Dignity in mental health care

Dignity as a human right

Dignity as a universal right is woven into international treaties, including the Universal Declaration of Human Rights.

The notion of dignity is at the heart of the Convention on Rights of People with Disabilities (CRPD), which was adopted by the UN General Assembly in 2006. Its stated purpose is to protect the rights and dignity of people with disabilities, including those with mental disabilities, and as of July 2023 it has 164 signatories.

In 2021, the World Health Organization’s (WHO) Comprehensive Mental Health Action Plan 2013-2030 was updated to set out clear actions for Member States and partners to, “promote mental health and well-being for all, to prevent mental health conditions for those at-risk, and to achieve universal coverage for mental health services ^[1].” The overall ambition for the plan is to enable people with mental health disorders to get access to high-quality healthcare to promote their recovery and be fully participatory members of society without being stigmatized or discriminated against because of their mental health.

While the understanding of dignity as a fundamental human right has shaped such frameworks for healthcare around the world, there are still many challenges when it comes to implementation.

Why dignity in mental health care is important

Dignity in mental health care is fundamentally important to an individual’s human rights, in that, a lack of dignity can infringe on a person’s rights. For example, being involuntarily detained in a treatment facility denies one’s right to liberty.

Dignity in mental health care is also important at a societal level. Globally, people with mental health disorders are marginalized and mistreated, furthering the social stigma around mental health disorders, impacting the self-worth of the individual, and impeding their recovery.

As an example, one study of people with depression from 35 different countries, found that discrimination related to their depression acted as a barrier to their social participation and integration. Some of the 1000 plus participants of the survey had stopped themselves from initiating a close personal relationship, others had stopped themselves from applying for work, and others from applying for education or training ^[2].

Embedding dignity into mental health care can free individuals from social stigma and low self-esteem, and instead of becoming socially isolated, enable them to become fully accepted members of society.

Issues affecting dignity in mental health care and how patients are affected

Some of the issues within mental health care that can affect a patient’s dignity include:

• Unnecessarily long stays or institutionalization in mental health care facilities - On average, 80% of mental hospital inpatients are discharged within one year. But in some areas of the world, more than 20% stay longer than five years ^[3]. Being institutionalized can negatively affect an individual’s self-esteem andcreates a negative perception of these individuals by society.
• Involuntary placement in mental health facilities - Holding somebody in a mental health facility against their will can infringe on their right to liberty and right to exercise legal capacity.
• Involuntary treatment - Being involuntarily treated for a mental health condition, through means including forced medication, restraint, or solitary confinement, can be traumatizing, and affect an individual’s self-worth.
• Lack of accessibility to good-quality mental health care - Most people affected by mental, neurological,and substance use disorders do not have access to the healthcare that they need. In many low-income countries, the percentage of people who have insufficient access to mental health care is as high as 75% ^[4]. Limited access to mental health facilities can lead to socioeconomic marginalization and poor health outcomes, which furthers inequality.
• Lack of mental health workers - Globally, on average, there is less than one mental health worker per 10,000 people. In low-incomecountries, this rate falls to below one per 100,000 people, and in high-income countries the rate is one per 2000 people ^[3]. Lack of mental health workers equates to a drop in quantity and quality of mental health services.
• Poor quality of facility buildings - Large, mixed sex dormitories, or facilities that are otherwise unfit for purpose can provide unsafe, or undignified settings for some residents, impeding their recovery.

What dignity in mental health care looks like

For dignity in mental health care to be achieved, healthcare providers must ensure that they provide the same quality of care to those with mental health conditions, as to those without.

Promoting dignity and respect across all their mental health care policies and practices, and by providing sufficient mental health care training to healthcare workers - which addresses the rights to dignity and autonomy of those with mental health conditions - are also positive steps that healthcare providers can take to safeguard mental health patients.

There are also frameworks that healthcare services can adopt to promote dignity within mental healthcare. In 2012, WHO launched its QualityRights project which aims to “change mindsets and practices… and empower all stakeholders to promote rights and recovery in order to improve the lives of people with psychosocial, intellectual, or cognitive disabilities everywhere ^[5].” The toolkit includes sets of standards that can be used to measure the quality of care being offered in mental health care facilities and ensure that dignity and human rights are being upheld.

Other indicators that dignity in mental health care is being upheld include:

• Individuals are taken seriously when they articulate the need for mental health support, and their wishes are respected by healthcare workers, including decisions around their treatment.
• Individuals and their support networks can pursue mental health care without a fear of social stigma.
• Long-term stays in mental health facilities are swapped for care in community-based settings.
• Patients feel safe in healthcare facility buildings.