IMPORTANCE OF MENTAL HEALTH FROM INTERNATIONAL HUMAN RIGHTS PERSPECTIVE
Updated: Feb 2
In this research paper, we see how Public Mental Health has pre-dominantly been considered as a socio-economic right and is always given second preference after civil and political rights. However, the inter-American court has included right to live a 'dignified life' within the meaning of right to life, thereby developing its scope and applicability. Then I analyse whether lack of Public Mental Health facilities and different application of human rights can be said to be discriminatory and whether the States can be held responsible for such deficiencies. Moving on I examine how poor Mental Health adversely affects a nation by hampering productivity within the society. Finally, by keeping the National Health System (NHS) of the United Kingdom as a base model, I analyse the differences in the Indian health system and how we can adopt a model framework that fits our requirements while learning from the system in the UK.
Public Mental Health as a socio-economic right and the inter-relationship between First- and Second-generation rights
Historically civil and political rights have inculcated rights like; right to life, right to a fair trial and judicial protection. These rights are also commonly termed as “First Generation rights” because they were the primary human rights recognised by States under International law.[i] Such rights demand a negative obligation from the States, to not interfere with the right that is being protected. Although some might argue otherwise like right to a fair trial, nonetheless, demands that the State provides resources for establishing basic courtrooms and support staff.[ii]
On the other hand, socio-economic and cultural rights have been referred to as “Second Generation rights” that include rights like; basic nutrition, health-care facilities, education, etc. These rights demand that the States commit to some positive action and contribute time and resources for their realisation.[iii]
The right to life is considered to be one of the most fundamental rights that is required in a person’s life. Traditionally, this right was seen as something which imposed a negative duty on the State to not interfere in a person’s right to life, having characteristics of ‘First-Generation’ right. However, the inter-American court of human rights has expanded such an understanding and held that a person's right to life incorporates right to live a ‘dignified life’, thus including the quality of one’s life as an inherent part of right to life.[iv] This stance by the inter-American court obligates the States to implement certain positive duties to meet minimum living conditions in a person’s life so they can live their lives with dignity.[v] Such measures become even more essential while dealing with vulnerable and at-risk people, whose care should be treated as high priority.[vi] The American court’s understanding thus integrates socio-economic rights with civil and political rights within the context of right to life. Such an interpretation progressively develops international law by giving due importance to one’s quality of life which is evidently dependant on one’s Mental health.[vii] Although a step in the right direction, one has to be varied of certain practical realities of this decision.
The State’s often face difficulties in taking positive actions to secure rights like Public health as it requires considerable expenditure like employing health-care staff and constructing appropriate institutions. Hence, the decision to include “Second Generation” rights, within the ambit of ‘right to life’ can be considered a step forward in realising the importance of human rights like Public Mental health, but not without certain limitations. Hence, we must look at the States responsibility and their accountability for the lack of such rights in the society.
Can States be held accountable for the lack of Public Mental Health facilities
One of the main principles in human rights treaties is that it requires the States to protect human rights without any form of discrimination, be it for economic status or any other purpose.[viii] Basic human rights allow the people to live peacefully and not become frustrated, which in turn could lead to further violations and crimes taking place in society. It becomes imperative to have an effective system in place to access justice and guarantee a ‘dignified life’ which entails taking positive measure to ensure such rights.[ix] There are pragmatic limitations to these obligations concerned with planning and adoption of public policies that greatly depend on the resources available with the State. State resources are mostly utilized on a priority basis, according to the needs of the society during a particular period. As these resources are scarce, only positive obligations of highest priority are given effect to avoid placing an undue burden on the State authorities. The inter-American court held that the State should carry out positive obligations which could ‘reasonably’ be expected from them.[x] This effectively gives the States much more flexibility in selecting which rights according to them, are more important and which rights can be neglected without facing any consequences.
