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Mismanaged mental healthcare: A global predicament

20% of all children suffer mental health problems. Poor healthcare is major obstacle to recovery which can have lifelong implications.
20% of all children suffer mental health problems. Poor healthcare is major obstacle to recovery which can have lifelong implications.

Failings in mental healthcare mean that patients are facing human rights violations all over the world. A glut of disturbing cases have come to light recently, revealing the truly appalling conditions many are forced to endure. Guest blogger Isabelle explores the stories and asks what needs to change.

According to the World Health Organization (WHO), people with mental and psychosocial disabilities experience human rights violations in most countries around the world. These include physical restraint, seclusion, and denial of basic needs and privacy. Very few nations have legal frameworks that adequately protect the rights of people with mental disorders.

Furthermore, there is still a belief that humans with mental disorders are untreatable, dangerous and unintelligent, or incapable of making decisions. Not only does this social stigma lead to ostracism and abuse, it also discourages affected populations from seeking mental healthcare.

The most troubling fact is that certain psychiatric hospitals – the very institutions that that are supposed to ensure the health and well-being of people with mental disorders – are the ones oppressing and mistreating them. From both developed and developing countries, many disturbing cases have recently come to light, highlighting some of the horrific situations that mental health patients find themselves in.

Corrupt international institutions

A BBC report investigated the Federico Mora Hospital in Guatemala, labelled as the world’s most abusive and dangerous mental health institution. The hospital director has admitted that patients are currently being sexually abused by the guards. In addition, former patients – both male and female – said they were raped by medical staff (doctors and nurses). One victim mentioned that he was raped throughout the three years he spent there, and was also misdiagnosed with schizophrenia. Others who have been admitted to the psychiatric hospital were denied medical care, exposed to contagious and life-threatening diseases, and retrained without cause. The isolations cells are particularly disturbing; they are tiny in size and poorly monitored. One patient recently committed suicide in there. 

Institutions like these face multiple issues. Firstly, there are not enough trained staff to meet the needs of each patient. In the Guatemala case, two to three nurses are assigned to 60-70 patients. They handle this by sedating the patients, who are then unable to use the toilet by themselves. The reporter spoke of people lying on the ground outside, naked and covered in their own waste. Hospital equipment and infrastructure is also sorely lacking; the beds are rusted and broken. The workers say that the conditions are unhygienic and that they don’t have the required medication for patients. The abuse that occurs there is apparently common knowledge; some of the staff have complained but no one listens.

Boy alone in his bedroom in an orphanage in Bulgaria
In some institutions, patients are allegedly
“treated worse than animals”

A recent Human Rights Watch (HRW) publication described a dire situation in India, where girls and women are forcibly institutionalised in mental hospitals and residential care institutions across the country. They suffer from psychosocial or intellectual disabilities, and are abandoned by family members or police. These victims experience several forms of abuse: overcrowding and unsanitary surroundings, inadequate healthcare, involuntary treatment (including shock therapy), and sexual violence. One woman says that they are “treated worse than animals”. HRW states that because the government has failed to provide sufficient support and services, these women are condemned to a life of isolation, fear, and abuse, with no hope of escape.

How should we address mental health?

Except for severe cases, we should cease forced institutional care. People should be able to make decisions regarding their own care and be well-informed of their treatment options. Governments, disability organisations, and human rights groups should enforce regular and thorough monitoring of all such hospitals or residential facilities. It is very important that patients have a secure and established platform to voice any concerns, report maltreatment, and consult legal professionals. It would also help if family and close friends were involved in patient care programs. A New York Times article states that this is a proven factor in reducing violent behaviour.

Furthermore, the criminally insane have to be separated from other patients. The NYT report looks at the fact that because of patients’ rights laws and state health bureaucracies, violent patients are given a dangerous amount of freedom. This is why every day across the USA, dozens of assaults – against staff members and other patients – are recorded. The writer talks about several individual cases that occurred at California’s Napa State Hospital, where he works: psychiatrists have been badly beaten, one patient fractured another one’s arms, an assailant attacked an elderly man and threw him on the cement, and half the nurses on his unit are on disability from assaults or attempted rape.

Incidents like these are especially traumatic for the non-violent patients. They face the most risk of being abused, and are not mentally or physically capable of defending themselves or handling the situation. This puts their lives in jeopardy and potentially reverses any recovery or progress they have made.

Protecting future generations

WHO notes that 20% of all children and adolescents have mental disorders or problems. Half of these disorders begin before age 14. A major obstacle is that there are poor levels of mental health resources in low and middle-income regions: a shortage of psychiatrists, psychiatric nurses, psychologists, and social workers. However, the challenge is widespread. The Guardian investigated certain areas of England, where children in mental health crises are locked up by the police, because there are no safe places to assess or treat them. Additionally, in the areas where mental health units do exist, these are often full or have staff shortages.

Barriers to effective care include the absence of mental health from the public health agenda, and the lack of public mental health leadership. Underfunding, second-rate treatment, and incorrect diagnoses mean that many existing care facilities are more likely to serve as jail cells. And such harmful environments threaten a patient’s health, dignity, and life. Numerous health organisations report that many suicides are linked to psychiatric disorders. This is why recognising, diagnosing and appropriately treating mental illnesses – before they reach a destructive or irreversible point – is essential. Most importantly, we need to acknowledge that there can be no health without mental health. With a fundamental change in attitude, people with such disorders will finally be free from discrimination and ill-treatment.

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