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Mental health care is an essential component of healthcare systems worldwide. However, the treatment of individuals with mental health conditions has often been marred by human rights abuses, stigma, and discrimination. In response to these issues, the World Health Organization (WHO) and Office of the United Nations High Commissioner for Human Rights (OHCHR) have developed guidance to improve laws addressing human rights abuses in mental health care. This post provides a brief overview of the significance of the guidance in promoting the rights and well-being of individuals with mental health conditions, and how Scotland’s own record compares.

 

The WHO-OHCHR Guidance

The guidance underscores the importance of placing human rights at the heart of mental health care policies and practices, recommending revision or enaction to mental health legislation to align with international human rights standards, such as ending forced treatment and institutionalisation.

It recommends a shift away from institutional care and promotion of community-based mental health services which allows individuals to receive care and support in a more integrated, inclusive, and less restrictive environment, fosters social inclusion and recovery.

The guidance also covers informed consent and advance directives, and effective mechanisms for monitoring and oversight to ensure compliance with human rights standards.

 

Significance of the Guidance

The WHO-OHCHR guidance reaffirms the fundamental human rights of individuals with mental health conditions and offers a framework for their protection. It has the potential to influence legislation and policies at a global level, encouraging countries to align their mental health laws with human rights standards. It also promotes a paradigm shift from outdated, coercive approaches towards more humane and inclusive community-based care and recognises that the presence of mental ill-health is not justification for limiting a person’s rights and freedoms and access to support and services.

 

Scotland’s Record

The Scottish Mental Health Law Review, commissioned in 2019, considered and recommended ways to better protect and promote the human rights of people through mental health, capacity and adult support and protection legislation. It is hoped that this work will help to bring about  a huge difference in the lives of people who experience mental and intellectual disabilities by making sure they get the support they need and giving them more say in their own lives. It can also be used globally as a model for other countries who are trying to incorporate the CRPD and follow WHO-OHCHR guidance into law, practice and policy.

 

Conclusion

The WHO-OHCHR guidance represents a milestone in the fight for the rights and well-being of individuals with mental health conditions. By championing human rights, promoting community-based care, and challenging stigma, this guidance offers a pathway to a more compassionate, inclusive, and just mental health system. It is a call to action for governments, healthcare providers, and society at large to ensure that mental health care respects the dignity and autonomy of every individual. The Scottish Mental Health Law Review’s recommendation also sought to do this and although these recommendations preceded the WHO-OHCHR guidance very much aligns with the guidance’s approach.

Nadine Dougall 

Trigger warning – content refers to suicide and risk factors relating to suicidal thoughts.

World Suicide Prevention Day is hosted on 10th September every year. During this same week, the number of deaths by suicide in 2022 was published by the National Records of Scotland. This latest data showed that deaths were very slightly up at 762, with females increased by 18 and males decreased by nine on the previous year. As part of the Academic Advisory Group to Scottish Government, I provided some analysis and commentary to this data release.

Working with suicide data can be a humbling and emotional experience. As someone personally affected by suicide, it is an all too powerful reminder that behind every number was a person and research has estimated that up to 135 people are deeply affected by each death.

Despite the very small increase in overall deaths in 2022, suicide remains a massive concern and much more needs to be done. This is especially the case in our communities  of highest deprivation, where the suicide rate is about three times greater than areas of least deprivation. Our national suicide prevention strategy ‘Creating Hope Together’ aims to bring down numbers of suicide and tackle deprivation to reduce inequalities between our communities.

However, suicide is everyone’s business, and we all have a part to play. One in five in the UK have suicidal thoughts during their lifetime. That means we likely know someone at work, home or in our friendship groups who is having, or will have, suicidal thoughts. Perhaps you have experienced such thoughts, but don’t realise how common it is.

Having suicidal thoughts does not necessarily mean we have poor mental health, but instead may be a natural reaction to distressing problems and situations. Usually there is no single reason that may lead us to think about suicide but rather a range of reasons or factors, which all contribute to how we may be feeling.