However, not all international bodies agree with this stance taken by the inter-American court. The Maastricht Guidelines progress further and specify that the States have a mandatory obligation to provide food, health-care, basic shelter and education, irrespective of the resources being available to the State.[xi] This view was taken as international bodies are often of the notion that poverty and lack of resources are attributable to poor policy decisions made by the States themselves, that lead to social exclusions.[xii] Thus, State’s policy decisions need to be analysed to assess whether lack of resources is a result of such intentional policy decisions administered by the State or not. In this sense, international courts holding States liable for violating right to a ‘dignified life’ would compel Governments to perform transparent use of public funds and lead to additional pressure against Government’s corrupt practices and warrant increased responsibility. The decision to include good mental health of a person to live with dignity and maintain his quality of life will inevitably lead the States to provide for necessary services to protect public health rights.[BB1]
Adverse effects of poor Mental Health on a nation
Poor mental health can have a drastic effect on an individual’s quality of life and in-turn influence the entire nation. As reported in the 2018 Lancet Commission report on Mental Health, global mental disorders are continuously rising in every country and an estimated cost of 16 trillion dollars will be suffered by the global economy by the year 2030 as a consequence.[xiii] This is no doubt a direct result of loss in productivity because of mental disorders and an estimated loss of around 12 billion working days as a repercussion.[xiv] Psychological disorders often tend to steer to other public health concerns like increase in drug usage through injections which leads to rise in HIV infections and co-infections. Another repercussion is maternal depression during pregnancy which may place infants in health problems and puts childhood mortality at risk.[xv]
It can be established that there is a relationship between homelessness and mental health issues due to inadequate access to mental health services.[xvi]Although not all individuals suffering from mental issues need such facilities, if these issues remain untreated, it can cause incidental harm to society. To deal with this, a comprehensive definition of mental health needs to be established that goes beyond “diagnosable psychological disorders” and includes one’s ability to realize their mental and emotional potential as well as subjective well-being.[xvii] Even the WHO recommends that there is a need to invest in preventive and comprehensive mental health programs to reduce the effects of mental issues, not just on individuals, but across the global world.[xviii] Only by investing in proper mechanisms to deal with poor mental health issues, can the individuals live a comfortable life and in-turn the nation as a whole can prosper. Therefore, importance needs to be given to the kind of health system that is prevailing in a nation.
Comparative analysis between the UK’s National Healthcare System (NHS) and India’s approach towards Public Health
In India, the National Human Rights Commission has been given the mandate to supervise the performance of all mental health institutions across India. Such supervision has resulted in positive outcomes like improvement in hospital infrastructure and sanitary facilities, improved access to clean water, improved hygiene and improved recreational mental health exercises.[xix] However, along with these benefits, there have also been continuing insufficiencies highlighted like a significant lack of psychologists, psychiatrists as well as overcrowding of institutions.[xx]
The United Kingdom’s National Healthcare System (NHS) has become a model framework for the entire world to emulate with all its welfare benefits in society. The UK Government spends almost 7.6% of its GDP on healthcare services whereas, only around 1% is spent by the Indian Government.[xxi] In India, one has to make a choice of either accepting poor healthcare facilities or spending money out of their own pocket and go to private institutions to avail treatment. Healthcare being a human right needs to be acknowledged as such and safeguards need to be implemented with proper regulations and political will of Government and other responsible agencies. Steps like improvements in healthcare infrastructure in hospitals and better-quality healthcare professionals being employed, need to be executed. Undoubtedly, we must keep in mind that the sheer population difference between India and UK does make things more complex, but with proper large-scale planning and introduction of essential solutions, India can certainly improve on its existing healthcare system. Instead of blindly adopting the welfare-based healthcare system like the NHS, what is required is to revamp the Indian system accordingly to make it more suitable for our needs. More innovative ideas that incorporate a subsidized, accountable and reliable system and proper utilisation of the taxpayer’s money is the need of the hour to tackle these challenges.
