Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability

Health and Human Rights

Volumn 11, Issue 2, 2009, Pages 19-31

  Burns, Jonathan Kenneth ^a  

^a UNIVERSITY OF KWAZULU NATAL   (South Africa)

Author keywords

[No Author keywords available]

Indexed keywords

ADVOCACY; CRITICAL ANALYSIS; DISABILITY; HEALTH CARE; HEALTH WORKER; HUMAN RIGHTS; INTEGRATED APPROACH; MENTAL HEALTH;

ARTICLE; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE DISPARITY; HEALTH DISPARITY; HUMAN; HUMAN RIGHTS; MENTAL PATIENT; ORGANIZATION AND MANAGEMENT; PERSONHOOD; PREVALENCE; SOCIAL JUSTICE; SOCIAL PSYCHOLOGY; SOCIOECONOMICS; SOCIOLOGY; MEDICAL SOCIOLOGY; PREJUDICE;

HEALTH SERVICES ACCESSIBILITY; HEALTH STATUS DISPARITIES; HEALTHCARE DISPARITIES; HUMAN RIGHTS; HUMANS; MENTALLY DISABLED PERSONS; PERSONHOOD; PREJUDICE; PREVALENCE; SOCIAL JUSTICE; SOCIOECONOMIC FACTORS; SOCIOLOGY, MEDICAL;

EID: 77951670249     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (89)

