COVID-19 Webinar 10: Mental health & human rights
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health have launched a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Chair: Alberto Vasquez
Panellists:
Akiko Hart, UK National Survivor and Users Network
Shantha Rau Barriga, Human Rights Watch
Innocentia Mgijima, Disability Unit, Centre on Human Rights at University of Pretoria
Dainius Puras, Special Rapporteur on the Right to Health
Alberto Vasquez
Recently UNSG issued a policy brief calling for prioritisation of mental health and psycho-social support in the process of Building Back Better. But what is missing is the discussion on the quality of services, the support needed, and human rights implications, the voices of survivors and those with lived experience.
What is happening in the UK?
Akiko Hart, UK National Survivor and Users Network
We know some people are accessing services but some are not and are being discharged. The increase in digital services works for some but not others – it depends on what it is for – whether it is for an appointment or therapeutic support. In England there has been anger and dismay over the number of COVID-19 deaths among British Asian and Minority Ethnic (BAME) communities. This is a collective trauma: it is systemic racism which is denied by the authorities who fail to address the issue and instead call for more data.
Alberto Vasquez
The UK has recently modified the mental health and mental health capacity legislation. What has been the impact?
Akiko Hart, UK National Survivor and Users Network
The changes have not been switched on in England and Scotland. The changes include sectioning people on the basis of one not two doctors’ recommendations; relaxing rules regulating forced treatment; and increasing time limits for mental health sectioning. These changes were made due to an anticipated shortage of doctors and the likely reconfiguration of the mental health physical facilities available (with less beds). We are not sure these measures will be enacted but they could if there is a rise in admissions. If so, then we would absolutely want to challenge the use of these new measures.
Alberto Vasquez
What is the situation in the African region?
Innocentia Mgijima, University of Pretoria
We don’t know. We are aware of confirmed infections in some institutions but there is no official data from governments which means that they are not monitoring the situation in these institutions. It demonstrates the lack of priority given to data on mental health. African countries like South Africa officially collect infection rates in correctional facilities but not data on mental health institutions. It is possible governments do have the data but are not publicly or proactively making it available to the public. The challenge for the public is to access data. The situation in institutions is deteriorating and the risk of infection is high unless we do something about it.
Alberto Vasquez
What are you doing and what have you found?
Innocentia Mgijima, University of Pretoria
We have a global initiative - the COVID19 Disabilities Rights Monitor - that is collecting data on the impact of COVID-19 and measures governments have put in place to protect the rights of persons with disabilities. We have started sharing preliminary findings.We have received updates from over 1600 people from over 126 countries and 10% of these from African countries. The majority were from persons with disabilities themselves and their family members. We are finding globally that many countries have inadequate infection prevention and control measures particularly regarding institutions and vulnerable groups. They are restricting people from leaving institutions or actively committing new persons e.g. homeless people. Some of human rights concerns are that governments are not providing the clear guidance and support that institutions need to cope with the pandemic. Several responses indicate that governments are not providing clear protocols or regulations, and where provided they are not clear or are constantly changing. This includes in regard to access to services and independent monitoring.
Alberto Vasquez
What is the situation for those that are shackled or locked up in their communities?
Shantha Rau Barriga, Human Rights Watch
Thousands of people are shackled around the world. We have visited traditional healing centres and rehabilitation centres. We found 300 people in one religious centre in Nigeria - lined up from ages 10 to 86 - chained in close proximity in overcrowded facilities with no soap and water and in conditions that were very unhygienic. How can you expect them to protect themselves from COVID-19 in such an environment? Often these people do not get access to health care in normal times. Our partners in Indonesia have started doing COVID-19 testing in the institutions where people are shackled and they have found cases but it is just the tip of the iceberg. Those living in these institutions need to understand what COVID-19 is and have access to the hygiene and health care they need. It is not all bad news. In Ghana there have been a number of great HRW partner organisations who are monitoring the spiritual healing centres and report people are being released in part because of pressure by HRW and its partners to do so and in part because of the threat of COVID-19. But if there aren’t the support and services people need then being released into the community is a very difficult situation. There needs to be more investment in support in community settings for people and respect for the rights of people with disabilities.
Alberto Vasquez
What are the intersectionalities when it comes to mental health and human rights?
Shantha Rau Barriga
First on gender, as people may be forced to stay at home and if they lose jobs this can lead to increases in violence. Women with mental ill health and other disabilities are particularly vulnerable to violence in the home. For example in Mexico there are reports of abuse by caregivers (see HRW report launched last week) such as a woman sent home from her residential school to parents who abuse her. A second intersection is race - especially in the context of prisons where the majority of the population are people with disabilities, many with psychosocial disabilities who are indigenous or racial minorities. In prisons social distancing is almost impossible and lockdown can further aggravate trauma. In Australia, a recent HRW report described how, during lockdown, prisoners with cognitive or psychosocial disabilities are more likely to be bullied, experience sexual violence, and be unable to access mental health services. A lot needs to be done to make sure prison COID-19 outbreaks are minimised and this should include the release of those imprisoned for low level crimes, those with intellectual disabilities, and elderly inmates.
