World Mental Health Day 2023
‘Mental health is universal human right’

Prof N Heramani Singh / Dr Seram Chaoba / Dr Meesha Haorongbam *

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This implies that mental health should not be neglected in our quest to attain good health. With this principle in mind, WHO has designated 10th October as World Mental Health Day to raise awareness for mental health and drive a positive change for everyone’s mental health.

The theme for World Mental Health Day 2023 is “Mental Health is a Universal Human Right.” This day is an opportunity for people and communities to unite and improve knowledge, raise awareness, and drive actions that promote and protect everyone’s mental health as a universal right.

The modern public mental health approach emerged on the global scene at the end of the 20th century. Two key messages of the modern public mental-health approach are: there is no health without mental health; and good mental health means much more than the absence of a mental impairment.

This approach still faces enormous challenges. The historical divide—both in policies and practices—between mental and physical health has unfortunately resulted in political, professional and geographical isolation; and marginalization and stigmatization of mental health care. Thankfully, mental health is coming out from the shadows and recent reports from global health organizations identify mental health as a global priority.

Human rights are rights inherent to all human beings, regardless of race, gender, sex, nationality, ethnicity, language, religion or any other status. This includes the right to life and liberty, freedom of opinion and expression, the right to work and education, etc.

Everyone is entitled to these rights, without any discrimination. The United Nations Declaration of Human rights articulates the ‘right to the highest attainable standard of physical and mental health’. It is the right to comprehensive mental, physical and socialwell-being by every human being.

This includes:
o the right to be protected from mental health risks
o the right to available, accessible, acceptable, and good quality care
o the right to liberty, independence and inclusion in the community.

The promotion of mental health and human rights are mutually reinforcing: when human rights are respected, protected and fulfilled, a person’s mental health is also supported. This is reflected in surveys where countries with high Human Freedom Indexes such as Sweden and Canada score higher in positive mental health index.

The bi-directional relationship between mental illness and human rights violations needs to be stressed upon. On the one hand, human rights violations (physical/mental/sexual abuse, involuntary confinement, discrimination, arbitrary arrest, war crimes etc) can themselves negatively impact mental health, while protecting human rights can buttress or even improve mental health outcomes.

Conversely, the presence of a mental health condition is more likely to place an individual at risk for human rights abuses and people with mental health conditions are often at higher risk of human rights violations like discriminations, stigma and coercive measures than the general population.

Such individuals may encounter restrictions on their ability to exercise their political and civil rights, including their right to participate in public affairs and decision-making processes on issues that affect them.

The current population of India is 140 crores out of which 14 crore (10%) have some form of mental illness and 1 crore (0.8%). Despite the tremendous progress made in the field of healthcare in the past few decades, the treatment gap for mental disorders (i.e. the proportion of people with mental illness who need treatment but do not get it) in India ranges between 70 and 86% for various disorders.

This gap needs to be narrowed to realize each person’s fundamental right to good health and well-being. A positive mental health is important for a positive self-image, healthier relationships, better productivity, and a higher quality of life.

This will lead, through a cascade of reactions, to improved economy and well-being of a nation.

The Mental Health Care Act 2017 was passed on 7th April 2017 and came into force from 29th May 2018. This is an “Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services”.

Section 18 of the Act deals with Right to Access Mental Healthcare. Under this the range of service that are to be made available to people with mental illnesses are:

o outpatient and inpatient facilities
o Support family of people with mental illness
o Rehabilitation services
o Child and geriatric mental health services
o Provision for free medicines (of essential drugs)
o Reimbursement of costs of treatment if state is unable to provide the above services

Sadly, mental health care continues to be a neglected area in our country. In a survey conducted by National Human Rights Commission, the report of which was released in January 2023, 46 Government Mental Healthcare Institutions across the country were found to be in deplorable conditions, depicting a very pathetic handling by the different stakeholders.

The inhuman and deplorable conditions of the mental health institutions recorded by the commission across the country present sorry states of affairs amounting to infringement of the human rights of mentally ill patients.

As a signatory to the Universal Declaration of Human Rights, the Government of India is obligated to ensure the highest attainable standard of mental health for its population. India is not meeting its human rights obligations: it has failed to address deep, long-standing gaps in the health system when it comes to the integration of mental health services and supports.

These gaps include lack of timely access, a lack of care in?remote locations, a lack of culturally sensitive programming, having to pay out of pocket for services, and a shortage of mental health care professionals.

A nationwide social and systems change is therefore the need of the hour. We need to deliver community-based programs, services and supports and work in solidarity with social justice organizations and activists to create a nation where everyone has:

1. Access to mental health care and services, where the mental health system is adequately funded and considered on par with physical health
2. Social determinants of health (e.g. poverty, education, stable housing and work, access to land and nature, etc.) are recognized as critical prerequisites of mental health.
3. Protection from discrimination and stigmawhere people living with mental illnessesare meaningfully integrated into society and given equal opportunity to participate in community life.
4. Freedom from violence, mistreatment and abuse, where people’s dignity and self-determination are centred in mental health programs, services and policies

Mental health is not a privilege but a fundamental human right and Government must provide care that promotes people’s recovery and upholds their rights. This requires continuous sustained efforts such as:

o Life skills training
o School mental health program
o Cyber hygiene in adolescents
o Intra and inter personal skill development
o Disability pension
o Caregivers’ pension
o Legal aid

Such tasks should not be left to the Government alone. We, the public, have an enormous role in mental health promotion. We must also tackle abuses and break down the barriers that prevent people from seeking support.

And we must address root causes (poverty, inequality, violence, discrimination) and create a more compassionate and resilient society.

On World Mental Health Day and every day, let us reaffirm and uphold mental health as a universal human right, and together, build a healthier world where everyone can thrive.