1. For an excellent summary of the Act and its implications, see Harvard Medical School, "Benefiting from mental health parity," Harvard Mental Health Letter (January 2009). Available at http://www.health.harvard.edu.
2. For an overview of the historical background of this legislation, see C. L. Barry, "The political evolution of mental health parity," Harvard Review of Psychiatry 14 (2006), pp. 185-194.
3. With respect to mental health, substance abuse conditions include a spectrum ranging from problematic abuse of alcohol and drugs to addiction to so-called "dual diagnosis" conditions (co-incidental substance abuse and mental disability where each compounds the negative impact of the other.)
4. Harvard Medical School (see note 1).
5. See S. Day and G. Brodsky, "Women's equality: The normative commitment," in S. Day and G. Brodsky (eds), Women and the equality deficit: The impact of restructuring Canada's social programs (Ottawa: Status of Women Canada, 1998), pp.43-78. Available at http://dsp-psd.pwgsc.gc.ca/Collection/SW21-32-1998E-1.pdf.
6. See Factum of the intervenor, Canadian Council of Disabilities, Part III (Point 6.) Available at http://www.ccdonline.ca/en/humanrights/promoting/andrews.
7. For example, mental health is notably absent from the Millennium Development Goals (MDGs). For a critique, see J. J. Miranda and V. Patel, "Achieving the millennium development goals: Does mental health play a role?" PLoS Medicine 2/10 (2005), pp. 962-965. Miranda and Patel have pointed out that even though mental disability impacts, both directly and indirectly, many areas of social and economic life, mental health is completely absent from the MDGs. They provide evidence linking mental health directly to three of the MDGs - the eradication of extreme poverty and hunger, the reduction of child mortality, and the improvement of maternal health. However, if one considers the numerous effects of mental disability on social and economic development at the individual and community levels, then it is apparent that combating mental disabilities and reducing the morbidity associated with mental disabilities must contribute to the realization of almost all of the MDGs. The omission of mental health from the MDG agenda is a good example of the inequality and discrimination that exists within the health and development discourse itself.
8. The UN Enable website was established to report all aspects of the treaty and contains information on the guiding principles, entry into force, signatories, and monitoring of the Convention, as well as full-text versions of the Convention and its Optional Protocol in a number of languages. Available at http://www.un.org/disabilities/default.asp?id=150.
9. The UN Enable website was established to report all aspects of the treaty and contains information on the guiding principles, entry into force, signatories, and monitoring of the Convention, as well as full-text versions of the Convention and its Optional Protocol in a number of languages. Available at http://www.un.org/disabilities/default.asp?id=150.
10. From the United Nations Convention on the Rights of Persons with Disabilities, Article 1, (2006), p. 4. Available at http://www.un.org/disabilities/default.asp?navid=12&pid=150 (see note 7).
11. Note: the use of the term "burden" here requires clarification. The term is not used in the sense of individuals being "burdensome" or a cause of hardship for others. The term is used to describe the added social and economic responsibilities and costs associated with either living with a mental disability or being in a care-giving role in relation to a person with a mental disability.
12. For a review of co-morbid mental disability and physical illness, see M. Prince, V. Patel, S. Saxena, et al., "No health without mental health," Lancet 370 (2007), pp. 859-877. For discussion of co-morbid mental disability and substance abuse, with particular emphasis on developing LMICs
13. see R. Srinivasa Murthy, "Psychiatric comorbidity presents special challenges in developing countries," World Psychiatry 3/1 (2004), pp. 28-30.
14. For a discussion of socioeconomic factors such as poverty and inequality and their effects on mental health, especially in LMICs, see V. Patel and A. Kleinman, "Poverty and common mental disorders in developing countries," Bulletin of the World Health Organization 81/8 (2003), pp. 609-615.
15. The 2001 World Health Report was dedicated to mental health, documenting many of the inequalities that exist. For more information, see World Health Organization, World health report 2001. Mental health: New understanding, new hope (Geneva: WHO, 2001).
16. The World Health Organization and the World Organization of Family Doctors co-sponsored an investigation into the progress made in integrating mental health into primary health care. For the full report, see World Health Organization and World Organization of Family Doctors, Integrating mental health into primary care: A global perspective (Geneva: WHO, 2008).
17. The September 2007 volume of The Lancet contained a series of six papers documenting the current evidence related to global mental health, with a focus on LMICs. The second paper focused on resource scarcities and inequities. See S. Saxena, G. Thornicroft, M. Knapp, and H. Whiteford, "Resources for mental health: Scarcity, inequity, and inefficiency," Lancet 370 (2007), pp. 878-889.
