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With Pandemic, Mental Health Services Even More Critical

At Summit, Governments Should Commit to Scale Up Community Services

Oluwasegun, a 29-year-old man sits chained at Oke Oloro clinic in Ibadan City, Oyo State, Nigeria where prayer and herbal medicine are used for his mental health condition. Before being taken to the clinic by his mother, he was a shoemaker. © 2019 Robin Hammond for Human Rights Watch

(Paris) – Governments and donors should take concrete steps to develop rights-respecting and community-based mental health services, Human Rights Watch said today in a letter to governments in advance of the third Global Mental Health Summit. The summit will take place on October 5 and 6, 2021, in Paris.

“The global pandemic has had an enormous toll on people’s mental health,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “Governments should make mental health a priority; not just in their rhetoric but in their actions.”

The summit, which is hosted by the French Ministers for Solidarity and Health and for Europe and Foreign Affairs, will gather policymakers, international organizations, health professionals, experts, and civil society actors. Participants will discuss how to enhance mental health services during and after the Covid-19 pandemic and to promote innovative practices for human rights in mental health, under this year’s theme ‘Mind Our Rights, Now!’

Government and donor investments should take a holistic approach to community-based services, with investments in housing, education, employment, and psychosocial support based on the free and informed consent of the person concerned, Human Rights Watch said.

Community health workers talking to local residents as part of the government outreach efforts on mental health in Banjarsari village in Ciawi, Bogor. © 2018 Andrea Star Reese for Human Rights Watch

Governments have long neglected to invest in mental health services. On average, countries spend less than 2 percent of their health budgets on mental health. In low-income countries, government mental health spending decreases to less than 1 percent of health budgets. These countries spend less than US $1 annually per person on mental health, compared with $80 in high-income countries.

The Covid-19 pandemic has affected people’s mental health and the consequences are likely to linger on for years. National surveys have shown that numbers of people reporting symptoms of anxiety and depression have increased since the start of the pandemic. At the same time, the pandemic has disrupted mental health services in 93 percent of countries around the world, according to a survey by the World Health Organization (WHO).

More than 40 percent of countries had a full or partial closure of community-based services. In addition, three-quarters of mental health services in schools and workplaces were disrupted, on top of about 60 percent of all therapy and counselling services.

The cost of neglecting mental health is significant. Studies have estimated that poor mental health accounted for $2.5 trillion of the global economic burden in 2010, projected to rise to $6 trillion by 2030. The WHO has found that spending $1 on mental health services can yield a return of $4 in the form of improved productivity and health.

The greatest concern is that in low- and middle-income countries, 80 percent of government spending on mental health goes to psychiatric hospitals and not for community-based services. Human Rights Watch research in over 25 countries around the world found that people with mental health conditions in psychiatric hospitals can face a range of abuses including arbitrary detention, forced treatment, including electroshock therapy, and forced seclusion as well as physical and sexual violence.

In many countries, prevalent stigma and the lack of community-based mental health services can lead to people with mental health conditions being shackled: chained or locked in confined spaces. Human Rights Watch found that hundreds of thousands of men, women, and children, some as young as 10, have been shackled across 60 countries in Asia, Africa, the Americas, Europe, and the Middle East.

TANDEMplus worker Richard Boland talking to Zaher Amiri in Amiri’s apartment. Amiri is an asylum seeker who struggles with depression. Brussels, Belgium. © 2019 Stephanie Hancock for Human Rights Watch

“Governments need to approach mental health holistically at the community level,” Barriga said. “When people can’t access these supports, they risk abuse and isolation. There are innovative initiatives at the local level, such as TANDEMPlus in Brussels or peer support groups in Kenya and Nigeria, which empower people with psychosocial disabilities to live independently in their homes and keep them out of the hospital. Programs such as these – with human rights at the core – need to be scaled up.”

For guidance, governments should draw on the WHO’s QualityRights Initiative and their Guidance on Community Mental Health Services which provides clear and practical direction on how to create a rights-respecting approach to mental health. One of the initiative’s core principles is that people should be able to maintain control over their lives. For example, innovative peer-to-peer initiatives run by Users and Survivors of Psychiatry Kenya and She Writes Woman in Nigeria are a testament to how it is possible to ensure that people with psychosocial disabilities receive support in their communities, rather than forcing them to spend time in a hospital or to take medication against their will.

“Rights-respecting, community-based services were already under-resourced prior to Covid-19,” Barriga said. “It is fundamental for governments to act quickly to develop community-based mental health services to help prevent shackling and other abuses, and support people with psychosocial disabilities to live independent lives.”


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