"Saving the World From Madness" (REPORT)

(Video: Sound bites from speakers at the UN WHO Meeting to launch the Quality Rights Tool Kit/NIA SPOONER)

By Dr. Judy Kuriansky

*Recently, the United Nations World Health Organization launched the Quality Rights Tool Kit, which supports countries in assessing and improving the quality of mental health care as a human rights condition. and civil society actors gathered together to lend their support to the project and to discuss how to promote the use of the Tool Kit in countries.  Dr. Judy Kuriansky was there to chronicle the discussion for HUMNEWS.

FACT:   Globally, one in four people will experience a mental health condition in their lifetime. Poor quality services and human rights violations in mental health facilities and social care homes are an everyday occurrence in many countries around the world. People living in mental health facilities are often exposed to inhuman and degrading treatment and many are subject to physical, sexual and emotional abuse. As a result, people with severe mental health conditions in some countries die as much as 10 years younger than the general population. (Source: WHO)

(DRAWING: ArtTherapy) “Derogatory words are used to describe us, such as mentally disturbed, having unsound minds, idiots, lunatics, imbeciles and many other hurtful labels,” declared Mrs. Robinah Alambuya of Uganda, to an invited audience of about 100 health professionals, UN agency officials, the UN Foundation academics, representatives of nongovernmental organizations, journalists and guests.  The diverse group was gathered at the Millennium Hotel Diplomat Ballroom in New York City, across the street from the main United Nations headquarters, for an event sponsored by the World Health Organization (WHO) highlighting abuses in the mental health care system and to launch a landmark product, the WHO QualityRights Toolkit, to address the problem.

“These words and the beliefs from which they derive, devalue us and form the basis of discrimination and the loss of inherent dignity,” Alambuya said. 

SHOWING RESPECT

Representing African women and the voices of survivors of people with psychiatric and psychosocial problems in Africa, Alambuya made a plea for respecting those who deal with mental health distress. In her role as President of the Pan African Network of People with Psychosocial Disabilities monitoring inhumane health care systems, she applauded WHO’s efforts to insure those rights in her keynote speech.

The `Tool Kit' is an awareness and training campaign to provide the public, the private sector,  and government groups with actionable steps to stop human rights violations against people with mental health conditions, in order to improve the quality of care and to promote human rights as including mental health.

The recommendations can be implemented in developing and developed nations by all stakeholders, and even includes those with mental disabilities themselves.

"IT CAN HAPPEN TO ANYONE"

Dr. Michelle Funk, Coordinator of Mental Health Policy and Service Development in the Mental Health and Substance Abuse department at WHO, pointed out the extent of the problem with "One in four people will experience a mental health condition in their lifetime," she said.

Suicide is among the top three cause of death in young people aged 15-34 worldwide. Qualified caregivers are scarce with less than one psychiatrist serving 200,000 in almost half the world populations. Yet poor quality services and human rights violations are pervasive in social care homes and mental health facilities where patents are often exposed to inhuman and degrading treatment. And worse, to physical, emotional and even sexual abuse. 

“It is a scandal that still today many mental health facilities are places of violence and harmful treatments practices rather than places of care and support," said Funk. “One of the most important points to note about this tool kit is that it establishes the key standards that need to be met in all inpatient and outpatient mental health and social care facilities across the world.” She went on to praise the role of the governments of Spain and Portugal in providing funds to help produce the toolkit.

NOTABLE ADVOCATES

Panelists at the June 28^th event represented a wide range of perspectives about the issue, including UN and government officials, an African woman with disabilities, and a former prisoner from the slums of India.

Hollywood film producer Gary Foster described his evolution to become a mental health advocate when producing the film “The Soloist“ - a true life story about a former cello prodigy who developed a mental health condition and became homeless on the streets of Los Angeles. Foster, who also produced “Sleepless in Seattle” and "The Score” spent time on skid row where he discovered that all people have “dream for success.”  

