CAGED+WITHIN+BODY+AND+MIND+–+An+observation+and+discussion+of+the+contrasting+challenges+faced+by+each+nation+in+tackling+mental+health+and+its+associated+issues

Mark Ogden n5078504 Tutor - Emily Mann T15

//INDIA, MURHU: Mr. Praveen (35), sleeps in a cage 24 April 2005, in a cage in which he has been kept by his father for the past year in Murhu, near Ranchi in the eastern region of Jharkhand, due to his mental instability. Even though mental illnesses are common and cause great problems in every part of the world, many care and health workers have a limited understanding about mental health and are less comfortable dealing with mental illness. More often than not, people with mental illness are misunderstood, shunned and isolated by their communities. AFP PHOTO/str//
 * This image is retrieved from www.globalmentalhealth.org and the caption as follows is taken directly from this website and applied to this wikispace file.**

As mentioned above - in the caption taken from the source - this image depicts a grown man suffering from a mental illness, being caged from society. The image clearly shows the cage to be small, close to the size of a walk in wardrobe in any modern Australian home. It also shows the man to be uncomfortable (obviously), lying on leaves, and only clothed with rags, which also appear to be very unsanitary. Since the man's face is blurred by the photographer, it is difficult to tell the appearance of his face, however he shows signs of muscle atrophy in his legs which would be attributed most likely to the physical boundaries of movement. The man inside does not even have the touch of the earth to comfort him, instead being suspended on steel bars inches from the ground, possibly to prevent him digging out from the inside.

In answering the question “How well does Australia deal with mental health in 2011?”, it is possible to use the image above as a representation of the imbalances and contrast between developing and developed nations mental health standards, together with the lack - or presence - of understanding, knowledge, funding, support and social integration within communities. Within the broader topic of Australia’s mental health care, is the concern for human rights for mental illness sufferers. This is the issue I will be discussing, and more specifically how Australia contrasts with other nations in its support for human rights.

Research within the last 10 years indicates a commonly accepted need for action on this issue, as demonstrated by the more recent //global mental health movement//. The underlying cause of the main issue is discussed from different perspectives within the papers hereafter mentioned. Not all authors agree on the best way forward in this public health issue, and not all authors refer to the same regions of the world, however some common themes continued to surface. These included the need for grassroots reform, rather than more broad legislation, and changes in mental health stigma which will allow social integration rather than isolation.

Gadit (2008) writes that ill treatment of mentally ill persons, in terms of human rights, is essentially a global phenomenon. Gadit reports cases of discrimination, violence, abuse, rape, harassment and torture from studies conducted in the UK, Turkey, Australia and Pakistan. Gadit also reasons that the social stigma attached to mental illness leads to discrimination and unfair treatment. Furthermore Gadit goes on to say that social judgment is often a barrier for social inclusion of the mentally ill. Gadit poses the question, are we doing enough to protect the mentally ill? Ray (2003) discussed the concern in India that the mentally ill have no protection from antagonism because of a lack of social assistance, education, employment and protection of rights. Ignorance, disdain and fear are the general attitudes towards mentally ill persons in India, Ray writes. Lunacy is often the final conclusion supported in society towards those who suffer from mental illness due to the absence of proper understanding of mental health. Ray predicts no change in the foreseeable future in the mental health human rights arena because of a lack of ‘awareness-raising’ by the government or social activists.

In Ethiopia, there are 11 psychiatrists to the population of 55 million (Alem, 2000). It is believed that mental afflictions are cause by evil spirits. Often these ill people are restrained with chains or rope and treated against their will with traditional healing methods. Alem (2000) goes on to discuss the fact that in Africa, where morbidity and mortality due to disease and hunger is very common, mental health is not seen as a life threatening problem. As a result, Alem reflects that mental health is often unworthy of attention and is neglected. In Africa it seems, giving priority to one problem is always at the expense of another. Research in Malaysia demonstrates the problem of human rights for mentally ill persons does not equate the same for both men and women. Crabtree (2004) investigated a psychiatric hospital in Malaysia and through qualitative analysis with patients and staff reported extreme gender-based separation and discrimination. Locking of wards permanently for vulnerable female patients and enforced immobilization was noted, along with obvious sexual harassment and dominating treatment of female patients. It was suggested that stereotyping leading to unequal treatment is problematic in this hospital and is a violation of human rights.

