Mental health and barriers to the achievement of the 'right to health'

Abstract

This paper explores issues relating to access to physical and mental health care for people with mental health problems in light of Australia's endorsement in 2008 of the Convention of the Rights of Persons with Disabilities, which established the right to health and to health care. Interviews were conducted with 10 key stakeholders with legal, policy, clinical and advocacy roles within South Australia and at a national and international level. Participants identified several barriers to the achievement of the right to health for people with mental illness, with discussion highlighting the legal definition of rights, governance of health and mental health, and structural barriers to receipt of care as the primary barriers. The data are explored in relation to social models of disability.

Nurses' views on physical activity for people with serious mental illness

“…The barriers raised by nurses were very consistent with the literature on physical health issues in mental health care: tight funding and resources (McGorry, 2005a); physical health problems associated with second generation antipsychotic medication (De Hert, Schreurs, Vancampfort, & van Winkel, 2009); difficulties of lifestyle adjustment due to the mental illness and anti-psychotic treatment (Hodgson et al, 2011;Roberts & Bailey, 2011); work priorities and lack of time to give more attention to physical activity guidance (e.g. Buchholz et al, 2009); fragmentation in service structures and roles (Henderson & Battams, 2011;Horvitz-Lennon, Kilbourne, & Pincus, 2006); accessibility of facilities, services and the need for transportation (Henderson & Battams, 2011), and social isolation and stigma (Hodgson et al, 2011).…”

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

“…In addition, the limited numbers of psychiatrists working within the public sector has undermined attempts to establish shared care schemes (Keleher 2006), while non-psychiatrists are reluctant to treat people with mental health disorders (Lambert 2003). Poorer monitoring of these patients has been associated with the misdiagnosis of physical symptoms (Henderson & Battams 2011), but also with lack of continuity in GP attendance (Lambert 2003). Further, when people with mental health disorders attend primary care services they are less likely to be monitored for physical health problems.…”

Editorial: Public Mental Health Policy, Mental Health Promotion, and Interventions Which Focus on the Social Determinants of Mental Health

“…The convention is based on a “social model” of disability, which underscores the role of social environments and systems in contributing to disability; it thus moves beyond a “medical model” where the focus is on individual deficits associated with disability, or a “charity model” that highlights need and dependency of people with disabilities (2, 3). The CRPD covers people with disability arising from mental disorders, who are particularly vulnerable to rights violations (4).…”

“…However, it has been noted that there is an undue attention on “negative rights” in treatment services (5), and limited capacity for the law to guarantee “positive rights” (2). Battams and Henderson note (5) that:

it has been argued that there is a much greater focus on ‘negative rights’, or the civil/political rights to refuse treatment and freedom from detention, rather than ‘positive’ rights such as the social/economic right to health care and access to treatment (6–8).

…”

“…They also found that in their own study on the implementation of the CRPD in Australia, there was a focus on rights in relation to treatment services, and a lack of focus on citizenship rights in relation to social inclusion and access to housing and other social determinants (2). …”