18 March 2014

Psychiatry, medication and human rights

‘The Global Movement for Mental Health could make a bridge between the public health and disability rights worlds. Aligning themselves with disability rights means rethinking views such as “I can cure mental illness therefore it is not a disability.”’ In the second of a three-part series I discuss how community living with supports has become a human right that should reshape the public mental health landscape.

The series is based on a chapter I wrote in ‘Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture’s 2013 Thematic Report’. You can read my chapter here, from page 247.

Rejecting the old view

Professor Vikram Patel is one of the leading figures of the Global Movement for Mental Health. He is playing a hugely important role advocating care – including pharmacology – and also psychological and social interventions. He talks about the need to respect autonomy and dignity, about efforts to reduce social exclusion and discrimination, and about addressing situational factors impacting on mental health like poverty and war.

Patel takes the view that the models used in the north and west – large numbers of psychiatrists, ample psychiatric beds, second generation medication, psychological treatments and so on, “have no chance of addressing the huge treatment gaps in [low and middle-income countries].”[1] He rejects the view that mental health professionals can solve the global mental health treatment gap. Instead, he suggests turning attention instead to tapping into the inherent resources of existing communities.

Vikram PatelVikram Patel

Supported community living as a human right

This approach is closely aligned to human rights principles. Community living with supports is no longer a favourable policy development but an internationally-recognised right in Article 19 of the UN Convention on the Rights of Persons with Disabilities. The provision sets out the right to choose where and with whom to live, to access a range of community support services, and to access community services and facilities for the general population, all with a view to prevent all forms of segregation or isolation.

The right is broader than decentralisation of mental health services. Medical practitioners should engage with the independent living movement to learn about the nature of this right to live in the community, what it means for their patients, and what role they have in implementing the right. Psychiatrists can then contribute back so that people with disabilities can benefit from their wisdom and insight.


The Movement as a bridge between old and new

In other words, the Movement could make a bridge between the public health and disability rights worlds. Aligning themselves with disability rights means rethinking views such as “I can cure mental illness therefore it is not a disability” or “disabilities are long-term and therefore short-term mental illnesses are not disabilities” (all views which I have heard many medical people say). These views are increasingly desperate attempts to stop their patients having the benefits of rights given to people with disabilities – rights which are indeed intended to rebalance psychiatric power and influence.

The Movement defines the word community narrowly to mean “the patient and their families, and lay health workers linked to primary health care facilities.”[2] Social psychologists Cathy Cambell and Rochell Burgess at the London School of Economics have pointed out how the Movement focuses on human vulnerability rather than resilience with the everyday challenges of life. They and others suggest that instead of quantitative symptom checklists that currently dominate research and practice, people would be better served by participatory research and interventions focused on understanding how people cope, and how their wider communities might best be supported to facilitate their coping.


Psychiatry and community supports

A focus on communities is gaining ground within psychiatry too. Recently in the British Journal of Psychiatry, social psychiatrists Stefan Priebe, Tom Burns, and Tom Craig have noted the lack of any useful research advances or treatment modalities within the last 30 years.

Observing that “community care has been established, with services that work in the community, but rarely with the community,” they call for a “social paradigm” of mental health that “requires research to study what happens between people rather than what is wrong with an individual wholly detached from a social context.”[3]

These social capital models snuggle up close to a paradigm grounded in human rights principles. Developing meanings of community, finding out how we can tap into it, discovering how its supportive potential can be unleashed so as to give effect to human rights standards: these are important tasks for further interdisciplinary scholarship.


[1] Vikram Patel, Global Mental Health: From Science to Action, 20(1) Harv. Rev. Psychiatry 6-12 (2012).

[2] Catherine Campbell & Rochelle Burgess, The Role of Communities in Advancing the Goals of the Movement for Global Mental Health, 49(3-4) Transcultural Psychiatry 379, 379-395 (2012).

[3] Stefan Priebe, Tom Burns & Tom Craig, The future of academic psychiatry may be social, 202 The Brit. J. of Psychiatry 1-2 (2013).