Butcher (2000) discussed a different perspective on human rights for the mentally ill. He proposed that a human rights legislative approach is fundamentally flawed, and that we need to ask different questions if we want to obtain different responses (and results). For example, we can ask “How can we effectively care for the mentally ill?” rather than the traditional approach “How can we protect their rights?”. Butcher says this on the basis that this traditional kind of thinking leads us to forget the personal reality of mental illness and innate responsibility we must uphold, and that by considering ourselves to be //normal// and granting the mentally ill the ‘privilege’ of human rights we will come to the conclusion that we have done all we can, even if it does not increase their quality of life.

Gauthier (2009) emphasizes that grassroots training, together with ethical support and guidance for mental health workers must be promoted, and based upon a balance of the conditions outlined in the //Universal Declaration of Human Rights// (1948) and the //Ethical Principles for Psychologists// (2008). In a letter to the Indian Journal of Medical Research, Agoramoorthy (2011) makes a similar recommendation, in that the government of India needs to raise funding, reform policy and produce grassroots changes and awareness to see any real outcomes. It was also reported in this letter several cases of human rights violation prevalent in his country. In 2009 for example, Agoramoorthy writes that 60 children suffering mental illnesses were buried up to their necks in mud during a solar eclipse, in the expectation of a spiritual healing and belief of a cure, when indeed all that resulted was a torturous ordeal for the children. In 2001, it was also included that the deaths of 28 people with mental illness in an asylum in Erwady village were the result of their legs being chained to stone pillars while a fire ravaged the building and they were burnt to death.

Maingay et al (2002) discussed the importance of the //Mental Illness (MI) Principles of the United Nations//, and the practical use of this legislation. They reported the fact that human rights violations represented a size-able problem in the mental healthcare system. This paper stated -

“Rhetoric rather than evidence and action still dominates mental health and human rights issues.”

Tarantola (2007) describes a three-way basis for the current situation for indigenous communities mental health care and human rights. The first aspect of his theory was stress, specifically the stress experienced by all populations as a result of health and human rights as part of the public health situation more broadly. Secondly is the difficulty in breaking away from the traditional health approaches, and aiming for a more integrated holistic approach, as is consistent with indigenous beliefs. Thirdly is the inequality of enjoying human rights among all indigenous people. A longitudinal study conducted by Read et al. (2009) in Ghana, Africa, describes the need for change at a local level. This paper gives several clear examples of human rights issues for the mentally ill. It describes the traditional ‘faith’ healing despite mistreatment, and mechanical restraint, beating and with-holding of food in order to punish the mentally ill, as they are classed as “spoiled” humans – morally corrupt/evil. The Christian pastors and traditional healers believe they are providing a great service to these families, and furthermore, the families are allowing their loved ones to be mistreated as they believe it is in their best interests.

An examination of the //Indonesian Constitution// and //National Human Rights Commission// by Irmansyah et al. (2009) found that despite the unsatisfactory standard of mental health care from a human rights perspective in Indonesia, there had been recent amendments to the constitution, and a formal commitment to the UN Human Rights Council in 2006, suggesting a positive step forward in this nation. The paper describes the practice of //pa sung// in Indonesia, where mentally ill persons are chained and confined in small rooms, and how there is an effort being made to stamp out this practice.

A major recommendation from the //Australian Senate Committee Report on Mental Health// (2006) was to provide constant funding to the //Human Rights and Equal Opportunity Commission// (HREOC) which would serve the following purposes :-
 * monitor human rights abuses and discrimination in employment, education and service provision of those with mental disability,
 * liaise with state and federal ombudsmen to identify trends and systemic failures that give rise to complaints, and
 * investigate discrimination against people with mental illness in //Supported Accommodation Assistance Program// (SAAP), respite and private and public rental housing

Australian mental health care standards are comparable to other developed nations, however what can not be disregarded is the probable fact that human rights violations exist in various regions of the nation that go unseen. Australia is however at the forefront of policy implementation and funding when it comes to mental health care and its associated human rights issues. The //National Mental Health Report// reveals that between 1993 and 2008 government spending on mental health in Australia increased by 137%, equivalent to $2.97 billion. Through worldwide, top –down planning together with grassroots funding and learning, an overall trend to continue to improve the human rights conditions of all mentally ill people is likely.

In order to develop more comprehensive and effective protection of the human rights of the mentally ill not just in Australia, but over the world, we must first understand the underlying cultural and societal attitudes and influences respective to each nation, and to each individual, when faced with mental illness. Below is a visual representation of the major factors that I have concluded to result in the current abuses of human rights for the mentally ill. As can be seen, each factor remains linked to the major issue while still presenting its own significant challenges. Developments in this public health issue are therefore complicated, as it is difficult to consider all these factors equally.



