Beyond Murphy : Sarah Knutson

Rethinking Public Mental Health Policy from a Human Rights Perspective

    Challenge is common. 1 in 4 people come into contact with the mental health system during their lives. 1 in 3 currently take some kind of psychoactive medication.

    ‘Trauma’ is pervasive. Ninety (90!) percent of those in the public mental health system are survivors of abuse or neglect, including experiencing or witnessing violence or lack of secure access to basic human needs.

    Trauma  is a common denominator.  We see this same ninety (90!) percent figure in other groups that have been labelled  ‘social problems’, including  substance use, criminal justice or homeless/ hard to house settings. Poverty also plays a huge role across demographics, both for children and adults.

    This is a human rights issue.  ‘Trauma’ is a euphemism.  It characterizes human rights violations as individual health concerns.  This distracts attention from the wholly preventable nature of these largely social causes and effects.  We also fail to connect the preceding disregard for human rights and needs with the kind of intense or extreme psychosocial responses that predictably ensue.

    This is a community social justice issue not an individual mental health issue. Vast numbers of our most vulnerable citizens are growing up without access to basic human rights – rights that have been pronounced universal and inalienable by the international human community.  These include:

    reliable access to food and habitable shelter;
    safety of person and property;
    dignity and respect by our fellow human beings;
    meaningful participation and voice in the communities where we live;
    access to the means to make a living and support a family;
    access to the relational and cultural resources necessary to develop our potential; and
    support to make sense of experience – and to share and communicate what one discovers with others – without fear of retaliation, discrimination or marginalization.

    Rights are predictive. When rights are protected, people tend to be happier, healthier and more socially engaged. We are also astronomically less prone to come into contact with the mental health or criminal justice system, to use substances in ways that generate social concern, or to experience housing challenges.

    The problem is human rights deprivation not mental illness, etc.  What most of society currently sees as individual deficiencies is actually a sign of societal ones.  We may think we are seeing symptoms of someone’s mental illness, addiction, crime, immorality, etc.  But, in all probability, we are actually seeing the predictable the effects of human rights deprivations – and of communities that have yet to learn how to respond in effective, socially restorative ways.

    Stop blaming individuals.  We need to stop assessing, diagnosing and treating individuals. Survivors of human rights deprivations should no longer be pathologized, labeled or segregated when they  manifest or express that an injury has occurred.  Rather, we should offer survivors opportunities reclaim their birthright to a full humanity and support to recover from the losses they have experienced.

    Make communities accountable. On the other hand, we should assess, diagnose and treat communities, governments and service systems.  We need to identify and actively work to remedy the unhealthy societal attitudes, institutions, and practices that allow human rights abuses to go continue.  Focusing on community systems and dynamics puts the ultimate responsibility for ending human rights abuses where it belongs.  It also assigns accountability for changing the relevant human rights climate to those who have the most power to do something about it.

    Predicted outcomes. Some predicted effects of implementing these changes include:

    Appropriate accountability. Communities will no longer be able to credibly blame their most vulnerable, least powerful members for the collective failure of local will and skill in addressing fundamental human needs.
    Meaningful incentives to address human rights concerns. Communities that are assessed and diagnosed as human rights deficient will have an incentive to change their image. In doing so, they may decide (or be required) to invest the resources actually needed to make these changes.
    Less stigma/ marginalization/ discrimination. The shifting moral responsibility from individuals to communities will go a long way toward eliminating the discrimination, stigma and hostility that is currently directed at survivors of human rights violations.
    ‘Help’ that is actually seen as helpful.  Communities will offer survivors services they want and need, and in an apologetic rather than blaming way.  This will remove current barriers to people seeking services.
    ‘Help’ that actually is helpful.  People who seek services will be supported to reclaim their personhood, including their capacity (and right) to participate as  respected, mutually responsible community members. This will vastly improve relationships between communities and those they historically have marginalized.
    Genuine social change.  As communities effectively assess, address and redress their human right climates, social problems will increasingly mitigate and largely disappear.  This will produce an attendant increase in the quality of life for all concerned.

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