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MENTAL HEALTH AND HUMAN RIGHTS: A CALL
FOR REVIEW OF THE MALAWI MENTAL
TREATMENT ACT & THE MENTAL HEALTH POLICY WITH EMPHASIS ON THE
RIGHTS OF MENTAL HEALTH PROFESSIONALS
AND USERS
By Mandala Mambulasa LL.B (Hons) Mw, LL.M (UP)
Quotable quotes
“All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person... There shall be no discrimination on the grounds of mental illness...” UN Principles for the Protection of Persons with Mental illness, GA Resolution 46/119 of 17 December 1991.
Quotable quotes...continued
“When the beat of the drum changes so must the step of the dance.” An African proverb
Overview of Presentation
Brief Background
Some brief salient features of legislation in South Africa & proposed Bill in Ghana
Human rights and limitation of rights
Rights of mental health professionals/carers
Rights of mental health users
Duties of mental health users
Conclusion
Brief Background
A consensus has emerged to redefine public health to include mental health needs
Traditionally, there is antagonism between the disciplines of public health and human rights
Old laws and policies still reflect this antagonism
In the African regional context, the beat of the drum has been changing since the 1990s
Brief Background...continued There is now recognition of
complementary between the two disciplines in achieving health and well-being of individuals and populations
South Africa led the way in 2002. It totally reformed its 1973 law, the Mental Health Care Act, 2002
It took effect in 2005
Ghana followed in 2007 with a progressive Bill as well.
Brief Background...continued Don’t ask me how old the Malawi Mental
Treatment Act is!
For avoidance of doubt, it is a 1948 piece of legislation
South Africa and Ghana reviewed their 1973 and 1972 pieces of legislation respectively
How much more ours? Shall we continue to lag behind?
I submit, it is time to change the step of the dance!
Some salient features of legislation in South African & proposed Bill in Ghana
Protection of human rights of persons with mental disorders and mental health professionals
Promotion of mental health care in primary health care settings
Introduction of safeguards against arbitrary and unjustified involuntary admission and treatment
Clarification of obligations of mental health care providers
Human rights and limitation of rights Human rights are entitlements to be
enjoyed by all human beings by virtue of being human
Some rights are absolute, non-derogable
Other rights are limitable
The limitation follows a prescribed standard provided for in the law
The limitation must use the least restrictive alternative (reasonableness)
Rights of mental health professionals/carers Right to health and its essential elements
Availability Accessibility Appropriateness Acceptability
Non- discrimination and equality by health establishment
To work in safe environment
To be provided with minimum core equipment, resources and supplies necessary for patient care
Rights of mental health professionals/carers Right to continuing education
Right to access prompt treatment for infections or injuries acquired while discharging their duties
These rights are in addition to all other rights that mental health professionals have as human beings under the Constitution and other laws
Rights of mental health users Right to health (Access to treatment and
care)
The right not to be discriminated against or stigmatized Refusal to treat Excessive delays in treatment Inappropriate treatment Early discharge
Security of the person Protection against arbitrary and unjustified
involuntary admission and treatment
Rights of mental health users...continued
To be informed of their rights by the professionals before receiving treatment, care and rehabilitation services-
To an effective remedy (right to justice)
Right to dignity, privacy and confidentiality
Right to rational healthcare (proportionality to mental health status)
Right to terminal care
Rights of mental health user...continued
Informed consent Founded in the right to autonomy and bodily integrity Medical treatment and surgical procedures involve
interference with the body Could be general or specific Proxy consent - mentally incapacitated persons or minors Exceptions- emergency cases (Doctrine of necessity) &
unconscious patients (Necessity to save life) Is required when using ECT
Access to medical records or data (Access to information)
Right to representation
Duties of a mental health user To provide healthcare providers with
accurate and relevant information subject to the user’s right to confidentiality and privacy
To comply with the prescribed health care treatment
To take care of healthcare records in his or her possession
To respect the rights of healthcare professionals by treating them with respect and dignity
Duties of a mental health user To sign a discharge certificate if he or
she refuses a recommended treatment
Consultation with mental health users The general rule: persons to be affected by any
decision, legislation or policy must be consulted
It ensures support and ownership of the process
It is also a democratic principle
Persons with mental disorders are no exception
Mental disorders are of varying degrees
Those that have capacity must surely be consulted and engaged throughout the review
Consultation with mental health users Lack of consultation could be fatal in
some cases
Conclusion
Mental Treatment Act is long overdue for reform
The National Mental Health Policy is also due for review
The reform/review should ensure protection of human rights of both the users and the professionals
Mental health users should be among the people to be consulted on the reforms/reviews
Thank you
Thank you very much
Merci
Asante sana
Ngiyabonga
Zikomo Kwambiri