cake’ by most people. The refrain is that if people do not have nutrition, shelter or non-abusive contexts, how can one think of mental health efforts in the developing world.

But then what are rights?

It is easier to say what is not a right. A right is not benevolence. It is not a mere gift or favour motivated by love, pity or a budget line. Rights are “... instruments that enable us to strand with dignity, if necessary to demand what is our due, without having to grovel, plead or beg or express gratitude when given our due, and to express indignation when what is our due is not forthcoming.” A world with rights is a world in which people are dignified objects of respect, both in their own eyes and those of others. Validity of a right is absolute. Lack of normative application of the right does not affect the fact that it exists. Rights exist even when they are infringed.

What are the impacts of not having human rights in place? What changes for the child who is trafficked? What changes for the woman who is slapped by her husband? What changes for the student who is ragged and bullied as a fresher? What is impacted is the mental health of the person. The way she thinks, the way she feels. What is intended to be protected by the human rights is not just the right to live, but the right to live with dignity. Dignity is a key aspect of mental health.

So can mental health be seen as a human right?

The operational point of vulnerability of people is their mental health.

Mental Health is a description of the way people think, feel and act.

A positive state of mental health is defined by people’s ability to view themselves, their relationships, their resources and their vulnerabilities in a reasonable and adaptive manner. It includes the ability to relate, to solve problems, set goals, work towards achieving them through various multiple alternative paths of accessing resources and addressing limitations. The impact of this adaptive view of self and surroundings is a subjective sense of well-being. This sense of well-being further reinforces the positive state of mental health.

Sometimes vulnerabilities overwhelm the individual and impact the way she views herself. For example, a child who has been sexually abused may think of herself as being responsible for abuse or the farmer who finds himself in a debt-trap may think that there is no future and attempt suicide or to sell his daughter to cope with the lack of options. The trucker who drives fast, uses considerable amount of alcohol and does not use a condom, like all others, is a person who has a view about himself, his relationships and his future. He may feel unacknowledged in his life, he may think of himself as incapable of sustaining continuity in his life. He may think that he has to assert control on his immediate context or he would be taken for granted. He is unlikely to accept to use a condom, even though he understands the risk. The risk of not being in control of his choices to him is greater than the risk of an illness.

At other times the negative state of mental health may make the person not access the resources that will help him or her to cope with the vulnerabilities that he or she faces.So, if someone thinks of herself negatively because she has been told repetitively that she is ‘good for nothing’, in spite of reassurance that she is capable and she can be independent, she is unlikely to be able to use the income generation program. To be able to access resources of help when one is vulnerable, one has to have a belief in oneself. This belief in oneself is challenged by vulnerability and unless there are efforts to address mental health impact of vulnerability, most programs of empowerment and participation cannot achieve their objectives fully.

Thus, there are three ways of considering mental health from the perspective of rights. One, wherein access to mental health services is seen as a right. Two, considering mental health impacts of situations where human rights are violated, such as violence against women, religion and caste based discrimination, sexual exploitation, neglect and abuse of children, etc. Three, mental health being a prerequisite to achievements of other rights of the person.

Given the stigma attached to mental illness, mental health interventions in most programs either ignore mental health needs of the person or address them through a euphemistic process of counselling. Counselling further gets confused with ‘providing information’.

Mental health is a definitive need. It is a right. It needs to be recognized. The focus has to be on recognition of a broader concept of mental health beyond psychiatric disorders, by including mental health impacts of vulnerability and mental health as a fundamental in relation to implementation of other rights.

Mental health needs are universal and all vulnerabilities and significant life events impact mental health. When mental health needs are not addressed, the human cost is large, for it is difficult to reclaim the person from the impact of the vulnerability.

Mental Health Interventions therefore need to be universal and available to all, not just to those showing symptoms or difficult behaviour.

Mental Health Interventions need to be seen as a right of the person, not an additional ‘icing on the cake’ service.