Serving as an important example of how the campaign goals can be accomplished, Ambassador Carlos Enrique Garcia Gonzalez, Deputy Permanent Representative of El Salvador to the UN, described his government’s recent advances in ambitious health care reform, including a social development component with a human rights approach - pointing out how abuses of mental health are not an isolated issue, because mental health care extends to all facets of society, and is integrally tied to attitudes and poverty. 

Often times, people with psychosocial disabilities become homeless, are abandoned by their families, and are detained against their will by authorities - neglected in inferior conditions. Therefore, mental health services need to encompass access to decent work, education and quality of life. 

Panelist Julian Eaton, a psychiatrist and mental health advisor from the West Africa Office of CBM in Togo, discussed how "the value of technology in such a campaign, particularly the use of mobile phones, is revolutionary". 

The initiative builds on WHO’s Mental Health and Development Report, published in 2010 and is also based on the framework of the UN Convention on the Rights of Persons with Disabilities, which asserts that “human rights standards that must be respected, protected and fulfilled in all facilities”.

(Video: WHO)

A short film was shown of cruel and deplorable conditions in a care center, showing emaciated patients, chained to beds, crying out and lying in excrement. Ambassador Gonzalez pointed out that mental health workers themselves, who have to work in substandard conditions, are another victimized group. 

As a psychologist who has worked in many mental health institutions with psychiatric patients, I asked Michele Funk whether a solution would be to allot needed funds for improvements in these facilities.  “No", she responded, “They must be shut down, and new ones opened.”

CRITICS, SUPPORTERS

While generally lauded, the Toolkit is not without criticism.  Alambuya expressed concern about the emphasis on a medical model of service delivery that does not adequately take into account the social problems faced by persons with mental disabilities, saying, "The voices of people with disabilities must be heard, using the popular phrase, `Nothing about us, without us'”.

(PHOTO: Adolescents are generally perceived as a healthy age group; yet an estimated 10-20% of them experience a mental health problem/WHO)In a powerful close to the panel, Gregory David Roberts, speaking from personal experience of his being imprisoned and overcoming drug abuse, the author of the best-selling novel “Shantaram”  recounted the story of a fellow inmate - mentally challenged - who had been abused by the other prisoners; and who despite consistently smiled.  One day the man found unhatched eggs, and put them under his armpits until they hatched.  The baby pigeons became valued and protected in the jail, eventually taming hard-hearted cruel prisoners.  The experience prompted Roberts to learn lessons about his shame for not defending the man, and about the power of people of mental disability to transform others.

Roberts recounted another story of a mentally challenged young man who would have been arrested had it not been for the community people who chained him up near them, where he could be cared for and protected from arrest,  underscoring his point that community-based programs are key.

More launches of the toolkit campaign will be held to gain more visibility for the project.

“Everyone should have access to mental health care,” said His Excellency Mr. Nassir Abdulaziz Al-Nasser, President of the sixty-sixth session of the United Nations General Assembly. Recommending mainstreaming of mental health care, he noted that his own state of Qatar introduced a resolution to the UN General Assembly to introduce and International Day of Autism.  "If we all consider human rights together," he said, “We can make a difference.”  

- Dr. Judy Kuriansky is the Main United Nations NGO Representative for the International Association of Applied Psychology and a member HUM's Board of Advisors.  A licensed clinical psychologist in the Departments of Clinical Psychology at Columbia University Teachers College, she is world renowned as a humanitarian who has led workshops on peace, trauma recovery, crisis counseling and on her unique East/West intervention programs around the world, from Argentina to India, Singapore, the Czech Republic, Israel, the UAE, and Iran. She has worked in disaster relief and psychological first aid at Ground Zero after 9/11, after SARS in China, bombings in Jerusalem, earthquakes in Australia and Haiti, the tsunami in Sri Lanka and the tsunami/earthquake in Japan, information about which is on www.DrJudy.com. An award-winning journalist and accomplished author, she is a tireless advocate for media which sheds light.