Guest editorial

Citation

Elnemais Fawzy, M. (2022), "Guest editorial", International Journal of Human Rights in Healthcare, Vol. 15 No. 1, pp. 1-3. https://doi.org/10.1108/IJHRH-02-2022-202

“A human rights approach to mental health services, policy and legislation”

In most countries around the world, people with mental disorders are denied basic rights such as the right to vote or the right to get married and have children. Access to basic needs such as education, employment or health care is also severely hampered.

Children with mental illness are amongst the most marginalized groups in terms of access to education; in developing countries, only 2% of children with any disability are enrolled in school. Children of parents with mental disorders are also more likely to drop out of school. Many people with mental disorders are spending shorter or longer periods of their lives in psychiatric hospitals and other institutions, sometimes these being the only “home” they will ever have.

While allegedly there for their best interest, to be protected and receive treatment, people with mental disorders are only isolated in places where access to information, education and employment. They are restricted from developing relationships with others. They are separated from families, friends and the wider society.

In addition, mental disorders have a major economic impact on individuals, their households and the entire society. First of all, when seeking care, people need to spend money on consultations, hospitalization fees and medications. Such costs can represent a critical share of the household budget, and it is often difficult to manage this situation for long periods of time. In addition to these direct health expenditures, people also need to spend money on transport and accommodation. People with mental disorders need to be accompanied. This means that at least one or two persons will need to pay for transportation and accommodation and will not be able to work during the time necessary to reach the mental health facility and receive the care needed.

During periods of illness, mental disorders reduce people’s productivity as well as the availability of their caregiver to work. Regarding the stigma, people are often discriminated against in terms of employment, being less able to access employment and more likely to lose their job as a result of having a mental disorder. At a society level, the economic impact has been estimated to be very significant. This is a consequence of absenteeism, low productivity, premature retirement and disability benefits. For individuals, businesses, society and the state, these indirect costs reduce income generation. For industry, losses will result in poor production outputs and reduced profits, which will in turn negatively affect employment and/or wages and the country’s economic performance. At the other end of the scale, households affected by mental illness face the possibility of catastrophic poverty. The combination of these impacts in concert with the costs incurred by the state and health insurers will negatively affect national economic growth, employment and poverty reduction.

This special issue aimed to shed light on best practices for maximizing dignity for every person, advancing the integration of people living with mental disorders in the community through the facilitation of an environment that enables them to achieve the maximum degree of functional independence and the highest possible quality of life, preserving their dignity.

While we were working on this issue, a cluster of atypical cases of pneumonia was reported in Wuhan, China, which was later designated as coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) on February 11, 2020, and on March 11, 2020, the WHO declared the outbreak a global pandemic (Anand et al., 2020).

The world faced substantial challenges in meeting the demands for mental health care, even before the emergence of coronavirus disease (COVID-19). The good news is that by October, 2020, mental health was top of the charts in terms of published papers on the effects of COVID-19. The bad news is that the quantity of papers is not matched by quality (The Lancet Psychiatry, 2021).

A systematic review on the impact of the COVID-19 pandemic on mental health in the general population published in August 2020 found that there are relatively high rates of symptoms of anxiety (6.33%–50.9%), depression (14.6%–48.3%), post-traumatic stress disorder (7%–53.8%), psychological distress (34.43%–38%) and stress (8.1%–81.9%) reported in the general population during the COVID-19 pandemic in China, Spain, Italy, Iran, the USA, Turkey, Nepal and Denmark. Risk factors associated with distress measures include female gender, younger age group (≤ 40 years), presence of chronic/psychiatric illnesses, unemployment, student status and frequent exposure to social media/news concerning COVID-19 (Xiong et al., 2020).