Many of us will experience significant issues that are known risk factors for suicidal thoughts and behaviours, including unemployment, work or money problems, relationship breakdowns, conflict, violence, experiencing disability or pain, life-changing events, significant childhood adversity and abuse, living alone or isolated, and using significant amounts of drugs and/or alcohol.

We also know from research that these risk factors may be offset by a range of beneficial experiences in childhood and adulthood, such as having a supportive and trusted adult around during childhood or being in a positive relationship as an adult.

What leads any of us to having suicidal thoughts is complex. One model of suicide (the ‘IMV Model’) recognises that biology, psychology, environment and culture all play a part in this complexity. Crucially, the IMV Model seeks to understand what causes the development of suicidal thoughts, and what are the factors that increase the chance of suicidal behaviour. It also identifies that a sense of defeat, feeling a burden to others, or feeling trapped can all lead to the (often rapid) development of suicidal thoughts.

The IMV Model acknowledges common pathways to suicidal thoughts and behaviours but also identifies potential areas for prevention and intervention. To create more hope around suicide, we need to make it easier to tell others and share our thoughts. In turn, this will likely have the effect of making us feel better, not to mention playing a small part in reducing stigma. This is part of the national suicide prevention strategy.

National suicide prevention programmes such as ‘Creating Hope Together’ no longer focus on individual risk factors as they have poorly predicted suicide in the past. Instead, they focus on broader ways of improving general population well-being, addressing causes and reducing stigma of poor mental health, and improving service response to support people with problems.

It is with the greatest of hope that ‘Creating Hope Together’ can achieve an impact and we see reduced numbers of suicide and reducing inequality over the coming years.

Every suicide is preventable, and our lives are valuable. For many of us, life may be overwhelming at times, and we may feel trapped in situations with no easy solutions. However, there is always hope even if things do not feel hopeful.

 

If you need help please do not hesitate to contact:

Breathing Space

Breathing Space is Scotland’s mental health helpline for individuals experiencing symptoms of low mood, depression, or anxiety, and offers free and confidential advice for individuals over the age of 16. They can be contacted on 0800 83 85 87, 6pm to 2am Monday to Thursday; and from 6pm Friday throughout the weekend to 6am Monday.

Samaritans

Samaritans provide confidential non-judgemental emotional support 24 hours a day for people who are experiencing feelings of distress or despair. You can contact Samaritans free by phoning 116 123 or via email on jo@samaritans.org

NHS24 Mental Health Hub

Telephone advice and support on healthcare can be obtained from NHS24 by phoning 111; the Mental Health Hub is open 24/7.

 

Acknowledgements:

With grateful thanks to Jan Savinc, and his expertise in R syntax to provide summary statistics and interpretations from the national suicide data release.

Dedication:

In memory of my nephew Connel Arthur, forever 21.

 

Nadine Dougall is Professor of Mental Health and Data Science at Edinburgh Napier University.

Welcome to Edinburgh Napier University Centre for Mental Health Practice, Policy and Law Research blog page.

The intention of this blog is to engage people in discussions around the evaluation, review and reform of practice, policy and law relating to persons with mental illness, personality disorder, learning disability, neurodivergence, dementia and other related conditions.

It will provide an opportunity to share and discuss research and related consultancy, knowledge exchange and learning, undertaken under the Centre’s auspices. However, it also provides a space to discuss wider practice, ethical, equality and human rights issues related to the achievement of the highest attainment of mental health. In particular, we welcome contributions related to the Centre’s main research themes:

• Psychological and social interventions for mental health and neurological conditions and intellectual disability.
• Practice, policy and law evaluation, review and reform – applying research and knowledge exchange to:
  • Care, treatment and other support
  • Law enforcement
  • Criminal justice
• Human rights, equality and non-discrimination
• Exploring and supporting the exercise of capacity and decision-making
• Barriers to achieving the highest attainable standard of mental health, including addiction, trauma, physical ill-health, physical disability, co-morbidities , socio-economic inequalities and intersectionality.

This blog will provide a safe space where views can be freely expressed and exchanged.  However, all communications with and questions for the presenters and others must be respectful. The Centre reserves the right to remove or refuse publish any material which is abusive and/or not respectful.

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