The World Health Organization has released new guidance that aims to put an end to abuse of people in psychiatric care by embracing community-based mental healthcare.
Around the world, most mental health care continues to be provided in psychiatric hospitals, and human rights abuses and coercive practices remain widespread. But providing community-based mental health care that is both respectful of human rights and focused on recovery is proving successful and cost-effective, according to new guidance released today by the World Health Organization.
The Life Esidimeni tragedy highlights the importance of providing adequate care to mental health patients. Mental health care recommended in the new guidance should be located in the community, and which also supports day-to-day living, such as facilitating access to accommodation and links with education and employment services.
WHO’s new “Guidance on community mental health services: promoting person-centred and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach, as recommended by the WHO Comprehensive Mental Health Action Plan 2020-2030 endorsed by the World Health Assembly in May 2021.
Faster transition needed
“This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions, to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support,” said Dr Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance.
A growing number of countries are seeking to reform their laws, policies and services related to mental health care since the adoption of the Convention on the Rights of Persons with Disabilities (CRPD) in 2006, But few countries have so far set down the necessary frameworks to meet the far-reaching changes required by international human rights standards. Severe human rights abuses and coercive practices are still far too common in countries of all income levels. Examples of these include forced admission and forced treatment; manual, physical and chemical restraint; unsanitary living conditions; and physical and verbal abuse.
Governments spend less than 2% of their health budgets on mental health, according to WHO’s latest estimates and most mental health expenditure is allocated to psychiatric hospitals, save for high-income countries where the figure is around 43%.
The new guidance, mainly aimed at people responsible for organising and managing mental health care, presents details of what is required in areas such as mental health law, policy and strategy, service delivery, financing, workforce development and civil society participation for mental health services to achieve compliance with the CRPD.
It includes examples from countries which have community-based mental health services that have shown good practices in respect of non-coercive practices, community inclusion, and respect of people’s legal capacity (ie the right to make decisions about their treatment and life).
The required services include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches and support provided by peer groups. Information about financing and results of evaluations of the services presented are included. The report include cost comparisons which show that the featured community-based services produce good outcomes, are preferred by service users and cost about the same as standard mental care services.
“Transformation of mental health service provision must, however, be accompanied by significant changes in the social sector,” said Gerard Quinn, UN Special Rapporteur on the Rights of Persons with Disabilities. “Until that happens, the discrimination that prevents people with mental health conditions from leading full and productive lives will continue.”
Source:Â The World Health Organization
