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The Human Rights Perspective

Services arc usually organized from a managerial perspective and users are forced to adjust to the particular structure of the service they wish to access. This service-led approach is characteristic of mental health services. Unlike the needs-led pproach, it results in significant barriers to access, especially for people with severe mental disorders whose needs go beyond purely medical and therapeutic interventions. There is a move towards models of service provision that are needs-led, e.g. case management, assertive treatment programs and psychiatric rehabilitation villages in rural areas. These models are an acknowledgment that the needs of patients should iced first and that services should adapt their organization to meet these needs.

Organization of Services for Mental Health -:Mental Health Policy and Service Guidance Package World Health Organization, 2003

Categories of Mental Health Services: World Health Organization

The World Health Organization (WHO) charts mental health services into three broad categories:
  • Services which are integrated into the general health system through primary and preventive care, as well as care and treatment offered through general hospitals
  • Formal and informal community mental health services
  • Specialist institutional mental health services and dedicated hospitals

With a view to changing mental health care and treatment system from the service-based to the needs-based approach, WHO recommends integrating the Human Rights framework. Usinghuman rights as a framework for health development implies:

  • Assessing and addressing the human rights implications of any health policy, programme or legislation
  • Making human rights an integral dimension of the design, implementation, monitoring and evaluation of health-related policies and programmes in all spheres, including political, economic and social
The Universal Declaration of Human Rights

The issue of human rights of people with psychosocial disability needs to be understood from the perspective of a constant tension between the State and its citizens, since the State is both the guarantor and the violator of the rights of its individual citizens.

To ensure that States play their guarantor role rather than the violator one, the world's nations came together in 1948 to issue a document known as the Universal Declaration of Human Rights. Since then there have been additions to this document in the form of international covenants, with different nations as signatories. The United Nations Resolution 46/119 outlining the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care recognizes:

  • The right to informed consent
  • The right to protection from harm
  • Prohibition of arbitrary or unnecessary isolation or physical restraint
  • The right to live, work and receive treatment within the community
  • Recognition of the patient's cultural background for more comprehensive reintegration into society
  • Use of the least restrictive environment available to treat the patient
  • Treatment of the mentally ill patient towards maintaining and furthering independence and promoting participation in the community

It is undeniable that the 1991 principles referred to above are committed to the basic principles of ethics and consent. However, mental health activists have been critical of these principles for liberally allowing forced treatment and involuntary institutionalization. This critique has been paid heed to in the recent draft of the UN Convention, which extends the guarantees of the 1991 principles. This draft further recognizes the right to full legal capacity and places restrictions on institutionalization and involuntary treatment. It endorses other civil, political and socio-economic rights.

The Indian Position

The National Human Rights Commission, India, defines the rights of persons with psychosocial disability as follows:
  • The same fundamental rights as their fellow citizens, including the right to a decent life, as normal and as full as possible
  • Legal safeguards against abuse and assistance to protect all rights
  • Appeal
  • Necessary treatment in the least restrictive setup and as far as possible, to be treated and cared for in the community
  • Rehabilitation
  • Personal Autonomy
  • Education and Training
  • Economic and Social Security
  • Employment
  • Protection against exploitation and discriminatory, abusive or degrading treatment.