Mental Health and disability

Mental health and the rights of persons experiencing psychosocial disabilities has been a neglected area in international development.

Psychosocial disabilities are common within all societies. However persons with psychosocial disabilities often face significant discrimination and stigma and are sometimes not well represented in Disabled Peoples Organisations.

Mental health cannot be considered in isolation from other areas of development, such as education, employment, emergency responses and human rights capacity building.

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) requires that States parties ensure that persons with disabilities have access to adequate health ( Article 25) and rehabilitative services (Article 26), which includes ensuring the right of people with psychosocial disabilities to access mainstream health services, and providing appropriate mental health services.

The UNCRPD also provides the right to personal security and freedom from inhumane treatment (Articles 14 and 15). However persons with psychosocial disabilities can face human rights violations in areas such as decision-making and legal capacity. Many also face violation of their rights to freedom from arbitrary detention and freedom from forced medical treatments.

Trauma from disasters, violence and conflict, can increase the incidence of psychosocial disabilities, necessitating appropriate measures in humanitarian assistance and post disaster responses.

The World Health Organization and partners have a focus on addressing access to quality mental health services for all.

Selected resources in this section include guidance documents, research findings, and network websites regarding inclusion of persons with psychosocial disabilities in development.

See also: Participation of Persons with Disabilities, Humanitarian and Disaster Risk Reduction, Law and Justice

CBM Global Inclusion Advisory Group (2022) People with Psychosocial Disabilities in Disaster Events

People with psychosocial disabilities are among those at the highest risk during and after disaster events. This is for a range of reasons, including that people with psychosocial disabilities: experience significant human rights abuses in most settings; are subject to pervasive negative attitudes, marginalisation and are often excluded from Disaster Risk Reduction (DRR) activities. Many thousands of people with psychosocial disabilities continue to be detained in institutions and/or shackled or locked up in the community against their will. They are often forgotten altogether during disaster planning or response, including during evacuation. A further danger is that the institutionalisation of people with psychosocial disabilities may rise after a disaster event. This is due to an ongoing lack of psychosocial supports and services provided in the community, based on free, informed consent. There is an urgent need to consider and address the needs of those with psychosocial disab

Inter-Agency Standing Committee (IASC) (2017) Reference Group for Mental Health and Psychosocial Support in Emergency Settings, A Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support in Emergency Settings, IASC, G

This document provides guidance in the assessment, research, design, implementation and monitoring and evaluation of mental health and psychosocial support (MHPSS) programmes in emergency settings. Although designed specifically for emergency contexts (including protracted crises), the framework may also be applicable for the transition phases from emergency to development (including disaster risk reduction initiatives). The framework assumes familiarity with the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings and an understanding of programming in humanitarian relief and/or development. It will be of use to DFAT officers who are providing support to, reviewing and monitoring projects which aim to provide MHPSS support to people in emergencies.

UN Special Rapporteur on the Right to Health (2017) Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest standard of physical and mental health

This report provides an excellent contextual overview, conclusions and recommendations relevant to promoting mental health consistently with the Convention on the Rights of Persons with Disabilities. The report challenges the biomedical approach, and clarifies how power imbalances and biased use of evidence have perpetuated a harmful approach to addressing mental health. The Special Rapporteur calls on all States to adopt a rights-based approach that moves mental health care and support out of institutions and into communities. The report ends with a series of conclusions and recommendations, including for international development cooperation.

WHO (2010) Mental health and development: targeting people with mental health conditions as a vulnerable group

This report presents evidence that persons with psychosocial disabilities are particularly vulnerable and neglected and require attention from development stakeholders. It provides guiding principles for the inclusion of persons with psychosocial disabilities across development priority areas, including case study examples. It lists a number of actions to be taken by development actors, including bilateral and multilateral aid agencies, NGOs, civil society, and academic institutions to promote inclusion.

Overseas Development Institute (2013) Background note on old age, disability and mental health: data issues for a post-2015 framework

This background note provides rationale for the collection of disaggregated data on disability, including persons with mental health issues, and provides a brief overview of gaps and opportunities in the measurement of excluded groups. It is a useful resource for development practitioners who are developing measurement tools that include persons with psychosocial disabilities.

Davar B (2012) Legal frameworks for and against people with psychosocial disability

This article provides an analysis of legal frameworks affecting persons with psychosocial disabilities in India. The article was a result of advocacy for the UNCRPD in India and contains policy analysis in the context of changing mental health legal frameworks. It provides useful guidance to inform the analysis of legal frameworks, and their influence on the participation of persons with psychosocial disability in daily life/their communities.

