Out of the Shadows: Using Human Rights Approaches to Secure Dignity and Well-Being for People with Mental Disabilities

Mental health is perhaps the most neglected area of health policy and programming. According to the 2001 World Health Report, “some 450 million people suffer from a mental or behavioral disorder, yet only a small minority of them receive even the most basic treatment” [1]. More than 40% of countries have no mental health policy and over 30% have no mental health program. Over 90% of countries have no mental health policy that includes children and adolescents [1]. According to the World Health Organization (WHO), mental and behavioral disorders are estimated to account for 12% of the global burden of disease, yet the mental health budgets of the majority of countries constitute less than 1% of their total health expenditures [1]. The relationship between disease burden and disease spending is clearly disproportionate. Those few who do receive services often fare just as badly. Mental Disability Rights International (MDRI; Washington, D.C., United States), a human rights group dedicated to the promotion of rights of the mentally disabled, has documented how, in many countries, severely mentally disabled individuals become targets of stigma, discrimination, and other human rights abuses. Routinely, children and adults with mental disabilities are arbitrarily detained in psychiatric facilities, social care homes, orphanages and other closed institutions. Out of public view, they are subject to the most extreme forms of inhuman and degrading treatment experienced by any population (Figure 1). In Kosovo, MDRI learned that women were raped in psychiatric facilities in plain view of local staff and international humanitarian relief workers [2]. In Hungary and Paraguay, MDRI found people locked in cages [3,4]. In Turkey, Peru, and Bulgaria, MDRI investigators learned of a practice called “unmodifi ed ECT”—the use of electroconvulsive therapy without any form of anaesthesia or muscle relaxants— a practice that is both painful and dangerous [5,6].