People with mental health problems are not ‘the other’. They can be you or I, our children, friends, colleagues. Every family is affected directly or indirectly as between 1 in 4 or 1 in 6 of us will develop psychiatric illness in our adulthood. They have a wide range of diagnoses from phobias to personality disorders to acute depression to dementia. Some are ill temporarily. Others have to be treated and monitored for a lifetime. Most are able to make important decisions about their lives. What they should all have is certain inalienable rights, but sadly this is not the case in many countries in the world.
According to a study funded by the World Psychiatric Association (WPA), of laws and policies in 193 United Nations (UN) member states, discrimination against people with mental health issues is widespread. The survey results, which were included in the ‘Social Justice for People with Mental Illness’ report published in the International Review of Psychiatry, found that 37 per cent of countries prohibit marriage by people with mental health problems. In 36 per cent of countries, people with mental health problems are not allowed to vote. 42 per cent do not recognize the right of people with mental health problems to write their own will and testament.
What we do know is that higher income countries tend to be less discriminatory that lower and middle-income countries and this is mainly due to greater advances in their legal system. Shockingly, we found that some Commonwealth countries were still basing their mental health laws on jurisprudence first instituted by the British Empire in the 19th century. Even the language is arcane with terms like lunacy, insanity, mental disturbance in common currency. In some countries, there is no provision at all to look after the needs of those who do not have capacity and to safeguard their interests. Cultural taboos can make it even harder for people with mental health issues to get the help and support they need and they may be alienated or even attacked.
The findings lead the WPA to create a Bill of Rights for individuals with mental health problems that can be used as a global standard. We hope it will encourage governments to review their own policies and look at how they can achieve minimum standards of health services including prompt diagnosis, support and affordable medication.
Those with mental illness/mental disability/mental health problems have the capacity to hold rights and exercise their rights and should, be treated on an equal basis with other citizens. The challenge for policy-makers, clinicians, and individuals with mental illness is to fight discrimination using strategies similar to civil liberties, gender equality, sexual minority (LGBT) communities, which in many parts of the world have proven to be useful.
It is important, that clinicians around the globe work with patients, their carers, and their families, as well as with relevant organisations representing these groups, to challenge discrimination, change laws, and ensure that these are applied equally. Clinicians need to advocate for our patients to work with policymakers to ensure that individuals with mental illness are not discriminated against.
There is simply no justification for continuing discrimination against individuals with mental illness, their families, and those who care for them, whether they are professional or lay carers.