Legacy of outdated approaches in mental health care: QualityRights panacea?

Persons with disabilities, particularly those with psychosocial, cognitive and intellectual disabilities, often experience human rights violations in their attempt to access mental health services.

Most countries with mental health laws allow involuntary hospitalisation, detention and treatment of persons with disabilities on grounds of their actual or perceived impairment.

Other factors that have given impetus to involuntary hospitalisation, detention and forced treatment have been society’s perceived assessment of how dangerous a person with psychosocial, cognitive and intellectual disability is and what is considered “medical necessity”.

Seclusion, restraints and other forms of coercive treatments are most often employed during emotional crisis and when patients exhibit severe distress in many mental health facilities.

They are also employed as forms of punishment to clients who are perceived to behave improperly.

Women and girls with psychosocial, cognitive and intellectual disabilities are regularly exposed to violence and abuses in their homes and places of work, and harmful practices in mental health settings, including forced contraception, forced sterilisation and forced abortion.

Coercion in care, often characterised by restraints, forced medications, being shut up in restrictive spaces, seclusion and institutional in-patient care, is generally adopted by many mental health care services around the world.

Interestingly, these forms of coercive practices are found within the curriculum of mental health training institutions as methods of managing patients.

This must be curtailed. Doing away with these legacies of outdated approaches in mental health care may not come easy.

There has been strong advocacy to keep the status quo as it is by some “power brokers” within the mental health space around the world; nonetheless, there is also growing understanding that the change towards rights-based and evidence-based mental health services is needed around the globe in high, middle and low-income economies.

Stakeholders around the world, who are willing to go in this direction to improve mental health care will find the WHO’s QualityRights initiative and its training and guidance materials extremely useful.

Background

Against this background, the WHO QualityRights initiative provides essential guidance on the implementation of mental health services and on community-based responses from a human rights perspective, offering a path towards ending institutionalisation and involuntary hospitalisation and treatment of persons with disabilities.

This initiative calls for training key stakeholders such as health-care professionals to provide health care and psychosocial support to persons with disabilities in a way that is respectful of their rights.

By promoting compliance with the CRPD and the 2030 Agenda frameworks, the WHO QualityRights modules bring us closer to realising the rights of persons with disabilities.

Under the QR concept, two key service delivery indicators will be attained.

First, persons with disabilities and other mental health conditions, who may need mental health services, will be motivated to use services that empower them and respect their views.

Second, providers of services will be competent and confident in applying measures that prevent coercion.

As a result, power asymmetries will be reduced, and mutual trust and therapeutic cooperation will be strengthened.

QualityRights

QualityRights offers a new approach to mental health care which is rights-based and recovery-oriented. There is increasing understanding that mental health care policies and services worldwide need to change.

Persistently, services for people with psychosocial disabilities and other mental health conditions are reliant on coercion, over-medicalisation and institutionalisation.

This status quo is not acceptable, as it may continue to reinforce stigma and helplessness among both users and providers of mental health services.

All stakeholders in mental health, policy-makers, mental health professionals and people using mental health services need to be equipped with knowledge and skills in effective ways to manage this change and to develop sustainable rights-based mental health services.

The apparent increase in interest in mental health as a development priority, particularly in this period of re-emerging from the COVID-19 pandemic, offers the opportunity to close the huge gap in care and support, enabling people to realize their right to good health care where this has previously been lacking.

Historically

Historically, most mental health services have often been of very poor quality and have ignored the priorities and perspectives of people using such services.

The WHO QualityRights programme has been instrumental in putting in place the means for measuring mental health services according to the standards of the Convention on the Rights of Persons with Disabilities.

This marks a paradigm shift from the way that services have historically worked. Its training modules facilitate better practice in supporting people with mental health conditions and psychosocial disabilities, enabling their voices to be heard and promoting healthier environments that foster recovery.

QualityRights has proven to be a crucial resource for service providers and users, guiding practical reform for services that value dignity and respect, wherever they may be in the world.

It recognizes and values the importance of the lived experience of people with psychosocial, intellectual or cognitive disabilities in promoting recovery, undertaking advocacy, conducting research and reducing stigma and discrimination.

QualityRights ensures compliance with human rights standards, implementing strategies to end coercive practices.

They show how persons with lived experience can provide peer support and can also contribute to the development, design, implementation, monitoring and evaluation of mental health and social services.

The mental health system is not the only societal system that presents barriers through which the person must navigate; access to other life opportunities such as education, employment, housing and overall health and well-being can be equally challenging.

The unique and in-depth perspectives of people with lived experience can be the catalyst for change and transformation of all societal systems in order to protect human rights, encourage inclusion in the community, improve quality of life, and promote empowerment — all of which can contribute towards improved mental health and well-being.