AN+ARM+AND+A+LEG,+FOR+WHAT?+–+A+discussion+and+analysis+of+the+challenges+facing+diverse+nations+with+regards+to+mental+health+and+its+attached+issues+of+human+rights

Lidia Rance 08290091 Tutor: Emily Mann



Image retrieved from; [] The Hindu News, Mogadishu, May 20, 2011. The following caption accompanies the image and is taken directly from the online news website.

//“In this photo, chained mentally ill patients sit within Ahlu Khayr mental health centre in Mogaidshu, Somalia. Somalia may be the worst place on earth to have a mental illness. A 20-year civil war has increased mental illness numbers and simultaneously destroyed any health care infrastructure.” //

=Artefact =

This picture depicts Somali mentally ill civilians shackled and tied to a boulder rock. The image clearly shows up to nine patients, tied in a small area, with nothing other than the hard concrete to sit or lie on at a clinic for the mentally ill. Their expressionless and grave faces depict their despair, confusion, and unhappiness with the conditions in which they find themselves. The image also depicts the men with torn and dirty clothes hanging off their lean bodies, possibly suggesting having muscle atrophy, from general physical inactivity, or their inability to use necessary muscles. In this region of Africa, the nation has been locked in anarchy and war for two decades, and as a result many families have been touched by tragedy. The civil war has destroyed health care infrastructure, and with many bullets fired around the region, more civilians are being subjected to violence resulting in traumatisation, and growth of the mentally ill. As a result, Somalis have been confined in mental wards for as long as eight years, according to the World Health Organisation (WHO) (2001).


 * Public Health Issue **

How well does Australia deal with mental health in 2011? One simply has to observe the above artefact to distinguish the highlighted differences and contrasts between developing and developed countries with mental health standards. The mental health crisis is at the forefront of evidence based practice and current governement campaigns, polices, and agendas. Nations are not all developed equally, while some have expanded in areas of funding, policies, offering health care and support, implementing change, acceptance, and human rights, others lack such growth. Maintaining human rights for the mentally ill is a vital part of any mental health aim both in Australia and internationally, thus such differences and distinctions between Australia and other nations, with reference to advocating human rights, will be explored.

=**Literature Review **=

According to the WHO (2006), humans with mental disorders are exposed to a wide range of human rights violations. The WHO writes that violations often occur in psychiatric institutions through inadequate, violent, and degrading care and treatment as well as unhygienic and inhumane living conditions. WHO further goes on to explain, people all over the world, outside institutional context, are experiencing limitation in the exercise of their civil liberties, and in the fields of education, employment, and housing, due to the stigma and misconceptions associated with mental disorders. This stigma and discrimination can, in turn, impact on a person’s ability to gain access to appropriate care, integrate into society, and recover from illness (WHO, 2006).

Gostin (2001) writes that human rights law is a powerful, but often neglected, tool in advancing the rights and freedoms of persons with mental disabilities. International law may seem marginal or unimportant in developed countries with democratic and constitutional systems of their own. Gostin goes on to reason that even democracies often resist reform of mental health law and policy, and domestic courts do not always compel changes necessary for the rights and welfare of persons with mental disabilities. Gostin states, that additionally, human rights are obviously important for countries without democratic and constitutional systems because they may provide the only genuine safeguard against abuse of persons with mental disabilities ostensibly based on political, social, or cultural justifications.

Furthermore Gostin (2001) states that human rights law is important in the context of mental health, globally protecting the rights and freedoms of those affected. Human rights are the only source of law that legitimises international scrutiny of mental health policies and practices, within a sovereign country, as well as a democratic one. Human rights norms extend to the exercise of a wide array of civil rights both within and outside of institutions. Simply because a person has a mental disability, or is subject to confinement, does not mean they are incapable of exercising rights of citizenship. According to Goston, persons with mental disabilities are entitled to civil rights, including privacy and confidentiality, freedom of communication, access to information, and no enforced labour.