Humanity & Inclusion Source: Key list resources on mental health

Source is a comprehensive and frequently updated online resource centre on disability inclusion. Its key list on mental health provides a range of resources, including research, guidelines, policy briefings, health practitioner information, and links to organisations’ websites. The list of documents contains helpful information for those who wish to better understand mental health and psychosocial disability.

WHO (2010) Promoting and protecting the rights of people with mental disabilities

This information sheet provides governments guidance on protecting and promoting the rights of persons with psychosocial disabilities. It links to supporting WHO documents regarding mental health as a neglected area of development.

WHO (2013) Investing in mental health: Evidence for action

This report is targeted at national and international funding agencies. It provides an overview of some of the social and cultural factors contributing to the neglect of mental health within health systems. It provides recent evidence on the benefits of investing in mental health systems and guidance for these investments.

Centre for Human Rights of Users and Survivors of Psychiatry

The CHRUSP is a leader in human rights advocacy and the monitoring of issues affecting persons with psychosocial disabilities. Their website contains resources that provide development practitioners with useful information regarding the implementation of the UNCRPD. It also provides links to publications, videos, and human rights advocacy materials.

WHO (2012) The WHO mental health policy and service guidance package

This package of resources contains 14 modules addressing policy, planning and service development. It provides useful guidance for governments and agencies providing technical support to governments regarding the development of mental health systems.

World Health Organisation (WHO) WHO MIND

This website outlines WHO’s approach and role in addressing mental health and development. It contains links to web pages and documents outlining WHO recommendations for the development of mental health services and inclusive general health services, mental health legal reforms, mental health response in emergencies, quality assessments of services, and human rights advocacy regarding persons with psychosocial disabilities. It includes guidance documents, toolkits, case studies, and policy briefings. Some key resources from the website are listed below. (Note that in these documents, the authors definition of persons with mental health conditions includes persons who have mental illness, epilepsy, substance use disorders, child and adolescent mental health problems, intellectual impairments, and persons with psychosocial disability).

Kleintjes A, Lund C and Swartz L (2013) Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: A qualitative study of perspectives of policy makers, professionals, religious leaders and academics

This research article examines the barriers to participation of persons with psychosocial disabilities in mental health policy development in South Africa. The findings contribute to the limited research regarding the exclusion of persons with psychosocial disability in policy formation and the authors make useful recommendations to policy makers for better inclusion. Although country-specific, the lessons may be used to inform the analysis of policy formation processes in other contexts.

World Network of Users and Survivors of Psychiatry (2008) Implementation manual on the United Nations Convention on the Rights of Persons with Disabilities

This manual sets out the actions required of States Parties to protect and promote the rights of persons with psychosocial disabilities.

By drawing on the lessons learned from the recent Ebola crisis in West Africa in 2013-2016, this brief outlines some of the challenges people living with mental illness face during epidemics. From these lessons, CBM looks at ways in which we can respond to the 2020 COVID-19 crisis with regard to addressing mental nhealth challenges in developing country communities and how we can best provide support to people with existing psychosocial disability.

CBM Global Disability Inclusion (2021) Community Mental Health Good Practice Guide: Peer Support

Peer support services for people with mental health issues promote connectedness, inspires hope, and offer a level of acceptance and understanding that is not found in other professional services. This good practice guide draws on CBM’s experiences supporting peer-to-peer programs in developing countries, featuring practical examples of the different ways that peer support can be delivered. This includes explaining what’s different between formal and informal peer support, self-help groups, and remote peer support. Includes links to other resources.

People with mental health problems and psychosocial disabilities often face barriers to exercising their rights and suffer a lot of shame, stigma and discrimination in accessing systems that should give people rights, including quality mental health care services. This good practice guide draws on CBM’s experience in mental health systems and service strengthening to demonstrate how mental health services can be improved. It includes examples of how CBM is strengthening mental health systems in West and Central Africa; how CBM is using the World Health Organisation’s (WHO) health system building blocks to improve mental health systems; recommendations for scaling-up mental health systems strengthening; and links to other resources.

Community Mental Health Forums (CMHFs) support community inclusion and participation, increase access to mental health services, and raise mental health awareness, reducing stigma and discrimination towards people living with mental health and/or psychosocial disabilities. This good practice guide draws on CBM’s experience with CMHFs to document and share ideas, good practice and lessons learned about CMHFs in low and middle income countries. It provides case studies evidencing the success of CMHFs, and explores the importance of involving traditional and faith healers in mental health care.

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Picture of a man from India holding a packet of milk that is for sale. His mother is in the background looking on.

Photo: Geoff Oliver Bugbee, 2010

Adi* (30) from India, experienced mental illness. He was able to access appropriate health services, including rehabilitation, for treatment of the illness. He has now established a business selling milk. (*pseudonym used) Copyright: CBM/Bugbee