The Year of Human Rights and Mental Health
- Alberto Vasquez, Sociedad y Discapacidad - SODIS (Chair)
- Michelle Funk, WHO Department of Mental Health & Substance Abuse
- Yvonne Owino-Wamari, OutRight Action International
- Simon Vasseur-Bacle, Head of International Affairs, WHO Collaborating Center for research and training in mental health
- Tanja Kleinsorge, Parliamentary Assembly of the Council of Europe, Committee on Social Affairs, Health and Sustainable Development
Welcome to today’s discussion on the 2021 agenda for mental health and human rights. Last time we looked at different human rights challenges in mental health, such as biomedical approaches, institutionalisation, lack of community support, and lack of participation of those with lived experience. Today we will look at the agenda for change, and the opportunities coming up this year.
The WHO runs the QualityRights Initiative, please can you tell us more about the initiative and the successes so far?
QualityRights is essentially a global initiative of the WHO to improve quality and care in mental health services and to promote rights of those with mental health conditions and disabilities. We work in several areas, including capacity building of stakeholders to combat stigma and discrimination in line with the Convention on the Rights of Persons with Disabilities (CRPD). This is the convention most countries have signed up to and are now obliged to implement.
We also help countries to build person-centred quality approaches to mental health through community care, and through working with civil society to empower people to promote advocacy work. We also support governments to reform policy law in line with the CRPD.
In addition we have launched a comprehensive set of tools that equip stakeholders with the knowledge, attitude and skills needed to adopt human rights-based approach on the ground. This includes tools for workshops, an e-training platform, and it has reached thousands of people across countries to make change on a large scale. For example, in Ghana 9000 people were successfully trained, including people with lived experience, students, NGO workers etc.
Another recent outcome was a wide scale assessment of mental health services using the QualityRights toolkit, with assessments now being used as part of the follow up work to transform services that we’ve developed. This includes transforming services into non-coercive services that truly respect human rights, and including the right to determine treatment.
Engagement of those with lived experience is another important success of our work. Persons with lived experience have had a big influence on all the tools we’ve developed, as well as on implementation at country level, service assessments and the development of advocacy campaigns.
We are now also working on helping countries to create frameworks that help develop systems that promote support and inclusion, which will end coercive practices.
OutRight International fights for the human rights of the LGBTQI+ community, can you tell us about your work promoting mental health in the LGBTQI+ community?
OutRight International is a global organisation that has been advancing human rights of LGBTQI+ individuals for over thirty years, headquartered in New York, with a presence in 5 continents.
Our work is carried out in three primary strategies. First is our publications that show exclusion, discrimination and criminalisation on gender identity. We also do research work that informs advocacy work, and we conduct research to create resources for LGBTQI+ individuals and groups.
OutRight Brings visibility to the mental health impacts and human rights violations of LGBTQI+ individuals. For example in our Asia programme, in Sri Lanka we have a resource project to capacitate counsellors so that LGBTQI+ survivors of gender based violence can have access to LGBTQI+ sensitised services. In the Philippines we have developed a ‘training of trainers’ curriculum revised to teach first responders to provide psychological first aid to LGBTQI+ people facing family and domestic violence.
We also released a global report on conversion therapy. We then launched our project in Africa to champion a complete ban of this practice in Kenya, Nigeria and South Africa. We have incorporated the expertise from respondents to ensure that we do not re-traumatise the survivors and have a ready response for survivors who might require psychosocial support.
In regards to the COVID-19 pandemic, OutRight carried out research into the impact of pandemic on LGBTQI+ persons to get a snapshot of how the global pandemic and subsequent public health measures affected their lives. Findings showed there was devastation of livelihoods, disruption of healthcare, increased isolation, family and domestic abuse and increased levels of anxiety and depression. This research showed that LGBTQI+ people suffer at disproportionate levels.