Social Stigma relates to the attitude of society and assumptions that people have about a certain issue or personal behavior in this case. For example in developed countries dealing with mentally ill and human rights, this may be assumptions of abnormality, unpredictability, lunacy, or that they can’t be helped. In developing countries however it may be assumptions of evilness, curses, bad luck, bad behavior or being “spoiled”. Abuses not known, refers to the fact that abuses of human rights can be simply unheard of or kept quiet. In developed countries for example these abuses may be committed by people who are power hungry, abusive, sexual predators, frustrated, angry or impatient. In developing countries they may be more simply reckless guards, unspoken, hidden, secretive, having a lack of social awareness, and a lack of political and authoritative figures.

Patients attitudes and mental comprehension is another important factor. This relates to feelings of helplessness, having no rights in psychiatric wards, being worthless, scared, isolated, unable to express themselves or even being unable to help themselves. This is perhaps one of the more pertinent factors, because it becomes very easy to take advantage of someone who is unable to seek help or even aware of their rights. An apparent lack of immediate repercussions also contributes to the abuses of human rights for mentally ill patients. This stems from possible attitudes such as “leave it up to the government, What can I do?, that doesn’t happen in my country, we can help by donating money.” Or even attitudes more consistent with developing countries such as wider, more important communal problems, no legal danger for offenders, no social judgment for offenders.

Legislation features importantly in this issue. It is critical for every nation to establish raw principles regarding human rights for the mentally ill, in accordance with broader worldwide documents including those presented by the UN. If the proper policies and directives are not in place, then it is difficult to obtain funding and also really achieve structured measurable improvements. The media portrayal and exposure of human rights abuses for the mentally ill will contribute greatly to worldwide discussion by all peoples, not just mental health workers or government officials. This will allow a greater understanding of why and where these abuses happen, and will encourage a greater network of response and support.

Passionate activists are necessary to bring about change especially in regions where government involvement is low or non-existent. The //global mental health movement// has been significant to producing worldwide changes and better outcomes for mentally ill people suffering from human rights abuses. Lastly, globalization is clearly a significant factor in understanding how this issue can be resolved or improved, through a broader knowledge of cultural differences, and why and how different societies treat their mentally ill, may those in developed nations be able to provide better assistance for change.

While researching this issue I found myself consistently asking the question, Why? Why do these abuses happen to people who have not intentionally caused wrong doings, if at all? Why do people let abuses happen? Why do people of some regions of the world lack the compassion for a human spirit when the mind does not function as most others do? Why do people punish mental illness sufferers but not physically ill? Could the answer to such a question as “Why abuse the rights of someone who can’t help themselves, or even control their own lives?” be so simple and unjust as “Because I can”?

Is it simply a matter of fact that whenever someone is in a position to be taken advantage of, human nature dictates that they will be taken advantage of for whatever psychological reasons, be they control, domination, or anger issues? Obviously some cultures are so isolated and undeveloped from the rest of the world that they hold on to traditional beliefs about the unexplained, which often leads to cruel and nonsensical behavior and treatment of the mentally ill. However why does human compassion not over-ride these beliefs? Is it innate evolutionary behavior which leads those without mental illness to feel compelled to subdue and dominate those who have mental illness in order to benefit the species? We must ask ourselves such questions.

The “artefact” that is presented above was chosen for its powerful, shocking and symbolic effect. It represents cruelty, a lack of understanding, isolation and frustration. It is a good case in point of the human rights abuses of mentally ill people around the world as it is a very extreme case, and conveys a message of significance. It shows that a lack of support, compassion, social structure or funding can lead to this kind of mistreatment. Personally this particular image evokes a powerful emotional response. I feel it difficult to absorb issues like this when I know that they go unseen all over the world. I find it to be symbolic of both the physical //and// mental isolation endured by those suffering with mental illness, and the mistreatment that some mental illness sufferers receive. This assessment piece has had three clear benefits to my learning. Firstly, it has exposed me to the importance of learning about world issues that don’t affect me directly, in day to day life. Secondly, I feel it has reminded me that opinion is relative to perspective and personal experiences, and that we can not make assumptions unless we have all the information to reason with. Thirdly and finally I have improved my ability to extract the //critical// details of an issue, rather than get mired in the surface information.

