1. Project Title: REFORMING MENTAL HEALTH LEGISLATION IN THE
SEYCHELLES: A SERVICE USER’S PERSPECTIVE
To Share my experience as a service user being part of a committee reforming Seychelles Mental Health Legislation and to make recommendations about how things could have been done better from a service user perspective and also if this would be replicated in other countries what would be the best way to do so.
2. PROJECT METHODOLOGY: WHAT WORKED AND WHAT DID NOT
The project methodology had four key components. The establishment of the NMHAC which I was part of; assessment of the mental health and related legislation of the Seychelles against the CRPD which was done by our external consultant; the development and implementation of a communication strategy which was not fully implemented; and engagement with stakeholders. We had two stakeholders meetings and I had to go through minutes and other reports and documents about the project also from documents I got while being part of the NMHAC and come up with what I wrote as a project. We had an expert on mental health legislation and an exterior manager for the project.
The Seychelles now has new mental health legislation before the Parliament that respects and protects the rights of persons with mental disability. It is not totally compliant with the CRPD in that it still allows ‘’facilitated’’
admission however the major focus of the legislation is on ‘’independent’’ admission. There are proper checks and balances to protect rights. The legislation has not yet been approved by Parliament and the NMHAC and
other members of civil society need to be vigilant.
2. Project Title: Comparison of primary health care provider’s attitude towards mental health conditions,
HIV/AIDS, hypertension and diabetes and the integration of the management of these conditions into
primary health care, Juba County, South Sudan
Introduction: Mental health disorders, HIV/AIDS and NCDs are inter-connected, highly co-morbid, share important pathways to disease and risk factors. The WHO thus, recommends the management of those conditions to be integrated into primary health care. Negative provider’s attitudes can potentially impede integration efforts therefore, denying service users right to access health services contrary to provisions in International Human Rights Charters. Documentation of attitudes of care providers towards those conditions and integration can inform policy makers on adaptation of guidelines for management of those conditions as well as guide the process of integration.
Objectives: To examine attitude and associated socio-demographic factors of care providers towards service users with mental health disorders, HIV/AIDS and NCDs and the integration of their management into primary health care as well as relate whether the provider’s views promote provisions of International Human Rights Charters.
Methods: Using convenience sampling, a total of 10 primary health centers in Jubek Country, South Sudan were selected as study sites. During August, 2018, we systematically approached and interviewed service providers more likely to be involved in the continuum of patient care such as nurses and clinical officers by administering a questionnaire.
Results: Of 140 service providers interviewed, responses of 134 primary health providers were analyzed. Three quarters of the respondent were female. About 70% of all respondent demonstrated positive attitude towards physical health conditions (HIV/AIDS and NCDs) compared to persons with mental health disorders (64%). Providers also perceived more positively the integration of management of physical health conditions (HIV/AIDS, 78%; NCDS, 76%) into routine primary health care then the integration of mental health disorders (68%). Health providers who have worked in a health facility for five or less years are more likely to have positive attitude towards HIV/AIDS (p-value 0.032) and mental health disorders (p-value 0.58) than those who have worked for a longer periods. However; age, gender, profession, recent training in those conditions, religious affiliation and the volume of monthly patient attendance at health facility were not associated with attitude towards any of the three set of disorders.
Conclusion and recommendations: Mental health unlike physical health disorders are perceived negatively among primary care providers. It is likely that greater stigma is directed by primary care providers towards persons with mental health disorders than it is the case for those with physical health conditions. Other than the duration of work in a particular health facility, gender, age, recent training in mental health or HIV/AIDs or NCDs, religious affiliation, working in a low or high volume center does not influence the attitude pattern of providers towards those conditions.
Negative attitude can lead to discrimination and therefore, deprivation of the right of service users to enjoyment of the highest possible standard of health as stipulated in international charters. Tainting and on the job mentorship especially targeting providers who have worked longer in a given health facility is recommended.
3.Project Topic – Safeguarding rights of people with mental disabilities by introducing supported decision making model for Lithuanian legal system. Aim:
To propose changes to existing legal guardianship system while introducing supported decision making model for Lithuanian legal system corresponding to requirements for equal recognition before the law under Art. 12 of Convention on the rights of people with disabilities (CRPD).
