The theme of World Mental Health Day 2023 has been assigned by the World Health Organization (WHO): mental health is a universal human right. I could not agree more. But what does this mean? What is the impact of that statement? There’s more controversy there than you might think. The idea that mental health is a universal human right means one thing to the WHO, but it means something a little more to me.
Mental health is a universal human right according to the World Health Organization
The WHO writes a few paragraphs about mental health as a universal human right (look here). Here is an excerpt:
“Mental health is a basic human right for all people. Everyone, whoever they are and wherever they are, has the right to the highest possible level of mental health. This includes the right to be protected from mental health risks, the right to available, accessible, acceptable and good quality care, and the right to freedom, independence and inclusion in the community.”
That all sounds pretty good. Things get a little more complicated around this statement:
“Having a mental health condition should never be a reason to deprive a person of their human rights or exclude them from decisions about their own health.
. . .
“WHO continues to work with partners to ensure that mental health is valued, promoted and protected, and that urgent action is taken so that everyone can exercise their human rights and access the quality mental health care they need.”
Of course, this is true and positive, but what they say is based on a broad assumption. They assume that people with mental illness can fully understand and appreciate their illness and seek help.
Unfortunately, this is a mistaken assumption when it comes to serious mental illness.
The universal human right to mental health for those who lack knowledge
Many people with serious mental illnesses have a clinical lack of awareness of their own mental illness. In other words, they don’t understand that they have a mental illness. They even go so far as to deny it, often regardless of what you say. This is known as anosognosia. Anosognosia is a neurological condition and is not the same as denial.
According information on the National Institute of Health website:
- Between 50 and 90% of people with schizophrenia have anosognosia.
- 40% of people with bipolar disorder have anosognosia.
And while it is widely known that people with diseases like Alzheimer’s disease have anosognosia (about 81%, in fact), few people understand its effect on people with bipolar disorder and schizophrenia.
So if a person with a mental illness has a universal human right to mental health but refuses to seek treatment because they don’t understand or believe they have an illness, what does that mean?
The effect that serious mental illness has on people
The problem with people with anosognosia is that their lives tend to be destroyed, and they often end up dying due to their mental illness or as a consequence of problems caused by their mental illness. Additionally, people with serious mental illnesses (particularly those with comorbid substance abuse) often hurt others along the way. (No, this is not talking about stigma).
For example, in a systematic review 2021It was found that of the homeless:
- 76.2% had a mental illness.
- 36.7% had an alcohol use disorder (10 times more than in the general population)
- 21.7% had a drug use disorder (almost 10 times more than in the general population)
- 12.4% suffered from a schizophrenia spectrum disorder (18 times more than in the general population)
- 12.6% suffered from major depression.
- 4.1% had a bipolar spectrum disorder.
Of course, many people suffer from more than one mental illness at the same time.
Regarding violence, a A study by Richard A. Van Dorn, PhD, of RTI International, and colleagues found that:
- 2.9% of people with a serious mental illness had committed a violent act, compared to 0.8% of people without a mental illness in the same period.
- 10% of people with serious mental illness and a substance use disorder committed a violent act in that same period.
Note that there are some confounding factors noted in the above:
- Many of the same factors that drive violence in a person without a mental illness to commit a violent act also drive those with a mental illness; it’s just that those factors are more likely to occur in people with serious mental illness.
- People with serious mental illnesses are much more likely to suffer victims of violence than the general population.
- The vast majority of people with serious mental illnesses No commit violent acts.
- People with serious mental illness who receive effective treatment are no more dangerous than individuals in the general population (look here).
Does the universal human right to mental health replace dying with rights?
So, here’s the question. What do you do when a person with a serious mental illness has anosognosia? If you know the person won’t seek treatment because you don’t understand his or her own mental health, do you treat him or her against his or her will and hope that the treatment will free him or her of anosognosia? What happens if it doesn’t? Do you still treat them anyway?
There are two schools of thought on the matter, and both question what a “universal human right” really is.
On the one hand, the person with a mental illness can be treated independently. You can put them in a treatment center and treat them with psychotropic drugs even if they say they don’t want them. You can inject them with an antipsychotic no matter how much they howl. At worst, that’s what it seems like.
On the other hand, many people would say that is inhumane. How can a person be forced to take medication against their will? How can you lock up a person who has possibly done nothing wrong? This goes against a person’s “universal human right” to live freely.
This conundrum leads to this feeling: If we don’t treat people, are we simply letting them die with their rights?
Because that happens. You have the death of the person, the death of his lifestyle, or both. When you see a person taking their next meal out of a trash can while talking to a being you cannot see, that person has lost everything and may end up losing their life to mental illness. Do we really not treat a person in that situation?
If we hold that mental health is a universal human right, aren’t we realizing a person’s rights by forcing them to receive treatment? Furthermore, doesn’t it benefit us all to reduce violence in the population and allow for more productive members of society?
However, if we maintain that freedom is the substitute right, then what we must do is let them die; nothing else matters.
Clearly, there are no good answers here. And the sad thing is that most people refuse to even seriously think about this problem. But we need to do it because one thing I know people deserve is consideration, one way or another.
If mental health is a universal human right, what do we do?
So, it’s easy to say that mental health is a universal human right. It’s much harder to know what to do about it.
It should come as no surprise that I move much closer to the extreme of non-consensual treatment. I believe that there is no health and, in fact, there is no life without mental health, and this is demonstrated by everyday examples from real life. You can’t tell me that a person trapped in paranoid delusions and hallucinations, without a home and without even food, has a life. They do not.
What’s more, no one would even consider allowing that to happen to a person with a disease like Alzheimer’s. No one would think that treating her grandmother for Alzheimer’s disease (even if she didn’t understand it) would be wrong. You would give him pills and not feel bad about it. And when she became so sick that she could no longer be cared for by her family, she would be admitted to a center that, again, would force her to receive treatment for any ailment she later had, whether she understood it or not. And no one in that situation would be demonized.
But people with mental illnesses don’t have that same luxury. People with mental illness are allowed to languish in their own shit because that is their “right.”
But I do not think so. I believe that mental health is not only a universal human right but a universal human requirement. I think society is in the business of providing a safety net for when people fall, and that also means when they lose their sanity. We give people the opportunity to have a better life. We give opportunities to people. But without mental health, no opportunity will matter. No chance will matter. You simply will not have life. Period.
As a quick addendum, I recognize the complexity of this topic, but this is at least one perspective from which to begin helping others have the life and fulfillment they deserve.
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