The respondents spoke to how these effects ultimately affected the mental health of LGBTQI+ individuals in those regions. We responded through an emergency COVID-19 fund to support organisations in those areas, to cushion the impact of the pandemic and support those in need. Through that grant we supported 17,380 individuals.
The Global Ministerial Mental Health Summit is being hosted by France this year, what are your plans for the event and what are your expectations?
We are happy to host this Mental Health Summit in Paris, which was postponed from 2020, and is now scheduled for 5th and 6th October 2021. 2021 will be an important year for mental health, and there will be a strong focus on human rights. There will be particular momentum at an international level around World Mental Health Day on 10th October, as well as at a French level with the weeks of information on mental health. This year the theme is “For my mental health, let’s respect my rights” and it will take place between October 4th and October 17th.
The theme of the Summit will be “Mind the rights now”. This will be the third summit of the Alliance of Champions for Mental Health after 2018 [hosted by the UK] and 2019 [hosted by the Netherlands], which covered other topics. We need a sustainable discussion to maintain momentum to create opportunities for concrete actions for promoting mental health care. The Summit will take into account the current health context, which has further revealed the vulnerabilities in the general population, as well as national and international health policies.
This is all crucial but it’s also not enough. That’s why the theme of human rights and mental health is important, as rights are a powerful lever for promoting mental health. There will be important exchanges and workshops between persons with lived experience, family carers, NGOs and policy makers, which will help accelerate practices based on innovative international experiences. We want to bring together these international actors to work on the subject together.
This is also an opportunity to promote human rights and mental health, but also to disseminate inspiring actions, share experiences, and highlight the levers to use, and also to promote deliverables to ensure sustainable action on mental health after the summit.
Can you explain a bit about your work at the PACE on mental health? What are your priorities this year and why? What led the Committee on Social Affairs, Health and Sustainable Development to undertake this process and what’s the significance of this resolution?
Today I am standing in for the Assembly’s Rapporteur on deinstitutionalisation, Ms De Bruijn-Wezeman, who is taking part in an urgent debate in the Dutch Senate as we speak.
This year is an important year for mental health in the Parliamentary Assembly. This is because we will be laying the groundwork for two key reports:
- the report on deinstitutionalisation
- and an opinion, for the organisation’s Committee of Ministers, on the draft additional protocol to the Oviedo Convention on involuntary measures in psychiatry.
These two reports are linked. We all know that involuntary placement and involuntary treatment within mental health care services can affect the most fundamental rights of a human being, including the right to integrity and the right to liberty. The Assembly believes that ending coercion in mental health is the way forward to safeguard human rights in mental health. Deinstitutionalisation is a valuable means to this end.
The Parliamentary Assembly started working on human rights in mental health several years ago, in 2013 to be exact, when the Council of Europe’s Committee on Bioethics started working on drawing up this additional protocol to the Oviedo Convention on involuntary measures in psychiatry.
Already in 2016, the Assembly adopted a Recommendation, no. 2091, making “The case against a Council of Europe legal instrument on involuntary measures in psychiatry”. In this recommendation, the Assembly recommended that the Committee of Ministers instruct the Committee on Bioethics (I cite):
1. to withdraw the proposal to draw up an additional protocol;
2. instead focus its work on promoting alternatives to involuntary measures in psychiatry, including by devising measures to increase the involvement of persons with psychosocial disabilities in decisions affecting their health.
The Assembly essentially repeated these recommendations last year, in Resolution 2158, unanimously adopted, on “ending coercion in mental health: the need for a human rights-based approach”. However, the Committee of Ministers did not heed the central recommendation of the Assembly, which is also supported by the Council of Europe Commissioner on Human Rights, to redirect efforts from work on the Additional Protocol to work on voluntary measures. Work on the Additional Protocol has continued, and, indeed, will probably be finalised this year within the Committee on Bioethics.
