NEPAL: Mental health and Human Rights
NEPAL: Mental health and Human Rights
Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. If there is discrepancy or disruption in mental well-being, which is must for an individual's wholeness, it will result in diminished capacity of coping with even ordinary demands of life. Therefore people with mental disorders are, or can be, particularly vulnerable to abuse and violation of rights (WHO 2005).
According to World Health Organization news release (WHO 2005) more than 450 million people throughout the world have mental, neurological, or behavioral problems, yet the majority of these people do not receive human rights protection or appropriate mental health treatment and care because of the low priority given to mental health.
People with mental and psychosocial disabilities in Low and Middle-Income Countries (LMIC) continue to experience a wide range of human rights violation including the inability to access adequate mental health services in a safe, therapeutic, and affordable setting (Natalie Drew 2011 & R. Das 2013). And Nepal, not being an exception, has been reported with routine and rampant cases of human rights violations against people with mental disorders throughout the country. Therefore this article advocates that protection of human rights of mentally ill people should receive appropriate attention from the global mental health sector.
The Universal Declaration of Human Rights states that "All human beings are born free and equal in dignity and rights", but it is a far cry in an LMIC like Nepal, which is still struggling with political and socio-economic instability and with poor mental health literacy. Despite the existence of effective treatments for mental disorders, there is a widespread belief that they are untreatable thus leading to abuse, rejection, isolation, and exclusion of people from health care and support. This is not a crisis of one day but it has been the reality of people suffering from the mental disorders for decades and probably for centuries before that. There have been many cases reported of people with mental disorders living under confinement for years, being locked up in small cages built behind houses, being tied or chained to their beds with lack of proper clothing, clean water, adequate food, or functioning toilet facilities (R. Adhikari 2012).
Not only this, they are hidden by the families, laughed at by community people, stoned by neighborhood children, and treated without dignity and respect. In addition they face unfair denial of employment opportunities and discrimination in access to service, health facilities, and other benefits. Thus this burden remains unqualified. It reflects the prevailing situation of neglect and abuse at large. The fundamental truth of global mental health is: the people with mental disorders are bound to exist under the worst of moral conditions.
This realization demands recognition and prioritization of mental health as much as other basic components of health like: reproductive health, HIV/AIDS, immunization, and infectious disease. Although 'the alarming rise on the global burden of disease & disability due to mental disorders and the toll they take on human suffering' has been frequently reported worldwide, and yet it goes unnoticed. Therefore the prioritization of moral transformation as the foundation for reform of global mental health is must for any kind of effective change. But how is that to happen? How can the government ensure the availability and accessibility of minimum mental health services for all the population of Nepal, with protection of their fundamental human rights when the government is itself not stable; when mental health is not even considered in the basic health components?
The concept of a government's responsibility for protection of its citizens has been accepted internationally. And surely the government's policies, acts, and resources must be applied to lessen this human tragedy. Therefore, this article emphasizes improving the lives of people with mental disorders through policies, plans, and programs. This requires advocacy and laws accompanied by transformation in ethical, legal, and political responses to human right violations in the mental health sector.
In Nepal, the National Mental Health Policy was developed in 1996, with a policy for protecting the fundamental human rights of mentally ill people. The strategy adopted for this policy was to develop and implement a mental health act suitable for the rights of the mentally ill and the wider community. But the policies have not yet been implemented, leading to no significant improvement in this sector. Developing mental health legislation should be the first priority, ensuring the provision of adequate and appropriate care and protection of human rights of people with mental disorders. The government agencies and the civil society should come together for the development of mental disability rights advocacy and plan strategies to bring about effective rights enforcement and service system reform.
Policy and legislation are two complementary approaches for improving mental health services and preventing human rights violations; but unless there are also adequate resources, appropriately functioning institutions, community support services, and well trained personnel, the best policy and legislation will be of little significance (WHO 2005). Last few years the government has focused on preparation of human resources by starting a residency program in Psychiatry, a Masters degree in Psychology, and a Psychiatry nursing course. But still the gap in service delivery at various levels hasn't been addressed. Therefore it is suggested to develop evidence based community mental health programs; services and rehabilitation facilities. A holistic approach of promoting mental health; making mental health services available and protecting their human rights is imperative.
According to the WHO Quality Rights Tool Kit 2012, efforts should be made to develop a movement of people with mental disabilities to provide mutual support, conduct advocacy and influence policy making processes. Therefore a moral transformation is must to bring about the change needed to protect the human rights of mentally ill people and shifting it to the central focus of institutions, professionals, and family movements in the mental health field.
The UN Convention on the Rights of Persons with Disabilities (CRPD) clearly mentions that preventing human rights violations and promoting a rights-compliant society for people with mental and psychosocial disabilities needs the cooperative participation of all stakeholders. As the spectrum of violations against people with mental and psychosocial disabilities is so wide, the realization of these rights depends on various entities, including the public and private sector. Thus the government, civil society, and other stakeholders should come together to formulate concrete steps to reshape social attitudes and public policy around mental health. It is advocated that protection of human rights assume its rightful place in mental health field and an initial change on improving the moral condition of people with mental disorders could be a promising step in influencing global mental health.