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World Mental Health Day 2023 has been given the theme by the World Health Organization (WHO): mental health is a universal human right. I couldn’t agree more. But what does this mean? What is the impact of that statement? There’s more controversy there than you might think. The idea that mental health is a universal human right means one thing to the WHO, but it means something a little bit more to me.
Mental Health Is a Universal Human Right According to the World Health Organization
The WHO writes a few paragraphs on mental health being a universal human right (see here). Here is an excerpt:
“Mental health is a basic human right for all people. Everyone, whoever and wherever they are, has a right to the highest attainable standard 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 liberty, independence and inclusion in the community.”
All of that 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 to exclude them from decisions about their own health.
. . .
WHO continues to work with its partners to ensure 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’re saying makes one broad assumption. They’re assuming people with mental illness can fully understand and appreciate their illness and are looking for help.
This, unfortunately, is a poor assumption when it comes to serious mental illness.
The Universal Human Right of Mental Health for Those with a Lack of Insight
Many people with serious mental illness have a clinical lack of insight into their own mental illness. In other words, they don’t understand that they have a mental illness. They go as far as to deny it, often no matter what you say. This is known as anosognosia. Anosognosia is a neurological condition and not the same thing as denial.
According to information on the National Institute of Health website:
- 50-90% of people with schizophrenia demonstrate anosognosia.
- 40% of people with bipolar disorder demonstrate anosognosia.
And while it is widely understood that people with illnesses like Alzheimer’s disease have anosognosia (about 81%, in fact), few people comprehend its effect on those 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 as they don’t understand or believe they have an illness, what does that mean?
The Effect Serious Mental Illness Has on People
The problem with people with anosognosia is that their lives tend to be destroyed, and they often end up dying because of their mental illness or as a result of problems caused by their mental illness. Moreover, people with serious mental illness (particularly those with comorbid substance abuse) often hurt other people along the way. (No, this is not stigma talking.)
For example, in a 2021 systematic review, it was found 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 drug use disorder (almost 10 times more than in the general population)
- 12.4% had a schizophrenia spectrum disorder (18 times more than in the general population)
- 12.6% had major depression
- 4.1% had a bipolar spectrum 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 serious mental illness had committed a violent act, compared with 0.8% of people without a mental illness in the same time period.
- 10% of people with both serious mental illness and a substance use disorder committed a violent act in that same time period.
Keep in mind there are some confounding factors noted in the above:
- Many of the same factors that lead to violence in a person without a mental illness to commit a violent act also drive those with a mental illness; it’s just that those factors are more likely to occur in those with serious mental illnesses.
- People with serious mental illness are much more likely to be victims of violence than the general population.
- The vast majority of people with serious mental illness do not commit violent acts.
- People with serious mental illness receiving effective treatment are no more dangerous than individuals in the general population (see here).
The Universal Human Right for Mental Heath Supercedes Dying with Your Rights On?
So, here’s the question. What do you do when a person with a serious mental illness has anosognosia? If you know the person won’t seek treatment as they don’t understand their own mental health, do you treat them against their will and hope that treatment will rid them of anosognosia? What if it doesn’t? Do you keep treating them anyway?
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 regardless. You can make them an inpatient at a treatment facility and treat them with psychotropics even though they say they don’t want it. You can inject them with an antipsychotic no matter how much they howl. In the worst-case scenario, that is what that looks like.
On the other hand, many people would say that is inhumane. How can you force a person to take medication against their will? How can you lock a person up who has possibly 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 on?
Because that happens. 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 can’t see, that person has lost everything and may end up losing their life to a mental illness. Do we really not treat a person in that situation?
If we argue that mental health is a universal human right, then aren’t we enabling a person’s rights by forcing treatment? Moreover, doesn’t it benefit all of us to reduce violence in the population and allow for more productive members of society?
However, if we argue that freedom is the superseding right, then leaving them to die is what we should do — nothing else matters.
Clearly, there are no good answers here. And what is sad is that most people refuse even to give this problem real thought. But we need to because one thing I know that people do deserve is consideration, one way or another.
If Mental Health Is a Universal Human Right, What Do We Do?
So, it’s easy to say that mental health is a universal human right. It’s much harder to know what to do about that.
It should come as no surprise that I fall much closer to the treatment-without-consent end of things. I believe that there is no health, and in fact, no life, without mental health, and this is borne out by everyday real-life examples. You cannot tell me that a person trapped inside paranoid delusions and hallucinations, without a home and without even food, has a life. They do not.
Moreover, no one would even consider letting that happen to a person with an illness like Alzheimer’s disease. No one would think that having your grandmother treated for Alzheimer’s disease — even if she didn’t understand it — would be wrong. You would hand her pills, and you wouldn’t feel bad about it at all. And when she became so sick she could no longer be cared for by family members, you would put her in a facility that, again, would force her to be treated for whatever ailments she would then have, whether she understood it or not. And no one in that situation would be demonized.
But, people with mental illness are not afforded that same luxury. People with mental illness are allowed to languish in their own shit because that is their “right.”
But I don’t believe that. I believe that mental health is not only a universal human right but a universal human requirement. I believe that society is in the business of providing a safety net for when people fall, and that means when they fall from sanity, too. We give people a chance to have a better life. We give people opportunities. But without mental health, no opportunity will matter. No chance will matter. You will simply have no life. Period.
As a quick addendum, I recognize the complexity of this topic, but this is at least a perspective from which to begin to help others have the lives and contentment they deserve.
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