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The theme of the ‘World Mental Health Day 2015’ commemorated on October 10 was ‘Dignity and Mental Health’. “All human beings are born equal in dignity and in rights”, affirms the Article One of the Universal Declaration of Human Rights.

The preamble of the UN Convention on the Rights of Persons with Disabilities states: “…Discrimination against any person on the basis of disability is a violation of the inherent dignity and worth of the human person.”

In the health-care system the society needs to provide better support and care for people with mental health conditions by providing community-based services, encompassing a recovery approach that inspires hope and supports people to achieve their goals and aspirations

Currently, the care available in mental health facilities around the world is of poor quality and in fact in many instances delays recovery. Generally, people with mental disabilities are retained isolated from human contact or to be chained to their beds, unable to move. Violations are not restricted to inpatient and residential facilities however; many people seeking care from outpatient and community care services are disempowered and also experience extensive restrictions to their basic human rights.

As regards the dignity of a person, it is the inherent value and worth of an individual which is strongly linked to respect, recognition, self-worth and the possibility to make choices. Dignity follows with the respect of basic human rights including freedom from violence and abuse. Around the world people with mental health conditions experience various problems with stigma, discrimination, and a vast number of violations that bars their dignity.

Such people are mostly isolated from society and subject to varied inhuman and degrading treatment. The attitude of normal people towards such people and the kind of attention paid on them is very inhuman and pathetic. People with mental ailments are neglected in hospitals and in other communities. Even in Sri Lanka, there are hospitals where people suffering from mental ailments cannot be admitted to take treatment for other physical ailment, even in an emergency. They refuse admission of people suffering from mental ailments to those hospitals as a principle. Does not this ‘principle’ violate human rights of these sick people living in this country? Have these authorities dealing with human rights thought about this discrimination?  This is absolute violation of human rights which discrimination has not been addressed so far by any institution set up to solve problems and issues related to human rights. This is a grave injustice met by people suffering from mental ailments.

It was reported in media recently that the Director of the National Mental Health Institute and the Mulleriyawa Unit had said that over 200 patients taking treatment in those two institutions whose permanent addresses and relatives could not be traced.

When trying to find the addresses of those patients, it has been revealed that those addresses were false and relatives of some patients had sold their houses and deserted the patients, he further stated.

Though there should be a system to support people, suffering from mental health problems, who have no income at all to meet with their day-to-day expenditure, including their medical costs; it is clear that so far their grievances have not been looked at or addressed by any government in Sri Lanka. Being citizens of the country, their problems, too, should have been taken into consideration in sympathetic and important manner by the government, especially they are not mentally fit to express their views and claim their demands as mentally sound people.

Thus they are very often deprived of the right to make decisions for themselves. Many are systematically denied the right to make decisions about their mental healthcare and treatment, where they want to live, and their personal and financial affairs. They are denied access to general and mental healthcare. As a consequence, they are more likely to die prematurely, compared with the general population.

Such people are often deprived of access to education and employment opportunities. Stigma and misconceptions about mental health conditions mean that people also face discrimination in employment, and are denied opportunities to work and make a living. Children with mental health conditions are also frequently excluded from educational opportunities. This leads to marginalization and exclusion from employment opportunities in later life.

They are prevented from participating fully in society. They are denied the possibility to take part in public affairs, to vote or stand for public office. They are not given the opportunity to participate in decision-making processes on issues affecting them, such as mental health policy and legislative or service reform. In addition, access to recreational and cultural activities is often denied to people with mental health conditions.

Social deprivation
Such patients are left in secluded rooms in hospital wards – just left to lie on the ice-cold concrete floor covered with urine and faeces and without anything to use to cover themselves in shivering cold. They are left in very dirty places with overflowing toilets, broken doors and windows, torn uniforms and at times patients are left naked. People with mental health problems are labeled everywhere – in the whole system, at home and no dignity afforded on them.

Their right to make their own decisions about their treatment and care should be given to them, and  ensuring access to good quality care which promotes human rights, is responsive to people’s needs, and respects their values, choices and preferences. In the community we need to support people with mental health conditions to participate in community life, and acknowledge the value of their contribution.

People with mental health problems are facing high levels of stigma and discrimination. When tagged as having a mental health problem, they experience social deprivation – losing their jobs, losing social prestige and becoming isolated from family and society.
In the health-care system the society needs to provide better support and care for people with mental health conditions by providing community-based services, encompassing a recovery approach that inspires hope and supports people to achieve their goals and aspirations;

Respecting people’s independence, including their right to make their own decisions about their treatment and care; and  ensuring access to good quality care which promotes human rights, is responsive to people’s needs, and respects their values, choices and preferences.

Role of community
Support people with mental health conditions to participate in community life, and acknowledge the value of their contribution. The community should provide them whatever support they may give to overcome the high levels of stigma and discrimination that they face. They should also be helped to overcome their desolation in whatever manner since these patients experience social deprivation – losing their jobs, losing social prestige and becoming isolated from family and society.

People can experience deprivation of dignity in a variety of ways –  Respect their independence to make decisions for themselves including their living arrangements and personal and financial matters,  ensure their access to employment, education, housing, social support and other opportunities,  include people in decision-making processes on issues affecting them, including policy, legislation and health service reform relating to mental health.

Promoting recovery approach
It is more than merely treating or managing symptoms. It is about building the capacity of mental health workers to support people with mental health conditions to realize their hopes and dreams, to work, to enjoy family and friends, and to live a full and rewarding life in their community

Supporting human rights
Quality Rights has developed training programs to build the capacity of families and health-care professionals to understand and promote the rights of people with mental health conditions, and to change attitudes and practices towards them.
Quality Rights is helping people with mental health conditions and families feel connected through mutually supportive relationships and by empowering them to advocate for the rights and dignity of people with mental health conditions.
WHO Quality Rights aims to improve the quality and human rights conditions in in-patient and out-patient mental health and socialcare facilities and empower organizations to advocate for the rights of people with mental and psychosocial disabilities.

Quality Rights Tool Kit
•    Improve quality of care and human rights in in-patient and out-patient mental health services.

•    Promote human rights, recovery, and independent living in the community.

•    Develop a movement of people with mental disabilities to provide mutual support, conduct advocacy and influence policy-making processes.

•    Reform national policies and legislation.
This tool kit is designed for use in low-, middle- and high-income countries. It can be used by many different stakeholders, including dedicated assessment committees, non governmental organizations, national human rights institutions, national health or mental health commissions, health service accreditation bodies and national mechanisms established under international treaties to monitor implementation of human rights standards and others with an interest in promoting the rights of people with disabilities.
The WHO Quality Rights tool kit is an essential resource, not only for putting an end to past neglect and abuses, but also for ensuring high quality services in the future.