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Report: Outdated Mental Health Care System in Need of Reform

  • Lisa Schlein

FILE - An Afghan mental health doctor, center, talks with patients in the Mental Health and Drug Addicts' Hospital in Kabul, Afghanistan, July 17, 2016.

A new report submitted to the United Nations Human Rights Council has called for the urgent retooling of what it calls an outdated mental health care system. The report contends the current system is injurious to mental well-being and violates the human rights of patients.

Dainius Puras is the author of the report and special investigator on the right to physical and mental health. His work found that mental health was grossly neglected within systems around the world and where they exist, “they do so in isolation, segregated from regular health care despite the intimate relationship between physical and mental health.”

He said there is a harmful overreliance on biological factors in the treatment of mental illness to the exclusion of psychological, environmental and social influences.

“Today, there is unequivocal evidence that the…excessive use of psychotropic medicines is a failure,” he said. “Yet, around the world, biomedical interventions dominate mental health investment and services.”

He said people with mild and moderate forms of depression too often are encouraged to use psychotropic medications “despite clear evidence that they should not.”

Worldwide problem

The World Health Organization reports nearly one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Currently, it estimates around 450 million people suffer from such conditions. It notes depression is the leading cause of ill health and disability worldwide, affecting more than 300 million people.

Despite the enormity of the problem, Puras said things have barely changed regarding the treatment of mentally ill people. He said governments worldwide continued to favor institutional care, a system he called outdated and open to human rights abuses.

FILE - Patients are treated in the Mental Health and Drug Addicts' Hospital in Kabul, Afghanistan, July 17, 2016.
FILE - Patients are treated in the Mental Health and Drug Addicts' Hospital in Kabul, Afghanistan, July 17, 2016.

He told VOA that the warehousing of people with mental disabilities in large institutions should stop and be replaced by community-based health care systems.

“The West investment is to invest in institutional care and I am very openly advocating to stop investing in institutional care. It is against human rights and it is the most expensive way of caring for people because it is 24-hour service.”

While community-based services may not be cheap, Puras said they respect the dignity of people with psychosocial, intellectual or other forms of mental disabilities. Unlike institutions, he said community systems do not “breed human rights violations, hopelessness and social exclusion.”

Outdated concepts

He said the entire mental health field has to be liberated from outdated and scientifically unsound concepts that undermine the human rights of people with mental disabilities.

FILE - A doctor checks the health of Deden, a teenager whose father says suffers from mental illness and lives chained to a tree next to a rice paddy near his home in Longkewang village in Serang, Banten province, Indonesia, March 23, 2016.
FILE - A doctor checks the health of Deden, a teenager whose father says suffers from mental illness and lives chained to a tree next to a rice paddy near his home in Longkewang village in Serang, Banten province, Indonesia, March 23, 2016.

For example, he said people who are diagnosed as having mental health conditions may be considered dangerous “and that is why they are often deprived of their liberty.”

He said another outdated, and seriously misused belief is that people who are diagnosed with a mental condition need some form of medical intervention.

“If they do not agree,” he said, “quite often force is used to provide treatment,” which research now shows “is not necessarily effective.”

Parus is a child and adolescent psychiatrist and professor at Vilnius University in Lithuania. He is particularly incensed at the thought that eight million children globally are living in institutional care, even though some of them have one or both parents.

“But, for some reason the State decides that they are better parents. So, instead of empowering parents, we enclose children into institutional care. This is a very bad investment,” he said.

Parus recommends that children without parental care be placed in a family setting instead. He said treating the mentally ill within communities breaks down dangerous and erroneous myths and lessens discrimination against them.

“If you have never seen and do not know a person with a psycho-social disability, your mind will be occupied by all these stigmatizing myths, that they are dangerous, they are hopeless and so on,” he said. "So, this integration of children and adults into society is very helpful. It brings about tolerance."

“The biggest problems I see are not on the side of persons with disabilities, but on the side of so-called normal society, which is very seriously biased by all these outdated concepts,” he added.

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