- To critically analyze Lithuanian legal guardianship system for its compliance/noncompliance to the equal recognition before the law requirements in Art. 12 of CRPD.
- To review and analyze supported decision making models existing in other countries.
- Based on the comparative analysis of the supported decision making models, to make recommendations for Lithuanian legislation and practice on possible supported decision making model.
- Review of national laws, policies and practices on legal capacity and guardianship, as well as international standards. Specific areas of WHO Mental health legislation and human rights checklist will be used for assessing the Lithuanian legislature regulating legal capacity and guardianship procedure.
- Supported decision making model. Requirements and principals as indicated in Art. 12 of CRPD.
- Review of supported decision making models existing in other countries.
- Analysis of Lithuanian practice as possible SDM measures.
- Conclusions and Recommendations
4. Project Topic – SURVEY ON HUMAN RIGHTS BASED ON WHO TOOL FOR ASSESSING QUALITY AND HUMAN RIGHTS CONDITIONS IN MENTAL HEALTH FACILITIES IN ETHIOPIA Purpose:
The purpose of this research is to assess quality of services, conditions and human rights in Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, using the WHO tool for assessing quality and human rights conditions in mental health facilities.
The research consisted of observations and interviews. Fourteen interviews were conducted, six with users, two with family members and six with staff members. The following thematic areas were investigated in the observations and interviews:
- Profession, professionalism and consulting with health professionals
- Building conditions and sleeping conditions
- Seclusion, restraint and management of crisis situations
- Food, water and diet
- Hygiene, bathing and toilet facilities
- Electroconvulsive Therapy (ECT), psychosurgery and other medical procedures that have permanent and irreversible effects
- Activities and restrictions to communicate and to leave the facility
- Humanity, dignity and respect
- Psychotropic medication
Observations and interviews were conducted by the author together with a hospital staff member assigned by the Chief Executive Officer (CEO) of the hospital.
The findings for each theme are summarized in the table below:
|Theme 1: The right to an adequate standard of living||Achievement Initiated (A/I)|
|Theme 2: The right to the enjoyment of the highest attainable standard of physical and mental health||Achieved partially (A/P)|
|Theme 4: Freedoms from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse||Not initiated (N/I)|
From the observations and interviews with users, family members and staff members several issues related to human rights transpired, and more specifically to violations of the rights to an adequate standard of living, the right to the enjoyment of the highest attainable standard of physical and mental health, the right to freedom from torture or cruel, inhuman or degrading treatment or punishment and the right of freedom from exploitation, violence and abuse.
Conclusions and Recommendations:
Many violations of human rights have been discovered in this survey. Users are denied basic rights and exposed to inhuman treatments.
Areas where human rights have to be implemented include: electroconvulsive therapy (ECT), general hygiene and clothing, seclusion and restraint, humanity, dignity and respect.
The quality of services needs to be greatly improved.
5. Project Topic – Human Rights Training for Mental Health Users Outline
Aims and Objectives:
This training program is aimed to increase the awareness of human rights to Mental health users who are involved in “Our Step” Association of mental health users” and to those who are devoted to promote – and encourage others to promote – mental health and human rights.
- To be able to acquire a basic knowledge of international human rights law and treaties, including the right to health.
- To understand and explore the value and impact of linking health and human rights.
- To be able to understand the health impacts resulting from violations of human rights.
- To have knowledge of how mental health workers and professionals can protect and respect human rights.
- To develop the capability to work efficiently and effectively in groups and be able to communicate through presentations and discussions (as potential trainers).
- To form a basic advocacy group of Mental Health and Human Rights that can be disseminated throughout Jordan.
The participatory approach will be used for the training program. Group discussion, questions and feedback will add value and enrich the learning process of the training.
The training program will include the four main processes of planning, implementation, follow up and evaluation.
Detailed scheduling of steps and dates will be provided later with the detailed proposal.
The WHO materials on human rights (capacity building package) will be used for the training purposes, a translation into Arabic language and some other adaptation will be made as needed.
The above mentioned materials are based on the CRPD.
For the evaluation process, a survey will be designed that match the material and reflect knowledge of Human Rights.