But the Assembly’s recommendations did have an impact. Guidelines on endingcoercion in mental health are also now currently being drafted by the Committee onBioethics. These guidelines will showcase positive examples of voluntary measures, including successful deinstitutionalisation of people with disabilities. Our Rapporteur believes that these guidelines will serve as an encouragement to member states to start to transition to end coercion in mental health. She hopes that member states will realise that voluntary measures work where involuntary measures do not, and that they are cheaper into the bargain, as well as more human-rights compliant.
WHO are soon to release a new report - the WHO good practice guidance and technical packages on rights-based community mental health services. Please can you tell us more about this report?
It’s really good to see that there are now several other initiatives moving towards ending coercive practices, being done by other organisations. The WHO is now close to finalising and launching our new report on good practice rights-based community mental health practices from around the world. It’s important to emphasise that services must be rights based, not just community based.
The report will launch 11th May. There is an overall document that introduces the CRPD, the overall concept of rights, the types of care from around the world that showcase this including outreach services, crisis services, peer support services, community services, and networks of these services working together. The guidance discusses the important interface between these services with the social sector, and concludes with a set of recommendations for integration of these services. There are also 7 accompanying technical packages with more detailed information on each of the types of services e.g. crisis, community outreach services, peer support services.
When we talk about right-based services, we mean services that do not use coercive practices, such as seclusion, restraint, and forced treatment. We must respect the choices that people make. We are talking about services that promote the inclusion of those with lived experience, and that are responsive to feedback of service users. By this we also mean services that promote community inclusion addressing all areas of a person’s life that they want to work on, rather than those with a narrow focus on symptom reduction.
The idea with this new guidance is to inspire policy makers, healthcare planners, and other groups to develop new services that truly meet people’s needs, meet people’s rights and support them in their recovery journey.
How do OutRight International’s plans for 2021 promote the work of mental health and human rights?
We will continue to incorporate specific steps for implementing mental health as part of our movement, through safety, security and wellness training for LGBTQI+ individuals and advocates, and through the research and materials that we develop that provide policy recommendations.
For the programme that we are implementing in Asia, one of the objectives is for the Asia regional network to develop support mechanisms for LGBTQI+ advocates and their work on gender-based violence, including domestic violence and abuse. This includes response to trauma, and support to ensure their mental health is maintained.
In Africa, again there is work being done to develop rapid response for survivors of conversion practices. We are working on psychosocial support for the survivors and information to support mental wellbeing, which is something already being incorporated in the project in Kenya.
There is a need to engage with medical and psychologist associations in the countries where we are implementing projects, both at global and regional level. We must work towards the regulation of the sector to eliminate harmful practices that are being carried out, in some instances by mental health professionals.
We are also actively working on hosting an expert meeting for pathways for learning for conversion practices. This will bring together activists, legal and medical professionals, faith and traditional leaders, for a roundtable where we can determine human rights based policy pathways to eliminate harmful practices.
In regards to COVID-19, LGBTQI+ persons are still being hard hit by the pandemic. Given the need for support at a local level, we will be reopening a call for applications for a second round of emergency grants, probably some time next month. We anticipate that this will be requesting work for mental health support. We received over 1500 applications and supported 125 applications last time, and we want to support as many as we can.
How are you going to highlight the importance of human rights at the Global Ministerial Mental Health Summit?
The theme of human rights and mental health is receiving growing national and international attention. At the Summit there will be two thematic axes with the international steering committee, including the place of mental health in the current health context, which is determined by many factors, and the integration of the issues relating to this.
One objective is to identify the levers for action. Issues include global public investments, global health fund, Universal Health Coverage, MHPSS, human rights through the prism of not just access to care but access to quality care, and how we can use related international tools (such as CRPD, WHO Quality Rights programme, etc).
We will also highlight the concrete, innovative practices on human rights and mental health, promoting the respect of rights by professionals, civil society, and political decision makers. The need to share experiences and challenges is essential. Meeting the current challenges requires ambition and expertise, but we can see innovation in mental health support and recovery-oriented perspectives.
Progressive and positive positioning must be the DNA of this summit, which will be enriched by international partners and experiences. The number of emerging initiatives, and the number of voices being raised to testify and advocate for better mental health, provide an important context.