Alberto Vasquez
How can we promote the mental health of the population but at same time avoid the medicalisation of mental health?
Dainius Puras, Special Rapporteur on Right to Health
This pandemic activates questions on all issues including human rights. It raises the question: should we invest in mental health systems that exist or rethink? If we rethink we need to try to understand the normal reactions of people who are anxious or afraid of uncertainty - and should be cautious of people being encouraged to take psychotropics. We have too far with the biomedical model of managing mental health conditions COVID-19 does not so much full mental illness but fuels a wave of over medicalisation and obstacles to change due to the over emphasis of medicalisation. The textbooks still state depression is because of chemical imbalances. COVID-19 should be a good opportunity for mental health and human rights. We need to have some sobering messages to policy makers and professional groups so that they rethink their positions.
Alberto Vasquez
You have a new report to the Human Rights Council on mental health this month. What is the message for policy makers on COVID-19?
Dainius Puras
The report says that mental health is connected to all human rights - to have good mental health we have to invest in enabling and supportive environments and mental health services free of violence and forced measures. This is the human rights based approach and mental health policies should fully embrace a human rights based approach and not selectively emphasise rights but rather ensure everyone is free from violence, ill treatment, and torture. These are the social determinants of mental health. Pandemics can increase risk factors and can reduce risk factors for poor mental health. I have had a very interesting few months working with other human rights professionals to convince policy makers there is no conflict between rights to health and all other rights. The human rights based approach is critical during this pandemic. We can see some hopeful messages from governments; and some understanding we need multilateralism and we should revitalise universal human rights principles.
Alberto Vasquez
There has been a lot of activity in the UK in the user/survivor community - what about peer support?
Akiko Hart
Interestingly so many people are talking about mutual aid and peer support. We have seen a huge amount of this springing up because people are supporting themselves. But these initiatives have been chronically underfunded. And now the new COVID-19 funds are not filtering down to new peer support initiatives. But we can share these initiatives within the UK and internationally - baring the time zones - which is both incredibly exciting and challenging (as all online services are in terms of safety etc). See peer support online example here.
Alberto Vasquez
In 1-2 minutes what would be your top priority for human rights, mental health and COVID-19?
Innocentia Mgijima
It is really important that, in an urgent and measured way, governments monitor the human rights situation in institutions and can provide the necessary support and oversight. They need to send the message that mental health and human rights are a priority to our countries. We need qualitative and quantitative data for us to inform policies and see where gaps in protection are. We need collaboration to collect and use the data to make a more informed policy response.
Alberto Vasquez
Do you get data from people with psychosocial disabilities? Or has this been missing?
Innocentia Mgijima
We have received data including from those in institutions (a small percentage of the total). We need to find accessible ways to get to these groups and make sure they participate in surveys.
Shantha Rau Barriga
Monitoring and peer support. I am hopeful. People have experienced isolation and maybe they have more insight than they did six months ago. People want to know what the rights perspective for mental health services looks like. They cannot conceive how it would work so the priority is to develop and amplify these solutions so people can see how it can be done and scale up these initiatives. We are all clear on problems but don't have a lot of good examples of the solutions.
Dainius Puras
It is important policy makers see how we can respect people's human rights and we need to use this strong wave towards deinstitutionalisation: institutions are harmful and now people see how it is wrong to keep people enclosed. We need to use this moment to press for accelerating deinstitutionalisation.
Alberto Vasquez
I agree with de-institutionalisation as a key priority, but how do we make this case for older people to be de-institutionalised too - particularly people with dementia? Is there an opportunity for older people to also be de-institutionalised?
Dainius Puras
I regret that I didn’t send a clear message always on that point. Yes, older people should be de-institutionalised too: they have the same right to be in the community.
Akiko Hart
Something around the process. If we move from service user involvement to leadership; from disabled people as one set of stakeholders among many to their needs and rights as central; and stop seeing it as individuals with individual experience and instead collective survivor knowledge. If we do these things then we would change the decisions and have different outcomes.
Alberto Vasquez
Thank you all. It is clear we cannot talk about mental health without talking about human rights. The most glaring gap is not the "treatment gap" but the lack of rights-based approaches in mental health systems. And we need to look at how to take this opportunity to rethink mental health provision as community based, user led and free from coercion.The WHO Quality RIghts initiative can help with this.
