The Other Health Care Announcement: A Tool Kit for the World’s Mentally Ill

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While the Supreme Court was making health care news in Washington, voting to uphold the Affordable Care Act on Thursday, a smaller gathering at the United Nations was discussing another, completely non-binding document that could nevertheless impact the care of many more people than will the decision by the august justices.

Put together by the World Health Organization (WHO), and therefore probably condemned to be largely ignored by the West, it’s a set of standards that enable countries to figure out if they’re abusing the human rights of their mentally ill people.

The WHO QualityRights Tool Kit, as it’s endearingly awfully named, is a booklet that medical personnel, bureaucrats, parents, clinic workers, politicians — and the mentally ill themselves — can use to assess whether the practices a facility or country has in place to treat those with psychosocial illnesses are up to snuff.

There’s a pretty good chance they’re not. Forty percent of the leading causes of disability around the world are mental health-related (depression is No. 1.), according to figures provided by Dr. Michelle Funk of WHO’s department of Mental Health and Substance Abuse. That’s a lot of people to look after. “Poor quality care is not exceptional,” said Dr. Funk. “Scandalously, the health care facility itself can often become the violator of people’s rights.”

Some of these facilities use techniques that are positively Dickensian, chaining people, tying them to chairs or leaving them to sit for hours in their own waste. (The chained Indonesian woman in the image above, for example, has been kept that way by her family because she has schizophrenia.) In El Salvador, explained Carlos Enrique Garcia Gonzalez, one of his country’s representatives to the U.N., more than half a century of political unrest left the country with just one mental health facility and widespread stigma not only against the mentally ill, but also against those who care for them. (The situation is on the mend now.) But, while developing countries are the hardest pressed, “[human rights] violations are happening in countries which are rich and poor,” said Funk.

The Tool Kit takes as its one of its key premises that mentally ill people have to be involved in decisions about their own care, which is still not a given in most countries and is, frankly, often not the simplest route to getting people treatment. But advocates are firm that real change, and real treatment, is impossible without such input. “For as long as others make decisions for us, we don’t have rights,” said Robinah Alambuya, president of the Pan African Network of People with Psychosocial Disabilities. “No amount of medicine or western technology can replace our human rights.”

The WHO document is ambitious. At the very least, it’s meant to inform people of the kind of care that the mentally ill — people whose disabilities may much less visible than those who are physically affected — should be getting and how to begin to implement those standards. It’s a little like the summer reading lists many Northern Hemisphere school students are getting around this time: aspirational and daunting-looking, but worth it for the benefits.

Of course, any tool is only as good as the worker who wields it. There is no WHO police force to go around and enforce the standards. Adherence is largely left to the countries themselves. If a facility or medical administration doesn’t care to change its practices, or can’t, there’s little a tool kit can do. But perhaps, as with the summer reading lists, it may start to create more healthy habits.