There is, and has been a history of, human rights violations of persons with mental disorders across the globe. Today, the most disturbing examples are found in developing countries. The health systems in low and middle <span class="ilad" style="color: #191a1c; font-family: 'Times New Roman',serif; font-size: 12pt;">income <span style="color: #191a1c; font-family: 'Times New Roman',serif; font-size: 12pt;">countries are hugely under-funded often resulting in enormous neglect and abuse of the human rights of people with mental illness according to Professor Harry Minas, Director of Melbourne’s University’s Centre for International Mental Health (as cited in Mohit, 2009). Mohit also mentions, in low-income countries such as Indonesia, the practice of restraining mentally ill people in shackles, or stokes, is still carried out. According to Minas, 80 to 90 percent of schizophrenia patients in low-income countries receive little or no treatment. In agreement, Patel, Saraceno, and Kleinman (2006), state that, in Asia, patients living in mentally ill hospitals are typically, long-term residents, who lose contact with their families, rarely see mental health professionals, are offered few rehabilitative therapies, and are kept in crowded wards with no thread of dignity. Patel, Saraceno, and Kleinman further mention the Erwadi tragedy in India in 2001, where, as a result of mentally ill persons being chained to their beds, they were burnt to death as a fire swept through the healing temple. Such tragedy only serves a reminder of the human rights abuses of the mentally ill, that still takes place today.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Roberts (2002) comments on the shocking state of the medical, legal, and social-care practice in mental health services in Central and Eastern Europe and how such neglect from national governments has served their countries. Roberts observes, in social care homes, that the lack of community based care, in these regions, means that beds in such institutions are still in demand, despite their frequently harsh living conditions and the severe restrictions they typically impose on residents’ liberty. A study undertaken by the Mental Health Interest Forum in Budapest, surveying 52 social care homes in Hungary in 2001, found that all homes restricted residents’ freedom of movement, despite having no legal authority to detain a person against their will (Roberts, 2002).

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">According to Goldberg (2000) there are two major limitations to the application of mental health delivery models in the context of developing countries, which may already be evolved in the developed world, the first administrative, the second cultural. Goldberg writes that in most developing countries, a low national priority has been accorded to mental health, in particular. The budget allocations for health are low, and only a fraction for mental health services provision. Goldberg mentions there are limited institutional and organisational support networks for such services and mental health planning and legislation are often ignored. It is also noted by Goldberg, that countries such as Kenya, the Philippines, and Papua New Guinea, have less than one per million psychiatrists in their countries contrasted to 50-200 per million in developed countries, thus highlighting a lack of trained professionals to deliver a model of service.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Additionally, Goldberg (2000) emphasises the choice that mental health delivery models use to embody assumptions, concepts, and methods evolved in a cultural setting, and that such are profoundly different from ones in developing countries. This is particularly noted in the separation of the functions of the mind into thought and feelings, and considering health and disease as separate entities. Furthermore, little efforts are made to enhance the communities’ awareness about the role of behavioural and psychosocial factors in health and disease in the developing world (Goldberg, 2000). Hence the developing countries have been out of tune with their sociocultural ethos, leaving the majority of the population un-serviced, with no advance in health goals.

<span style="color: #191a1c; font-family: 'Times New Roman',serif; font-size: 12pt;">In 2001, the WHO devoted both its annual health day and its annual health report to mental health, which called on countries to develop mental health policies. In the same year, the Institute of Medicine, in America, launched a scientific report on neurological, psychiatric, and developmental disorders in low-income countries. At national level, various governments, professional bodies, and the media have played important roles in prioritising mental health in their countries. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Reid (2004) states that Australia has ratified all international human rights law instruments in which the right to health is enshrined, and so is obliged to ensure that its foreign policy, including its development assistance program, contributes towards the progressive realisation of the right to health for the mentally ill.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">In Australia, mental health-related services are provided in a variety of ways—from hospitalisation and other residential care, hospital-based outpatient services and community mental health care services, through to consultations with both specialists and general practitioners (AIHW, 2010). The Australian Government assists in this service provision by subsidising consultations, other medical and certain allied health services, and prescribed medications through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme (AIHW, 2010). State and Territory governments also provide funding, it was revealed by The National Mental Health Report that government spending on mental health in Australia increased by 137%, equivalent to $2.97 billion, since 1993 (Mental Health & Wellbeing, 2011).