In the article entitled “Mental Health under Occupation: An Analysis of the De-politicization of the Mental Health Discourse in Palestine and a Call for a Human Rights Approach,” Helbich, Maria; and Jabr, Samah highlight that to truly understand social suffering in Palestine, it needs to be related to the prevalence of human rights violations, which in turn have a conceivable impact on the mental health well-being of individuals. The article presents the viewpoint and perspectives of the authors on significant mental health issues in Palestine. The methodology is based on a literature review of the de-politicization of the mental health discourse and on the theoretical framework of a human rights approach. At the base of this discourse lies the demand for social justice and professional solidarity. It advocates for a shift from a de-contextualized, de-politicized and individualistic approach to mental health to acknowledging the importance of the social and political context in which trauma develops. It further illustrates how the adaptation of a human rights approach can strengthen demands of social justice and oppose the victimization of Palestinians.

Since the emergence of a coronavirus disease (2019-nCoV) in December 2019, the whole world is in a state of chaos. Dr Aqeel and his colleagues proposed a model to address mental health problems during the lockdown, in their article entitled “The influence of illness perception, anxiety and depression disorders on students’ mental health during COVID-19 outbreak in Pakistan: a Web-based cross-sectional survey.” The study evaluated the potential mediation pathways of depression and anxiety disorders symptoms in the relationship between illness perception and mental health. The study examined the association of mental health with anxiety, depression and illness perception in a sample of Pakistani students during the current lockdown. This Web-based cross-sectional study indicated a high prevalence of anxiety and depression disorder in the sample of Pakistani students during the current lockdown due to the COVID-19 outbreak. The study results clarified and provided empirical support for precisely comprehending the source of panic in samples of Pakistani students during COVID-19 lockdown.

In their article entitled “The Mental Health Status of Faculty Members and Students as the Contemporary and Future Health System Providers,” Piroozi, Bakhtiar and his colleagues investigated the mental health of the faculty members and students of Kurdistan University of Medical Sciences using the 28-item General Health Questionnaire (GHQ-28). They found that the prevalence of mental health disorders among faculty members and medical students of Kurdistan’s medical university is high and this issue must be noticed by policymakers and health system managers. They recommended conducting periodic surveys to control the mental health of faculty members and students, and establishing a centralized supporting system for screening and planning appropriate interventions to promote mental health is recommended.

There are few studies that are studying the amplification effects of the COVID-19 pandemic context on the current opioid crisis. In his paper entitled “Exploring opioid addictions and responsibilities: Almost lost in the midst of the Covid-19 pandemic,” Smith, Alan tried to describe the amplification effects of the COVID-19 pandemic context on the current opioid crisis. The study found that the opioid epidemic is widespread and still perceived as a great health concern or risk for society. There are many health-related risks involved in using opioids and they do not just hurt the one using them. The emotional and financial tolls of those involved with opioid users in their personal lives can significantly and detrimentally alter many people’s futures. One aspect derived from the present study is that the twin crises have laid bare the inadequacies of the studied health-care system compared to other more progressive policies of other nations.

In her article entitled “The ‘stay at home’ orders effect on the mental health of Egyptian adults during the COVID-19 pandemic partial lockdown,” Saleh, Mai surveyed the impact of the partial lockdown and “stay-at-home” orders on Mental Well-being and emergence of Stress Signs. The study is the first in Egypt to figure out affected populations and vulnerable categories that need extra care in the future. It provides valuable data and expresses reasonable explanations for the obtained findings. The study also introduces recommendations and highlights hot topics for future research.

Agarwal, Varsha, and his colleagues reviewed Human Rights in Mental Health with Specific Focus on International Standards and Clinical Practices. Firstly, they discussed the problems faced by mental impairment to the maximum benefit of human rights and then the approaches to the development of the human rights system. Their third segment examined the incorporation of an approach to human rights as well as intellectual wellness that is both structural and practical. They suggested recommendations for practicing mental wellness and applying civil rights standards to mental health. They advocated new paradigm structures focused on philosophical, analytical, programmatic, policy and regulatory rights that promote a new ecosystem of mental well-being that places personal and social mental health as connected inseparably.