18. See M. Bury, "Defining and researching disability: Challenges and responses," in C. Barnes and G. Mercer (eds), Exploring the divide: Illness and disability (Leeds: The Disability Press, 1996), pp. 17-38.
19. Also see World Health Organization, The international classification of impairments, activities and participation (ICDH-2) (Geneva: WHO, 1980) for the prevailing medical model of disability.
20. See M. Oliver, Understanding disability: From theory to practice (Basingstoke: Palgrave, 1996), p. 32. According to Oliver, the social model "does not deny the problem of disability but locates it squarely within society." Disability is "the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have... impairments and thus excludes them from participation in the mainstream of social activities."
21. See M. Bury, "On chronic illness and disability," in C. E. Bird, P. Conrad, and A. M. Fremont (eds), Handbook of medical sociology (5th edition) (New Jersey, PA: Prentice Hall, 2000), p. 179. Bury understands disability to be both biologically and socially caused - this giving rise to a conceptualization of disability that focuses on the interactions between individuals and their social location. For a discussion of sociological approaches to disability
22. C. Thomas, "How is disability understood? An examination of sociological approaches," Disability and Society 19/6 (2004), pp. 569-583.
23. For critiques of the social model of disability, see L. Terzi, "The social model of disability: A philosophical critique," Journal of Applied Philosophy 21/2 (2004), pp. 141-157.
24. See also C. Thomas, "Disability theory: Key ideas, issues and thinkers," in C. Barnes, M. Oliver, and L. Barton (eds), Disability studies today (Cambridge, UK: Polity Press, 2002), p. 48.
25. Lorella Terzi, whose work in educational philosophy focuses on disability and capability issues, quotes disability author Carol Thomas's challenge of the materialist framework that underpins the social model of disability, arguing that the "materialist prioritization of the economic roots of disability" excludes other important dimensions of disability, such as the role of culture and cultural processes in shaping disabled persons' position in society. Terzi also questions the validity of the "break-up of the causal link between impairment and disability, and the consequent causality established between society and disability."
26. Terzi (see note 18).
27. For good reviews of the literature on geneenvironment interactions during neurodevelopment and in relation to the causation of mental disabilities, see J. Van Os and P. Sham, "Gene-environment correlation and interaction in schizophrenia," in R. M. Murray, P. B. Jones, E. Susser, et al. (eds), The epidemiology of schizophrenia (Cambridge, UK: Cambridge University Press, 2003.)
28. Also see A. Caspi and T. E. Moffitt, "Gene-environment interactions in psychiatry: Joining forces with neuroscience," Nature Reviews Neuroscience 7/7 (2006), pp. 583-590, as well as
29. R. K. Lenroot and J. N. Giedd, "The changing impact of genes and environment on brain development during childhood and adolescence: Initial findings from a neuroimaging study of pediatric twins," Developmental Psychopathology 20/4 (2008), pp. 1161-1175.
30. For systematic reviews of the prevalence and incidence of schizophrenia, see E. M. Goldner, L. Hsu, P. Waraich, et al., "Prevalence and incidence studies of schizophrenic disorders: A systematic review of the literature," Canadian Journal of Psychiatry 47 (2002), pp. 833-843
31. S. Saha, D. Chant, J. Welham, et al., "A systematic review of the prevalence of schizophrenia," PLoS Medicine 2 (2005), p. e141.
32. For a discussion on the relationship between schizophrenia and urbanicity, see L. Krabbendam and J. van Os, "Schizophrenia and urbanicity: A major environmental influence - conditional on genetic risk," Schizophrenia Research 31 (2005), pp. 795-799.
33. For evidence relating to schizophrenia and social class, see B. Cooper, "Schizophrenia, social class and immigrant status: The epidemiological evidence," Epidemiologia e Psichiatria Sociale 14 (2005), pp. 137-144
34. G. Harrison, D. Gunnell, C. Glazebrook, et al., "Association between schizophrenia and social inequality at birth: A case-control study," British Journal of Psychiatry 179 (2001), pp. 346-350.
35. For a meta-analysis and review of migration as a risk factor for schizophrenia, see E. Cantor-Graae and J. P. Selten, "Schizophrenia and migration: A meta-analysis and review," American Journal of Psychiatry 162 (2005), pp. 12-24.
36. For a comprehensive review of the literature on schizophrenia and employment, see S. Marwaha and S. Johnson, "Schizophrenia and employment," Social Psychiatry and Psychiatric Epidemiology 39 (2004), pp. 337-349.
37. For evidence on homelessness, see S. L. George, N. J. Shanks, and L. Westlake, "Census of single homeless people in Sheffield," British Medical Journal 302 (1991), pp. 1387-1389.