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">According to Smith and Williams (2008) Australia has committed to improving the mental health of Australians through the National Mental Health Strategy and the Council of Australian Governments’ (COAG) National Action Plan on Mental Health. These two major initiatives set the broad agenda for mental health service provision in Australia. The <span style="color: #050d24; font-family: 'Times New Roman',serif; font-size: 12pt;">Fourth National Mental Health Plan: an agenda for collaborative government action in mental health 2009-2014 has five <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">priority areas for government action in mental health:
 * 1) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> Social inclusion and recovery
 * 2) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> Prevention and early intervention
 * 3) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> Service access, coordination and continuity of care
 * 4) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> Quality improvement and innovation and
 * 5) <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> Accountability - measuring and reporting progress

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australia has established the //Australian Human Rights Commission// (2006) that promotes and protects human rights in a number of ways. For example, the Commission reviews and monitors legislation, conducts public inquiries, investigates and conciliates complaints, provides policy advice and delivers human rights education to promote greater understanding of human rights issues in Australia. The //Australian Human Rights Commission// conducted a national inquiry on the human rights of people with a mental illness, was reported in 1993, and recently has had consultations in conjunction with the Mental Health Council of Australia and the Brain and Mind Research Institute.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australia is at the forefront of government campaigns, agendas, funding, and the making and implementation of policies when compared to lesser counterparts. Mental health standards are similar to other developed countries. We argue that moral arguments are just as important as evidence to make the case for mental health intervention and the integrated issues of human rights. A measure of any society is how it treats its most vulnerable, and Australia’s continued improvement to the human rights of the mentally ill is more than some.

=**<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Cultural and Social Analysis **=

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">In order for Australia and other nations to move forward and develop and widen their approach to establishing and maintaining effectual human rights for the mentally ill, one must comprehend the cultural and social attitudes that influence people, countries, nations, when presented with the mentally ill and all its associated concerns.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The significance of raising public awareness cannot be understated. An important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioural disorders (WHO, 2001). Tackling stigma and discrimination requires a multilevel approach involving education of health professionals, the closing down of psychiatric institutions, the provision of mental health services in the community, and the implementation of legislation to protect the rights of the mentally ill (WHO, 2001). Fighting stigma also requires public information campaigns to educate and inform the community about the nature, extent and impact of mental disorders in order to dispel common myths and encourage more positive attitudes (WHO, 2001).

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The integration of mental health care into general health services, particularly at the primary health care level, has many advantages, including less stigmatization of patients and staff, improved screening and treatment, and the potential for improved treatment of the physical problems of those suffering from mental illness.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The role of the mass media can be influential in mental health. Various forms of the mass media can be used to foster more positive community attitudes and behaviours towards people with mental disorders. The media can also be used to inform the public, to persuade or motivate individual attitude and behaviour change, and to advocate for change in social, structural and economic factors that influence mental and behavioural disorders (WHO, 2001). Advertising is useful for increasing awareness of issues and for neutralizing misperceptions. Examples of public information campaigns which have been used by the media to overcome stigma include; “Changing minds – every family in the land”, by the Royal College of Psychiatrists in the UK and the World Psychiatric Association’s campaign “Open the doors” (WHO, 2001). Australian mental health campaigns include; Beyondblue, Mindmatters, and Queensland’s Be Kind to Your Mind (Australian Government Department of Health and Ageing, 2010).

<span style="background-color: white; font-family: 'Times New Roman',serif; font-size: 12pt;">Put simply, our mental health system, and those adopted by other countries, must move from delivering pills to delivering practical support and care built around fundamental needs such as employment, housing, and respecting human rights. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> The problem as it stands is that clinical intervention comes first and the support and care required to help mentally ill people participate fully in our community comes a distant second. We must be attentive to the needs of vulnerable populations and continuously evaluate our services. Understanding society and culture are crucial when trying to understand and redress this population health issue. What will reduce such inequity? We already have the evidence we need to make the case for international mental health, it is the moral argument that we now need to make.

=**<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Artefact Analysis and Reflection **=

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The presented artefact above, represents to me personally, that as sad and tragic as the reality of mental ill health is, in any society, what is even more regrettable is that any one, individual or governmental body, needs to be reminded of its presence and that it is essential that it is acknowledged and addressed in order that it is dealt with compassionately, appropriately and effectively.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Perhaps it is still necessary that even in this modern, seemingly enlightened age, many societies still need to be brave enough to examine themselves and admit that not only can mental ill health occur but that it is present and inevitable. A fact of life, a human condition.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Admitting to a problem, surely, is the first step in solving it. Hiding mental health problems, and hiding away those who are suffering it, will not only not solve any of the associating problems attached to it, it will, in the long run, exacerbate the problem and put a stain on a society’s image.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Yes, the cost of doing this may indeed seem like ‘an arm and a leg’ but not doing anything will most assuredly be even more costly. How is chaining up the arms and legs of the mentally ill beneficial to them? Complacency and inactivity will cost us the sanity and self respect of our whole society, because historians are not kind to any society that has a poor record of treatment of its citizens, especially its weakest.

