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Mental health: towards economic and social inclusion

I attended the Commonwealth Health Ministers’ Meeting (CHMM) in Geneva.

They meet in the wings of the World Health Assembly and use the opportunity to convene on key themes for the week. This year the focus was “Mental Health: Towards Economic and Social Inclusion.” This is a pressing global concern, with one in four of us likely to experience some form of mental ill health at some stage during our lives.

I listened to Ministers present their experiences of meeting the challenges. As they did so it was clear that governments and public health systems (whether well-resourced or not) are struggling to cope. They all acknowledge the limits to institutional care and made continuing references to community based strategies. While there was an implicit assumption that civil society organisations must be an essential component there were few explicit examples of how this is being enabled.

Another common factor in the country presentations was the issue of stigma attached to mental illness. Again this was a global challenge – although experienced differently across the Commonwealth: industrial contexts citing employment and workplace discrimination; and rural contexts referring to long held belief systems that ostracise and exclude. Many Ministers raised the need for awareness raising and public education as part of the process of changing attitudes – again an area where it would have been good to hear how civil society organisations have been playing their part.

The problem was that the meeting took place over the course of a morning, sandwiched in between other happenings around the WHA. This left little time for meaningful engagement with civil society organisations on these issues – areas where value could be added to ministerial deliberations. I think it is right that the periodicity and duration of the CHMM be looked at again by the Commonwealth Secretariat and civil society inputs to that review should be encouraged.

I went from the CHMM to the Commonwealth Partners’ Forum (CPF) – a separate event organised by the Commonwealth Health Professionals Alliance (a group of seven Commonwealth accredited civil society networks). This had been designed as a counterpoint to the CHMM and it is unfortunate that time did not allow any formal exchange between the two. The CPF theme was: Mental Health: A legislative framework to empower, protect and care. I was asked to open the Forum and in my comments I highlighted the importance of engagement between civil society and Commonwealth political processes. These need to be more than symbolic – they also need to be substantive.

The Forum saw the presentation of an excellent review of mental health legislation across the Commonwealth made by Dr Soumitra Pathare. He made several astute observations that I wished Ministers had heard. For example he reminded the audience that community care is not a panacea – that the abuse of people with mental illness occurs in the community as well as in institutions, highlighting the need for sound legislative frameworks. These he argued should be rooted in concepts of human dignity and associated rights. The primary mechanism to enable this was the UN Convention on the Rights of People with Disabilities (CRPD) which had been ratified by most Commonwealth countries. Yet in his review of legislation he found several instances where the law reinforces stigma and discrimination (for example there are 12 countries where there remain references to the term “lunatic”).

The Forum ended with several examples of good practice and inevitably these included instances where civil society organisations had played an active role in shaping policy and implementing legislation. What is clear is that public health institutions need help in engaging with civil society organisations and people with mental illness. The point was made that the involvement and engagement of People Living with HIV and AIDS was instrumental in changing the global HIV paradigm – perhaps the same could happen with mental health: there is scope for exchange and learning within the public health sector and civil society can make that happen.

Read the report