Perhaps one solution could be to adopt a human rights-based approach which emphasises on making sure that human rights are at the centre of the service providing institution instead of just avoiding violations against them.[xxii]
By incorporating right to a “dignified life” within the ambit of right to life, the inter- American court has blurred the line between “First Generation” civil and political rights and “Second Generation” socio-economic rights. This decision placed obligations on the States to take positive measures to safeguard the right to a "dignified life" or else be found guilty of violating right to life. Poor Mental health has often had an adverse effect, not only on individuals but also on entire nations and to deal with this problem we must take affirmative actions and implement proper mechanisms. It is necessary to recognize, not only diagnosable mental health problems but also issues like anxiety faced by a common man in everyday life. This can only be done by spreading proper awareness and normalizing the issue of mental health faced by individuals and perhaps addressing it as a collective health concern. Public Mental Health issues have escalated globally during the Covid-19 pandemic and the importance of dealing with this serious problem is of great importance. The State and an individual must work together to implement and promote measures that fulfil the realization of right to Public Health.
[i] Asbjorn Eide, Economic, Social and Cultural Rights as Human Rights, in ECONOMIC, SOCIAL AND CULTURAL RIGHTS 9, 10 (Asbjorn Eide, Catarina Krause, and Allan Rosas, eds., Nijhoff Publ. 2nd ed. 2001). [ii] Id. (citing G.A. Res. 41/128, U.N. Doc. AIRES/41/128 (Dec. 4, 1986). [iii] Eide, Economic, Social and Cultural Rights as Human Rights, supra note 32 (citing G.A. Res. 41/128, U.N. Doc. A/RES/41/128 (Dec. 4, 1986). [iv] Indigenous Community Yakye Axa Case (Paraguay), Inter-Am. Ct. H.R. (ser. C) No. 125, at 162-4 (June 17, 2005). [v] Ibid. [vi] Ibid. [vii] M. Pasqualucci, J., “The Right to a Dignified Life (Vida Digna): The Integration of Economic and Social Rights with Civil and Political Rights in the Inter-American Human Rights System”, 31 Hastings ICLR, (2008). [viii] American Convention, supra note 2, at art. 1(1). [ix] Sawhoyamaxa, supra note 9 at 153 (citing Juvenile Re-education Institute Case, supra note 59, at 156). [x] Sawhoyamaxa, supra note 9, at 160. [xi] Maastricht Guidelines, at 18 U.N. Doc. E/C.12/2000/13 (2000). [xii] Kenneth Roth, Defending Economic, Social and Cultural Rights: Practical Issues Faced by an International Human Rights Organization2 6 HuM. RRS. Q. 63, 72-73 (2004). [xiii] Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P. (2018). The Lancet Commission on global mental health and sustainable development. [xiv] Ibid. [xv] Patek, V. (2007). Mental health in low- and middle-income countries. British Medical Bulletin, 81-82: 81-96. [xvi] Greenberg, G.A., Rosenheck, R.A. (2008). Jail incarceration, homelessness, and mental health: a national study. Psychiatric Services, 59(2): 170-177. [xvii] Ritchie, H., Roser, M. (2018). Mental Health. [xviii] World Health Organization. 2003. “Investing in Mental Health”. [xix] Indian National Human Rights Commission (2012, see note 22). [xx] Ibid. [xxi] Online, F. (2020, February 01). Budget 2020 expectations for India's healthcare sector. Retrieved October 17, 2020, from https://www.financialexpress.com/budget/budget-2020-expectations-for-indias-healthcare-sector/1842519/. [xxii] M. J. Curtice and T. Exworthy, “FREDA: A human rights-based approach to healthcare.” The Psychiatrist 34 (2010) pp. 150-156.
Cover Image: Doug Chayka
About the author: Siddharth Kohli is a final year Law student pursuing the three-year Bachelor of Law (LLB) course at Jindal Global Law School.