References

Agoramoorthy, G. (2011). Correspondence. Are women with mental illness and the mentally challenged adequately protected in India? //Indian Journal of Medical Research//, 133, 552- 554. Alem, A. (2000). Human rights and psychiatric care in Africa with particular reference to the Ethiopian situation. //Acta Psychiatrica Scandinavica//, 101, 93- 96. Butcher, A. P. (2000). The relative irrelevance of human rights for the care and protection of the mentally ill. //Australian Journal of Political Science//, 35(1), 85- 97. Crabtree, S. A. (2004). Strategies of social and sexual control of Malaysian women in psychiatric institutional care. //Health Care for Women International//, 25, 581- 595. Gadit, A. A. M. (2008). Abuse of mentally ill patients: are we ignoring the human rights principle? //Journal of the Pakistan Medical Association//, 58 (9), 523- 524. Gauthier, J. (2009). Ethical principles and human rights: building a better world globally. //Counselling Psychology Quarterly//, 22(1), 25- 32. Irmansyah, I., Prasetyo, Y. A. and Minas, H. (2009). Human rights of person with mental illness in Indonesia: more than legislation is needed//. International Journal of Mental Health Systems,// 3, doi:10.1186/1752-4458-3-14. Maingay, S., Thorncroft, G., Huxley, P., Jenkins, R. and Szmukler, G. (2002). Mental health and human rights: the MI Principles – turning rhetoric into action. //International Review of Psychiatry//, 14, 19- 25. Ray, R. (2003). Of human bondage: glimpses into the human rights situation of the mentally ill in West Bengal. //Indian Journal of Medical Ethics//, 11(1), ¶1. Read, U. M., Adiibokah, E. and Nyame, S. (2009). Local suffering and the global discourse of mental health and human rights: An ethnographic study of responses to mental illness in rural Ghana. //Globalisation and Health//, 5, doi:10.1186/1744-8603-5-13. Tarantola, D. (2007). The interface of mental health and human rights in Indigenous peoples: triple jeopardy and triple opportunity. //Australian Psychiatry//, 15, 10- 17.

//** Reflections on the works of other students **//

"Where to from now? The future of women's sport" =Well done= I enjoyed reading this wiki. This topic is obviously very well discussed - with good reason- within the media and general public, however you have raised a couple of interesting points I had not previously considered. Firstly, the fact that Steph Rice was portrayed as a 'sexy' athlete was interesting, as it made me think about how many decisions are made by the athlete themselves, and how much is dictated by their agent. Of course everyone is in control of their own choices, however if Steph Rice was pushed into modelling, and magazines, and dating Quade Cooper, (by her agent) it makes for an interesting sub-story. Another interesting point you made is the strategy of boosting participation in order to boost spectatorship in the future. This is sound logic and I believe that generally speaking most supporters have played, or know someone who play the sport that they enjoy. When it comes to equality of monetary gains across genders, my personal opinion is that pay can only be equal if the gender's are competing against each-other. If there are two competitions, there are two different standards of play, and this determines the differences in prizemoney. Just as the Wimbledon Mens tournament has X-value prizemoney, so too will the Brisbane International have a different X-value of prizemoney. Understandably you raise this point in order to generate discussion and you have done it well. Nice job Stephen. ||
 * [[image:http://c1.wikicdn.com/i/user_none_lg.jpg width="48" height="48" caption="mdogden" link="http://www.wikispaces.com/user/view/mdogden"]] || [|mdogden] Saturday, 12:56 pm
 * [[image:http://c1.wikicdn.com/i/user_none_lg.jpg width="48" height="48" caption="mdogden" link="http://www.wikispaces.com/user/view/mdogden"]] || [|mdogden] Saturday, 12:56 pm

"An island of misery, in an ocean of happiness? - Gen Y's mental health." =Well done= I was drawn to read this wiki from the Chuck Pal quote. Have you happened to have read many of his books? He's an interesting author with an especially quirky attitude towards society (and materialism) I think! For me a few main points were significant - The fact that anxiety disorders are so prevalent in Gen Y is interesting, and perhaps related to the fact that as you mentioned there is less emotional stability in this generation? I also found it notable that as you put it, there are no secrets in our society/culture, and that freedom of expression (and information) I think has caused many problems (legal circuses, over-exposure to adult interests and sexualisation of children). Personally I think much of this individualism and materialism (and anxiety) stems from the over-growing population, in that people feel pressured to differentiate themselves further from others. Nice job. ||
 * [[image:http://c1.wikicdn.com/i/user_none_lg.jpg width="48" height="48" caption="mdogden" link="http://www.wikispaces.com/user/view/mdogden"]] || [|mdogden] Saturday, 12:15 pm
 * [[image:http://c1.wikicdn.com/i/user_none_lg.jpg width="48" height="48" caption="mdogden" link="http://www.wikispaces.com/user/view/mdogden"]] || [|mdogden] Saturday, 12:15 pm