38. For a study linking income inequality to incidence of psychosis, see J. K. Burns and T. Esterhuizen, "Poverty, inequality and the treated incidence of first-episode psychosis: An ecological study from South Africa," Social Psychiatry and Psychiatric Epidemiology 43 (2008), pp. 331-335.
39. For example, see S. Wicks, A. Hjern, D. Gunnell, et al., "Social adversity in childhood and the risk of developing psychosis: A national cohort study," American Journal of Psychiatry 162 (2005), pp. 1652-1657.
40. Paul Farmer introduced the term "structural violence" to public health literature in relation to infectious diseases (in particular) and their relationship to social, political, and economic forces; see P. Farmer, Pathologies of power: Health, human rights and the new war on the poor (Berkeley, CA: University of California Press, Berkeley, 2005), pp. 40-50
41. Brendan Kelly applied the concept of "structural violence" to schizophrenia; see B. D. Kelly, "Structural violence and schizophrenia," Social Science and Medicine 61 (2005), pp. 721-730.
42. Kelly (see note 23).
43. For reviews and evidence on the prevalence of mental disabilities in relation to social class, unemployment, low income, homelessness, poverty, and income inequality, see A. B. Ludermir and G. Lewis, "Links between social class and common mental disorders in Northeast Brazil," Social Psychiatry and Psychiatric Epidemiology 36/3 (2001), pp. 101-107
44. T. Fryers, D. Melzer, and R. Jenkins, "Social inequalities and the common mental disorders: A systematic review of the evidence," Social Psychiatry and Psychiatric Epidemiology 38/5 (2003), pp. 229-237
45. S. Weich and G. Lewis, "Material standard of living, social class, and the prevalence of common mental disorders in Great Britain," Journal of Epidemiology and Community Health 52/1 (1998), pp. 8-14
46. S. Fazel, V. Khosla, H. Doll, et al., "The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis," PLoS Medicine 5/12 (2008), p. e225
47. S. Weich, G. Lewis, and S. P. Jenkins, "Income inequality and the prevalence of common mental disorders in Britain," British Journal of Psychiatry 179 (2001), pp. 222-227
48. R. S. Kahn, P. H. Wise, B. P. Kennedy, et al., "State income inequality, household income, and maternal mental and physical health: Cross sectional national survey," British Medical Journal 321 (2000), pp. 1311-1315; and Patel and Kleinman (see note 12).
49. See I. Kawachi, S. V. Subramanian, and N. Almeida-Filho, "A glossary for health inequalities," Journal of Epidemiology and Community Health 56 (2002), pp. 647-652.
50. See J. Sareen, A. Jaqdeo, B. J. Cox, et al., "Perceived barriers to mental health service utilization in the United States, Ontario and the Netherlands," Psychiatric Services 58/3 (2007), pp. 357-364.
51. See P. W. Newacheck, Y. Y. Hung, M. J. Park, et al., "Disparities in adolescent health and health care: Does socioeconomic status matter?" Health Services Research 38/5 (2003), pp. 1229-1233.
52. See, for example, R. Kohn, S. Saxena, I. Levav, et al., "The treatment gap in mental health care," Bulletin of the World Health Organization 82/11 (2004), pp. 858-866.
53. See J. Bonander, R. Kohn, B. Arana, et al., "An anthropological and epidemiological overview of mental health in Belize," Transcultural Psychiatry 37 (2000), pp. 57-72.
54. The World Health Organization Mental Health Survey was conducted by a consortium from many countries throughout the world, yielding much valuable data. See WHO World Mental Health Survey Consortium, "Prevalence, severity, and unmet need for treatment of mental disorders in World Health Organization World Mental Health Surveys," Journal of the American Medical Association 291/21 (2004), pp. 2581-2590.
55. For evidence on racial and ethnic discrimination in mental health care, see M. Alegría, P. Chatterji, K. Wells, et al., "Disparity in depression treatment among racial and ethnic minority populations in the United States," Psychiatric Services 59/11 (2008), pp. 1264-1272
56. D. Rosen, R. M. Tolman, L. A. Warner, et al., "Racial differences in mental health service utilization among low-income women," Social Work and Public Health 23/2-3 (2007), pp. 89-105.
57. D. Rosen, R. M. Tolman, L. A. Warner, et al., "Racial differences in mental health service utilization among low-income women," Social Work and Public Health 23/2-3 (2007), pp. 89-105.
58. See, for example, R. A. Van Dorn, J. W. Swanson, M. S. Swartz, et al., "The effects of race and criminal justice involvement on access to atypical antipsychotic medications among persons with schizophrenia," Mental Health Services Research 7/2 (2005), pp. 123-134.
59. For an Irish study showing unequal access to mental health services for women of low socioeconomic status, see G. Luddy, "Women, disadvantage and health," Irish Medical Journal 100/8 (2007), pp. 71-73.
60. For evidence that women are disadvantaged in accessing alcohol treatment services, see C. Weisner and L. Schmidt, "Gender disparities in treatment for alcohol problems," Journal of the American Medical Association 268/14 (1992), pp. 1872-1876.
61. For an excellent discussion of gender issues underlying the borderline personality disorder diagnosis, see N. Nehls, "Borderline personality disorder: Gender stereotypes, stigma, and limited system of care," Issues in Mental Health Nursing 19/2 (1998), pp. 97-112.
