World Mental Health Day 2023 has been designated by the World Health Organization (WHO): mental health is a universal human right. I could not agree more. But what does this mean? What is the impact of this statement? There is more controversy than you might imagine. The idea that mental health is a universal human right means one thing to the WHO, but it means a little more to me.
Mental health is a universal human right according to the World Health Organization
The WHO writes a few paragraphs about mental health as a universal human right (Look here). Here’s an excerpt:
“Mental health is a basic human right for everyone. Everyone, no matter where they are, has a right to the highest possible level of mental health. This includes the right to be protected from mental health risks, the right to available, accessible, acceptable and good quality care and the right to freedom, independence and community integration.’
That all sounds pretty good. Things get a little stickier around this statement:
“Having a mental health condition should never be a reason to deprive a person of their human rights or exclude them from decisions about their own health.
. . .
WHO continues to work with its partners to ensure that mental health is valued, promoted and protected and that urgent action is taken so that everyone can exercise their human rights and access the quality mental health care they need.”
Of course, this is true and positive, but what they are saying is making a broad assumption. They assume that people with mental illness can fully understand and appreciate their illness and seek help.
This, unfortunately, is a bad assumption when it comes to serious mental illness.
The Universal Human Right to Mental Health for those who lack insight
Many people with serious mental illness have a clinical lack of knowledge about their own mental illness. In other words, they don’t understand that they have a mental illness. They go so far as to deny it, often no matter what you say. This is known as anognosis. Agnosia is a neurological condition and is not the same thing as denial.
According information on the National Institutes of Health website:
- 50-90% of people with schizophrenia experience anognosia.
- 40% of people with bipolar disorder experience anognosia.
And while it’s widely understood that people with diseases like Alzheimer’s disease have anognosia (about 81%, in fact), few people understand its impact on people with bipolar disorder and schizophrenia.
So if a person with a mental illness has a universal human right to mental health but refuses to seek treatment because they don’t understand or believe they have an illness, what does that mean?
The effect that serious mental illness has on people
The problem with anognosis is that their lives tend to be ruined and they often end up dying because of their mental illness or as a result of problems caused by their mental illness. Additionally, people with serious mental illnesses (especially those with substance abuse comorbidity) often hurt other people along the way. (No, it’s not a stigma.)
For example, in one 2021 systematic reviewfound that of those experiencing homelessness:
- 76.2% had a mental illness
- 36.7% had an alcohol use disorder (10 times more than in the general population)
- 21.7% had a substance use disorder (almost 10 times more than the general population)
- 12.4% had a schizophrenia spectrum disorder (18 times more than in the general population)
- 12.6% had severe depression
- 4.1% had bipolar disorder
Many people, of course, have more than one mental illness at the same time.
Regarding violence, a study by Richard A. Van Dorn, PhD, of RTI International and colleagues, found that:
- 2.9% of people with severe mental illness had committed a violent act, compared to 0.8% of people without mental illness during the same time period.
- 10% of people with serious mental illness and substance use disorder committed a violent act during the same time period.
Note that there are some confounding factors noted above:
- Many of the same factors that lead to violence in a person without mental illness to commit a violent act also drive those with mental illness. It’s just that these factors are more likely to occur in people with serious mental illnesses.
- People with serious mental illnesses are much more likely to be victims of violence by the general population.
- The vast majority of people with serious mental illness do not commit violent acts.
- People with serious mental illness who receive effective treatment are no more dangerous than people in the general population (Look here).
Does The Universal Human Right To Mental Health Surpass Death With Your Rights On?
Well, here’s the question. What do you do when a person with a serious mental illness is agnostic? If you know the person won’t seek treatment because they don’t understand their own mental health, do you treat them against their will and hope that treatment will free them from anognosia? What if he doesn’t? Are you still dealing with them?
There are two schools of thought on this, and both question what a “universal human right” actually is.
On the one hand, you can treat the person with mental illness independently. You can make them inpatients in a treatment facility and medicate them even though they say they don’t want it. You can inject them with an antipsychotic no matter how much they scream. At worst, this is what it looks like.
On the other hand, many people would say that this is inhumane. How can you force a person to take medication against their will? How can you lock up a person who has done nothing wrong? This is against a person’s “universal human right” to live freely.
This conundrum leads to this sentiment: If we don’t treat people, are we just letting people die with their rights?
Because this is happening. You have the death of the person, the death of their lifestyle, or both. When you see a person getting their next meal from a garbage can while talking to a being you cannot see, that person has lost everything and may end up dying of a mental illness. Are we not really dealing with a person in this situation?
If we argue that mental health is a universal human right, then aren’t we allowing an individual’s rights by mandating treatment? Furthermore, isn’t it to all of our benefit to reduce violence in the population and allow for more productive members of society?
However, if we argue that freedom is the overriding right, then what we should do is let them die – nothing else matters.
Obviously, there are no good answers here. And what is sad is that most people refuse to even really think about this problem. But we have to because one thing I know people deserve is attention, one way or another.
If Mental Health is a universal human right, what do we do?
Thus, it is easy to say that mental health is a universal human right. It’s much harder to know what to do about it.
It should come as no surprise that I’m much closer to the treatment-without-consent end of things. I believe that there is no health, and indeed life, without mental health, and this is confirmed by everyday examples of real life. You cannot tell me that a man trapped in paranoid hallucinations and delusions, without a home and without even food, has a life. They do not.
Furthermore, no one would even think of letting this happen to a person with a disease like Alzheimer’s. No one would think that treating your grandmother for Alzheimer’s—even if she didn’t realize it—would be wrong. You would give her the pills and not feel bad about it at all. And when she got so sick that she could no longer be cared for by family members, you’d put her in a facility that, again, would force her to be treated for whatever illnesses she had at the time, whether she knew it or not. And no one in that situation would be demonized.
But people with mental illness don’t have that same luxury. People with mental illness are allowed to languish in their own shit because that’s their “right”.
But I don’t believe that. I believe that mental health is not only a universal human right, but a universal human demand. I believe society is in the business of providing a safety net for when people fall, and that means when they also fall from reason. We give people a chance to have a better life. We give people opportunities. But without mental health, no opportunity will matter. No probability will matter. You just won’t have a life. Period.
As a quick addendum, I recognize the complexity of this topic, but this is at least one perspective from which we can begin to help others have the life and contentment they deserve.
