A Washington, D.C., organization with only two employees is making many foreign leaders rethink their policy towards those with mental disabilities.

Now that’s power.

Although in existence for only seven years, this organization, Mental Disability Rights International (MDRI), has been instrumental in having foreign countries improve abusive and unsanitary conditions at psychiatric hospitals, orphanages, and other institutions. It has also helped promote new laws and consumer-rights programs and establish community-based psychiatric treatment in foreign countries.

MDRI is believed to be the only major nongovernmental organization in the U.S. dedicated exclusively to promoting human rights for those with mental disabilities (including mental retardation) in foreign countries.

"MDRI has been at the forefront in the worldwide fight for the rights of people with mental disabilities—a fight that is often overlooked by the mainstream human rights organizations," said Humberto L. Martinez, M.D., a member of MDRI’s advisory board and the past chair of APA’s Committee on Human Rights. He is also the executive director of the South Bronx Mental Health Council Inc.

The organization’s board believes that people with mental disabilities who are languishing away in isolated foreign institutions are capable of living productive lives in society if they receive appropriate community-based mental health care.

To accomplish this transition to the community and meet other goals, MDRI founder and executive director Eric Rosenthal, a 36-year-old attorney, and his lone paid associate work closely with their 31 volunteer board members and 20 additional volunteers including lawyers, psychiatrists, psychologists, and mental health professionals. The volunteers’ work is very important because MDRI’s limited funding (all of which is private) has prevented it from building a core staff, noted Rosenthal. Some of the volunteers even accompany him abroad.

For example, Martinez and Robert Okin, M.D., chief of psychiatry at San Francisco General Hospital, recently accompanied Rosenthal to Mexico, where in a 100-page report they documented the horrible conditions and abuses at psychiatric hospitals. In February and March their findings were featured in the New York Times Magazine and on NPR, CNN, and ABC News’ "20/20."

But the Mexico report is only one of three on foreign psychiatric institutions. The two others are on Uruguay (coauthored by Martinez) and Hungary (coauthored by Okin). Also, UNICEF supported an MDRI report on the rights and disabilities of children in Russia’s orphanages, "many of whom suffer major psychological deficits as a result of their placement in these institutions," explained Rosenthal.

These reports document the conditions at these institutions. Some had horrific physical conditions (urine-stained floors and patients tied to beds), brain-numbing boredom (not even a single book), and complete lack of patient and legal rights (patients are stripped of virtually all their rights upon admittance).

Having documented these conditions, MDRI then publicizes the reports both in the U.S. and in the respective countries. "Publicity is key because it puts public pressure on countries to comply with international law. Basically, it’s the shame factor—the force of public outrage gets countries to enforce human rights law," said Rosenthal. "We highlight the abuses in institutions in hopes of having leaders say, ‘This is inhumane. Let’s invest in good community mental health programs.’"

For example, "because of MDRI’s publicity for the Mexico report and because of pressure from Mexican advocates, the Mexican government promised major new funding to improve conditions in its institutions. In addition, [the government] invited Okin to Mexico to assist officials in developing a plan for moving patients from the more abusive institutions into the community," explained Rosenthal.

One critical reason this transition is difficult is because in most of these countries there is very little community care. To change this, MDRI trains and supports locally based grass-roots advocates (patients, family members, psychiatrists, and mental health professionals) on how to advocate for and set up community programs.

MDRI representatives do not, however, just tell other countries what to do. "We learn from the people in other countries as well," explained Rosenthal. "We also spend a lot of time explaining to people in other countries about the failures of the United States’s community mental health services. Everyone in the world knows about our problem of homeless mentally ill people living in the streets, and they ask, ‘Who are you to call for such reform when you have problems at home?’

"We have to explain to them that they can learn from our mistakes and that we also have positive models of community integration. . .and important rights protections including the ADA [Americans With Disabilities Act]—one of the greatest pieces of disability rights legislation in the world, which has served as a model for legislation in many countries," said Rosenthal

A common theme in all these efforts is the establishment and enforcement of laws for people with mental disabilities: "Currently the U.N. has a minimum human-rights standard for people with mental illness but no enforcement mechanism. Also, there are general U.N. human rights conventions that can be applied to people with mental disabilities. However, there is almost no effort to monitor or enforce these conventions as they apply to people with mental disabilities," said Rosenthal.

Thus, one of his paramount goals is to have the U.N. enforce the general human rights conventions and develop laws and programs in the respective countries.

"For example, MDRI has helped create human rights ombudsman programs that advocate for the rights of people with mental disabilities as well as ‘disability councils’ that promote the participation of ex-patients in human rights and public-policy advocacy," explained Rosenthal.