62. See G. Thornicroft, "Stigma and discrimination limit access to mental health care," Epidemiologia e Psichiatria Sociale 17/1 (2008), pp. 1-9.
63. For a review of stigma experienced within the health services by people with mental disability, see D. Lawrence and R. Coghlan, "Health inequalities and the health needs of people with mental illness," NSW Public Health Bulletin 13/7 (2002), pp. 155-158.
64. See, for example, D. L. Mkize, "Human rights abuses at a psychiatric hospital in KwaZulu-Natal," South African Journal of Psychiatry 13/4 (2007), pp. 137-142
65. Mental Disability Rights International and Center for Legal and Social Studies, Ruined lives: Segregation from society in Argentina's psychiatric asylums (Washington, DC: Mental Disability Rights International, 2007). Available at http://www.mdri.org/PDFs/reports/MDRI.ARG.ENG.NEW.pdf.
66. For discussion of differential care of co-morbid physical illness in those with mental disabilities within HICs, see A. Bahm and C. Forchuk, "Interlocking oppressions: The effect of a comorbid physical disability on perceived stigma and discrimination among mental health consumers in Canada," Health and Social Care in the Community 17/1 (2009), pp. 63-70
67. M. M. Desai, R. A. Rosenheck, B. G. Druss, et al., "Mental disorders and quality of diabetes care in the veterans health administration," American Journal of Psychiatry 159/9 (2002), pp. 1584-1590.
68. For similar discussion and evidence from LMICs, see A. Cohen, V. Patel, R. Thara, et al., "Questioning an axiom: Better prognosis for schizophrenia in the developing world?" Schizophrenia Bulletin 34/2 (2008), pp. 229-244.
69. See World Health Organization, Mental health fact sheet (2009). Available at http://www.who.int/mental_health/en/index.html
70. A. A. Shah and R. H. Beinecke, "Global mental health needs, services, barriers and challenges," International Journal of Mental Health 38/1 (2009), pp. 14-29.
71. For an excellent interactive database on the WHO website containing a range of data on mental health systems in over 100 countries, see World Health Organization, Atlas: Country profiles on mental health resources (2005). Available at http://www.who.int/mental_health/ evidence/atlas/.
72. Shah and Bienecke (see note 41).
73. World Health Organization (2005, see note 41). 44. Shah and Bienecke (see note 41).
74. For a review, see G. Thornicroft and M. Tansella, "Components of a modern mental health service: A pragmatic balance of community and hospital care. Overview of systematic evidence," British Journal of Psychiatry 185/4 (2004), pp. 283-290.
75. Mkize (see note 39); and Mental Disability Rights International and Center for Legal and Social Studies (see note 39).
76. See A. E. Yamin and E. Rosenthal, "Out of the shadows: Using human rights approaches to secure dignity and well-being for people with mental disabilities," PLoS Medicine 2/4 (2005), pp. 296-298.
77. UN Enable (see note 7).
78. UN Enable (see note 7).
79. See D. Goodley, "Empowerment, self-advocacy and resilience," Journal of Intellectual Disability 9/4 (2005), pp. 333-343.
80. Yamin and Rosenthal (see note 47).
81. For an online version of the South African Mental Health Care Act (2002), see http://www.acts.co.za/mental_health_care_act_2002.htm.
82. See Lancet Global Mental Health Group, "Scale up services for mental disorders: A call for action," Lancet 370/9594 (2007), pp. 1241-1252.
83. UN Enable (see note 7).
84. Harvard Medical School (see note 1). 56. Yamin and Rosenthal (see note 47)
85. Harvard Medical School (see note 1). 56. Yamin and Rosenthal (see note 47)
86. See G. Thornicroft and A. Kassam, "Public attitudes, stigma and discrimination against people with mental illness," in C. Morgan, K. McKenzie, and P. Fearon (eds), Society and psychosis (Cambridge, UK: Cambridge University Press, 2008), pp. 179-197.
87. See G. Thornicroft and A. Kassam, "Public attitudes, stigma and discrimination against people with mental illness," in C. Morgan, K. McKenzie, and P. Fearon (eds), Society and psychosis (Cambridge, UK: Cambridge University Press, 2008), pp. 179-197.
88. For a discussion of policy development within Africa, see O. Gureje and A. Alem, "Mental health policy development in Africa," Bulletin of the World Health Organization 78/4 (2000), pp. 475-482. WHO is actively engaged in projects to promote the development of mental health policy and legislation around the globe (with an emphasis on LMICs.) For an excellent WHO resource, see World Health Organization, WHO resource book on mental health, human rights and legislation (2005). Available at http://www.who.int/mental_health/policy/legislation/essentialpackage2v1/en/index.html. An important platform for promoting the scaling up of mental health services globally is the Movement for Global Mental Health. For a variety of resources, see the MGMH website at http://www.globalmentalhealth. org/articles.php?id=72.
89. For a discussion, see M. Donohoe, "Roles and responsibilities of health care professionals in combating environmental degradation and social injustice: Education and activism," Monash Bioethics Review 27/1-2 (2008), pp. 65-82.