Often, when we think of the mistreatment of the mentally ill and the violation of their rights we focus on institutional exploitation of those who are incarcerated. That is an appropriate place to make an assessment since it's an identifiable population, vulnerable by means of their health status and relying on others for support with needed care.
Yet, it is only a small percentage of the so disordered for whom institutionalisation is necessary. But since the globally accepted ratio of people living with a mental disorder is one in every four, there has to be a greater accounting for the violation of rights and protections of the mentally ill who live and thrive in communities, those whose mental illness range from mild to severe but who do not require institutionalisation.
Many of the mental health disorders which impact on societies today are not the major psychotic ones to which we instinctively defer, like schizophrenia. In fact, depression is the most prevalent mental disorder and is the leading cause of disability globally.
The World Health Organization (WHO) says, "Depression is a common mental disorder. Globally, an estimated 350 million people of all ages suffer from depression. Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease."
In fact, the WHO has made depression one of the priority conditions covered its 2013 Mental Health Gap Action Programme (mhGAP). The programme aims to, "help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health."
The WHO emphasises that "with proper care, psychosocial assistance and medication, tens of millions of people with mental disorders, including depression, could begin to lead normal lives–even where resources are scarce."
Where a country does not provide such care, access to care, including psychiatric interventions other than medication, policy for housing, employment, education, and the like, it is neglecting to honour its obligation to protect the human rights of individuals by the lack of provision of and therefore denial to, these services.
To deny the rights of the citizenry by omission is equally punishing as denying the rights by commission of direct acts, on those placed in institutions. In fact, the subtlety of denying my rights by doing nothing to ensure that I enjoy those rights and entitlements for which provisions have been made in international law is a greater infraction for mental health here in T&T, since in practicality "most of us are outside than inside," as we like to jokingly say.
Article 12 of the International Covenant of Economic, Social and Cultural Rights (ICESCR) sets out the right to the highest attainable (possible) standard of physical and mental health. Amnesty International (AI) explains in a document that, "This is not a right to be healthy, rather it consists of entitlements and is closely linked to a number of other rights and freedoms. It is also based on the principles of non-discrimination and participation."
What therefore are my entitlements under the right to the highest attainable standard of physical and mental health? To quote AI, "By entitlement we mean a right to facilities, goods, services and conditions that help any person to achieve the highest attainable standard of physical and mental health. These include the entitlement to a system of health protection, including health care. As well as granting an entitlement to a system of mental health care, the State must protect other rights, such as housing, employment and education."
T&T is obligated under law International human rights law to not only provide health services for the mentally ill but to ensure that the "health services, goods and facilities, including the underlying determinants of health, are:
�2 Available–enough mental health related facilities and services and trained medical and other professionals must be available.
�2 Accessible–appropriate facilities, goods and services must be affordable, not too far away and available without discrimination. Information on such matters must also be easy to read and understand.
�2 Acceptable–facilities, goods and services must respect different cultures and medical ethics, and
�2 Of good quality–facilities, goods and services must meet medical and scientific standards.
My grief will remain abundant mainly due to the fact that T&T is still showing no active will to take steps to ensure people with mental health disorders/issues have the equal opportunity to enjoy their human rights. In fact, the provisions for physical health far outweigh that for mental health care and no one has shown any interest yet in changing that discriminating order.
Yet, the mentally ill makes up a quarter of our population and is a vulnerable group, which fact compels the State to allocate appropriate funding and other resources to mental health services on an equal basis with other health services.
�2 Caroline C Ravello is a strategic communications and media practitioner with over 30 years of proficiency. She holds an MA in Mass Communications and is pursuing the MSc in Public Health (MPH) from the UWI. Write to: mindful.tt@gmail.com.