New WHO guidance aims to stamp out rights violations in mental health services

Globally, mental health care mainly continues to be provided in psychiatric hospitals, and rights abuses and coercive practices remain all too common, according to the UN agency.

‘A more holistic approach’

The guidance recommends that mental health provision should be located in the community and include support for daily living, such as facilitating access to accommodation, as well as education and employment services.

“This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions, to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support,” said Dr. Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance.

Severe abuses continue

WHO estimated that governments currently spend less than two per cent of their overall health budgets on mental health.  This expenditure is mainly allocated to psychiatric hospitals, except in high-income countries where the figure is around 43 per cent.

The guidance promotes services that are person-centred and grounded in a human rights-based approach, as recommended under WHO’s Mental Health Action Plan 2020-2030, endorsed last month.

WHO pointed out that although countries have increasingly sought to reform their laws, policies and services regarding mental health care, following adoption of the UN Convention on the Rights of Persons with Disabilities in 2006, few have made progress in meeting the changes required by international human rights standards.

Severe human rights abuses and coercive practices are still far too common across countries, the agency said. Examples include forced admission and forced treatment, as well as manual, physical and chemical restraint, unsanitary living conditions, and physical and verbal abuse.

Good practices showcased

The new guidance outlines what is required in areas such as mental health law, service delivery, financing and workforce development so that mental health services comply with the disability rights treaty.

It contains examples of community-based mental health services from countries such as Brazil, India, Kenya, Myanmar, New Zealand, Norway and the United Kingdom which have demonstrated good practices, for example in non-coercion, community inclusion and respecting people’s right to make decisions about their treatment and life.

The services highlighted include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches and support provided by peer groups.  Cost comparisons indicate that they provide good outcomes and are preferred by users.  They also can be provided at comparable cost to mainstream health services.

“Transformation of mental health service provision must, however, be accompanied by significant changes in the social sector”, said Gerard Quinn, UN Special Rapporteur on the Rights of Persons with Disabilities.

“Until that happens, the discrimination that prevents people with mental health conditions from leading full and productive lives will continue.”