It’s time for change: World Mental Health Day 2016

By Dr Judy Laing, Reader in Law (University of Bristol Law School).

world-mental-health-dayToday is World Mental Health Day and time for us to spare a thought for the millions of people around the world suffering from mental health problems. The World Health Organization (WHO) estimates that one in four people in the world will be affected by mental/neurological disorders at some point in their lives. Approximately 450 million people in the world are suffering from these conditions at any one time. This means that mental disorder is among the leading causes of ill-health and disability worldwide.

The WHO has urged governments to move away from large mental institutions and towards health care in the community. Governments must also ensure that mental health care is well integrated into the general health care system. Whilst many Western governments have adopted this de-institutionalisation approach, treatment facilities and standards in many countries, especially in the developing world, are still woefully inadequate. Indeed, the WHO reports that more than 40% of countries have no mental health policy and a quarter of countries don’t even have any form of mental health legislation or regulation of mental health care. Added to this is the troubling fact that mental health services across the globe are continually under-funded: 33% of countries spend less than 1% of their total health budgets on mental health care/services.

These statistics paint a very gloomy picture of mental health provision across the globe. Closer to home in the UK, whilst we have witnessed a move away from institutional care since the 1960s, the outlook is far from rosy. A report published last week by the National Confidential Inquiry into Suicides and Self Harm at the University of Manchester has highlighted that suicide rates are three times higher among patients living in the community, than for those in hospital. The evidence is clear that, despite the move to providing care in the community, mentally ill patients are still being failed by the system. Community provision is inadequate and crisis/ specialist care services in particular are severely overstretched. Without appropriate funding and access to specialist care and services, people suffering from mental illness will continue to suffer.

The consequences of this chronic underfunding are that the dignity and rights of many people with mental ill health are not respected. This occurs in several ways. Patients are denied access to mental health care and, as a result, they are more likely to die prematurely. Patients may also be denied the right to be involved in and make decisions about their mental health care and treatment. Many patients are also subjected to physical and emotional abuse in hospitals and care homes, as the appalling ill-treatment at Winterbourne View hospital in 2011 demonstrates.

So what can be done to improve the lives of millions of people suffering from a mental ill health? An obvious answer is for governments to provide more money and fund appropriate mental health facilities and staff as well as treatment programmes. The Health Secretary announced at the Conservative Party Conference last week that an extra £12.5 million will be committed to the Time to Change mental health campaign over the next 4 years to combat mental health discrimination and stigma in the UK. This is certainly welcome and much needed, but must be accompanied by a corresponding increase in funding in mental health services in order to make a real difference to the lives of people with mental health problems in the UK.

A glimmer of hope for the future to promote dignity and respect for patients with mental disability may be offered by the Convention on the Rights of the Persons with Disabilities (CRPD), which was adopted by the United Nations in 2006 and formally ratified by the UK in 2009. The Convention now has 160 signatories worldwide. The Convention was described by the UN Secretary General at the time, Kofi Annan, as heralding the ‘dawn of a new era’ for people with disabilities, including those with mental disability. The Convention seeks to ensure that those with disabilities enjoy the same human rights as everyone else as its Preamble states:

 “… discrimination against any person on the basis of disability is a violation of the inherent dignity and worth of the human person”.

The Convention is founded on the principles of equality, dignity, autonomy, participation and non-discrimination and it enshrines a number of key rights for disabled people, such as the right to good quality health care and to be free from ill-treatment, violence, exploitation and abuse. The Convention has the potential to bring about change, provided governments are committed to it and take the necessary steps to provide and ensure access to good quality care which promotes human rights – that means care that is responsive to people’s needs, and respects their values and choices. It is also vital to include disabled people in decision-making processes on issues affecting them, including mental health policy, legislation and health service reforms.

Article 4(3) of the Convention encourages ‘close consultation’ and ‘active involvement’ of disabled people in such decision making. My recent research with colleagues at the Law School and Norah Fry Centre for Disability Studies at the University of Bristol examines the experience of disabled people’s organisations in trying to bring about change and influence government decision making in line with this article of the Convention. Funded by the Brigstow Institute, the project team have been working with representatives from the Bristol Disability Equality Forum to identify strategies for disabled people to work with local and national government to bring about change. We have been developing guidance and an advocacy toolkit for disabled people to influence decision making. In this way, we can take some small steps together towards making the Convention a reality and improve the lives of disabled people, including those who suffer from mental ill health and disability.

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