WHO/OHCHR Guidance on mental health, human rights and legislation; a game changer for civil society and policy makers

WHO-OHCHR launch new guidance to improve laws addressing human rights abuses in mental health care

Mental health is increasingly being viewed as a human rights and public health issue, resulting in several countries working to update or enact new mental health legislation to replace outdated acts. These acts have often been unable to address issues such as stigma and discrimination and human rights violations, whilst being heavily focused on institutional care rather than primary and community based care. 

Good mental health legislation can form the foundation for a health system which provides mental health promotion, prevention, care and support for all, which in turn can also have a huge positive impact on physical health outcomes due to comorbidities between physical and mental health. This makes it essential for health advocates to ensure that their mental health legislation is human rights based and up to date with the World Health Organization’s (WHO) standards and best practices. 

To assist advocates with this, the WHO recently launched a joint publication with the Office of the United Nations High Commissioner for Human Rights (OHCHR) titled “Mental health, human rights and legislation: guidance and practice”. Its objective is to ensure that mental health policies, systems, services, and programmes provide high-quality care and support for all, in line with international human rights standards, including the Convention on the Rights of Persons with Disabilities (CRPD).

The guidance is an excellent resource for Civil Society advocates and policy makers alike, as it tackles every aspect of updating and accountability of mental health legislation. The first chapter makes an excellent case for why mental health legislation in most countries is in dire need of reform and alignment with international human rights frameworks, citing examples that fit most if not all country contexts. Advocates can adapt and use these arguments to make the case for reform directly with their policymakers.

This is followed by a chapter dissecting specific issues that mental health legislation should address, whilst providing proposed language for provisions on the issue to include in national mental health legislation. Issues touched upon include equality and non-discrimination, equal recognition of rights, physical and social conditions within services, respecting personhood and legal capacity, elimination of coercive practices, involuntary treatment, crisis support, training for healthcare providers, equitable access to services, health insurance, mental health financing and more. 

For advocates already engaged in formal processes with policymakers to provide inputs to or review mental health legislation, these model provisions can be lifted directly from the report, adapted and put forward as suggestions. The provisions can also form the basis for proposed mental health legislation that advocates can either develop jointly with policymakers or prepare for them should the arguments from chapter one prove convincing that reform is needed in the national context. In all scenarios, it makes the work of civil society much easier. 

In addition to providing clear examples of what the law should say, the guidance also covers what the process of developing mental health legislation should look like, including the stakeholders that ought to be engaged at every step of the process. For those unfamiliar with the legislative process, the guidance not only touches upon each step of the official process but also talks about the necessary steps required for implementation of the legislation once enacted, such as developing regulations, public education and awareness, training, resource allocation and evaluation etc. 

Finally, the guidance provides a check-list template for evaluating rights based mental health legislation that advocates and policy makers alike can download directly from the guidance and use as is to evaluate whether their existing legislation meets human rights standards or is in need of reform, as well as proving helpful in determining which areas require the most attention. 

The resource is timely as appreciation and understanding of the importance of mental health grows. Already we have seen reform of mental health legislation in countries such as Botswana and Nigeria, whilst other countries such as Sierra Leone and Kenya may soon follow suit. If utilised by civil society and policy makers, this resource can prove an accelerant in achieving a world where human rights based mental health services are available and accessible to all.