The respect of rights should be a common objective, and we want to underline this during the summit.
The PACE Committee on Social Affairs, Health and Sustainable Development is working now on a new report on deinstitutionalization of persons with disabilities. What is the purpose and scope of this report, and what do you think it would be its impact?
This report is a follow-up to Ms De Bruijn-Wezeman’s last report on “ending coercion in mental health: the need for a rights-based approach”, as deinstitutionalisation is a key stepping-stone to ending coercion in mental health. Institutionalisation is increasingly acknowledged as poor policy and a potential violation of human rights. The UN Convention on the Rights of Persons with Disabilities (as well as other human rights instruments) have enabled a shift to a human rights-based approach to this issue.
For residents in institutions, neglect and inadequate health care is too often a reality. Persons with disabilities who are placed in institutions are deprived of their liberty for long periods of time, and in some cases even for a lifetime. Most of them are institutionalised against their will or without their free and informed consent. It is important to have in mind that these persons are some of the most vulnerable in our society, as is highlighted by the Covid-19 pandemic in which they are disproportionately affected.
The process of deinstitutionalisation requires a long-term strategy that ensures that good quality care is available in community settings. As institutionalised persons are being reintegrated into society, there is need for comprehensive social services and individualised support in the deinstitutionalisation process in order to support these persons, and in many cases their families or other carers. Such support must be accompanied by specific access to services outside institutions, enabling people to obtain care, work, social assistance, housing, etc., thus also addressing the social determinants of health. If deinstitutionalisation is not managed properly, and withoutdue consideration of the special needs of each person concerned, this can haveunfortunate consequences. The lack of support and monitoring can lead to abuse and violence, or a return to institutions.
Several Council of Europe member States still hesitate to close down residential institutions and develop community-based services for persons with disabilities. In some countries the numbers are in fact increasing, in spite of international obligations and longstanding calls from international human-rights bodies to end such practices.
Ms De Bruijn-Wezeman’s report will shed light on and give a better understanding of the living conditions of persons with disabilities in institutions. She wants to engage with individuals and NGOs to propose recommendations to member States on how to provide appropriate community-based services. The Rapporteur would also like to explore the possibility of further supporting member States who need it in their processes of deinstitutionalisation through the Council of Europe Development Bank.
In this regard, she is, amongst other things, organising a hearing on 16 March, at 2 pm CET. The hearing is aimed at gathering information from human rights experts and NGOs. It will be public, so everyone is more than welcome to follow. The Committee on Social Affairs, Health and Sustainable Development I work for has already considered and declassified an introductory memorandum which you can find on our website, if you are interested in more information.
Do you anticipate that the pandemic will help to better integrate human rights in the mental health agenda?
It will if we make the effort to promote it and make it happen. Increased awareness may actually just exacerbate the existing model of treatment, services and policies. We need to actively move forward and build back better, and specifically integrate human rights into our work.
We all need to be involved in decision making processes to ensure nobody is left behind when coming up with interventions and ways to better manage the situation. So we need to bring everybody to the table and have a conversation around how we can better respond to the impact on the diverse population. This will enable more inclusive responses so we leave no one behind.
Yes. More and more people are now aware of their own mental health, and we know we have to act on this topic and that we need to invest. I am sure that we will be able to show that this change is possible.
It’s not all rosy - the pandemic has created more human rights challenges, not just in mental health. I’m still optimistic as the time for really recognising human rights and mental health has come. We’re fighting a backlash against human rights in general, but I think we are winning.
In our last session we talked about human rights issues in mental health, and today we heard about some of the actions being taken against them. We have learned a lot, and shown that there is still much to be done but also a willingness to integrate human rights and mental health on a global level. We have also seen the potential of participatory processes, and the importance of including those with lived experiences if we are to get better outcomes for all.
The next #MHForAll webinar will explore the link between mental health and marginalised communities, and you can register your place here.