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">As for my learning experience, I feel this assessment piece has allowed me to gain a deep understanding into the mental health crisis around the world, and that such extreme and diverse differences do exist outside of Australia. While we might have a higher standard of care for the mentally ill, other nations are still behind on reforming and consequently acts such as those in the artefact still exist. I am now able to distinguish between my own personal experience and identifying the critical details of an issue without falling into presumption.

**<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Reference List ** <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Government Department of Health and Ageing. (2010). //Better access to mental health care.// Retrieved October 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Human Rights Commission. (2006). //Human rights and mental illness.// Retrieved November 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Australian Institute of Health and Welfare. (2010, August 12). //Mental health services in Australia 2007-08. Mental health series no. 12.// Retrieved October 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Goldberg, D. (2000). Development in mental health services--a world view. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">International Review of Psychiatry,12 //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">(3), 240-240-248. Retrieved from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt; text-decoration: none;">@http://search.proquest.com/docview/213373915?accountid=13380

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Gostin, L. O. (2001). Beyond moral claims: A human rights approach in mental health. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Cambridge Quarterly of Healthcare Ethics, 10 //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">(3), 264-264-74. Retrieved from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt; text-decoration: none;">@http://search.proquest.com/docview/201451165?accountid=13380

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Mental Health & Wellbeing. (2011). //Policies.// Retrieved October 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Mohit, J. (2009, July 2). //Now, an international observatory to improve global mental health.// Retrieved November 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Patel, V., Saraceno, B., & Kleinman, A. (2006). Beyond evidence: The moral case for international mental health. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The American Journal of Psychiatry,163 //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">(8), 1312-1312-5. Retrieved from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt; text-decoration: none;">@http://search.proquest.com/docview/220504045?accountid=13380

Reid, E. A. (2004). Health, human rights and Australia’s foreign policies.Medical Journal of Australia, 180(4), 163-163-5. Retrieved from http://search.proquest.com/docview/235743364?accountid=13380

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Roberts, H. (2002). Mental health care still poor in eastern europe. //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The Lancet, 360 //<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">(9332), 552-552. Retrieved from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt; text-decoration: none;">@http://search.proquest.com/docview/199010531?accountid=13380

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Smith, G., & Williams, T. (2008, September 18). //Policy in action, 15 years of mental health reform in Australia.// Retrieved October 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">The Hindu. (2011, May 20). //Kept in chains, mental illness rampant in Somalia.// Retrieved November 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">World Health Organisation. (2001). //The World Health Report 2001. Mental health: new understanding, new hope.// Retrieved October 1, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">World Health Organisation. (2006). //WHO mental health and human rights project.// Retrieved October 28, 2011, from <span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">[]

=<span style="color: windowtext; font-family: 'Times New Roman',serif; font-size: 12pt;">Discussion on; = 'You are not a beautiful and unique snowflake, you are the same decaying organic matter as everyone else' Gen Y's craving for individuality and consumerism

Hi Airle, Well done on an excellent Wiki - I found it very informative. Firstly, what got my attention was the title out of all the others in the thread. It made me want to read and find out more. Very creative and bold with humor. As too, is your artefact. What an odd advertisement! To be honest, I hadn't really thought of connecting Gen Y with mental illness until I read your Wiki. It's no doubt Gen Y certainly are different from previous generations. The extent that we're now displaying rises in mental health in Gen Y highlights such a relevant public health issue. I guess when you've got professional bodies, retail businesses, advertisements etc..all targeting individuality in their quest to reach specific audiences, groups or ages, Gen Y are going to keep striving for such 'uniqueness' and consequently get swept up in consumerism and health issues, while remaining unaware to such impact. Durkhiem’s theory of suicide applies very well here. Thanks for the read.

'Each time you sleep with someone, you’re also sleeping with his past'

This surely was an interesting, and at times a little confronting read. Your artefact is very powerful and provocative. With HIV such a serious and potentially life diminishing/threatening disease, the importance of this growing public health issue could not be understated. I very much agree with your comments on the media and perhaps their part in the growing number of Gen Y engaging in unsafe sexual practices by displaying many sexual themes in a variety of media outlets. The high statistical figures of STD's are quite alarming. I pose the question, however, with such a rise in 'younger generations' unsafe sex practices and the resulting consequences, are our schools and education facilities compensating with increased sexual education, are they diminishing, or simply remaining as they were?