Mental health: The human rights imperative in Universal Health Coverage

Universal health coverage (UHC) is a simple concept: everyone everywhere should be able to access the highest attainable standards of health without suffering financial hardship. Global leaders in a high level UN meeting in 2019 committed to achieving UHC by 2030, and stated that it was the right of every human being, without distinction, to enjoy the highest standard of mental health as a part of UHC.

Yet today the coverage gap in care for common mental health conditions can be as high as 90% in some low income countries. Mental health care and support is often not available at the very level where people could most easily access it – their communities. It can also be unaffordable for some, of poor quality and even violate human rights. As an example, in a recent documentary launched by the South African Federation for Mental Health, many individuals with mental health conditions from South Africa spoke about their struggles in accessing mental health support and the stigma they face from society.

That is why this UHC Day we are releasing a new Policy Brief – titled “Mental Health as a Matter of Rights”, which highlights some of the problems people with mental health conditions face and explains why it is important to integrate mental health into UHC using a human rights based approach.

It also sets out five key recommendations, informed by the WHO’s guidelines and experts like Prof. Shekhar Saxena of Harvard University, on how people can access the highest quality and affordable mental health support, whilst also ensuring protection of human rights of people with mental health conditions in line with  international human rights conventions such as the Convention on the Rights of Persons with Disabilities.

The first step, already being undertaken by many CSOs in their countries, is working to reform outdated laws and policies. As the WHO’s Mental Health Atlas of 2020 reveals, only 39% of all member states have mental health laws that are in line with international human rights conventions and this needs to change. Discussions around health reforms and the provision of UHC, which account for issues like discrimination or abusive and involuntary treatment of people with mental health conditions, are important ways to further progress in this area.

The brief features the powerful story of Francis Pii, who was chained to a log for two years as a way of treating his mental health condition before being rescued by our partners at  BasicNeeds Ghana. Their Executive Director, Peter Yaro, in a recent #MentalhealthforAll webinar agreed with the recommendations of the brief: providing mental health care in communities, and including community outreach and education in UHC, is a way to help people prevent the kinds of abuse Francis experienced and tackle  the stigma faced by people with mental health conditions. Many organisations – from UN agencies to CSOs – are calling for greater investment in community based care.

It is also crucial that UHC policies take into account the views of people with lived experience of mental health conditions, as they are best placed to speak to their own needs and identify gaps in the system that allow human rights violations to occur. You can find out more about this through the work of the Global Mental Health Peer Network and others.

And it is  essential that when UHC policy and systems are in place, they are monitored and authorities held accountable to ensure they are delivering on their promise to provide quality, equitable and affordable mental healthcare and that human rights abuses end. Partners such as Human Rights Watch are actively working with national partners to help end these abuses. Initiatives such as the Countdown Global Mental Health 2030 provide data from multiple different sources on how countries are performing so that people can hold their governments to account.

The recommendations set out in the policy brief, if adopted, enable the development of inclusive health systems, where the rights of people with mental health issues are respected and safeguarded.

Isn’t that the kind of mental health services and support we all want to see? Couldn’t this be the future of Universal Health Coverage for us all?