December 4, 1998

By Humberto L. Martinez, M.D.

As chair of APA's Committee on Human Rights, I am urging all psychiatrists to join in the celebration of the 50th anniversary of the Universal Declaration of Human Rights, adopted in 1948 by the United Nations General Assembly to guarantee all human beings security, dignity, and well-being in every country of the world.

This declaration is especially important to psychiatrists because of its goals of alleviating suffering and promoting the conditions for improving the health and well-being of all people. The United Nations and other international policymaking bodies have endorsed specific resolutions to ensure that the human rights of mentally ill individuals are protected and that proper mental health care is given to them.

Documents such as U.N. Resolution 46/119 have been created to address this issue specifically. This resolution is the U.N.'s most detailed and comprehensive statement about the rights of mentally ill individuals. No other statement covers the variety of topics that this resolution does. It recognizes (1) the right to informed consent, (2) the right to protection from harm, (3) prohibition of arbitrary or unnecessary isolation or physical restraint, (4) the right to live, work, and receive treatment within the community, (5) the importance of acknowledging the patient's cultural background as he or she is helped to reintegrate into society, and (6) the right to be treated in the least-restrictive environment available.

The treatment of patients must be geared toward maintaining and furthering their independence, as well as promoting their participation in the community, the resolution points out.

The APA Committee on Human Rights, as psychiatrists Walter Reich, M.D., and Loren H. Roth, M.D., have indicated in articles previously published in Psychiatric News, continues to address the psychiatric impact and consequences of human rights violations through methods of terror and/or torture and other cruel methods of incarceration and punishment. The committee also provides policy recommendations to the APA Board of Trustees concerning these critical issues.

Human rights of mentally ill individuals have not been given adequate attention compared with other violations of human rights.

The U.N. resolution calls for more community-based services in all societies in an effort to make the mentally ill individual more a member of his or her community than an outcast, thereby improving treatment outcome.

Informed consent is also an important issue, because mentally ill individuals are poorly informed, if informed at all, about their rights pertaining to their treatment. In many countries mentally ill individuals are not given the opportunity to make decisions of their own and are left to waste away when laws protecting their rights are lacking.

In addition, particular attention must be paid to the increased involvement of patients and their families in treatment decisions. Patients in many countries receive little, if any, treatment by a psychiatrist or mental health professional.

Attention should also be given to the quality of care mentally ill individuals receive around the world. There should be a movement toward educating the community about mental illness so that the stigma of being mentally ill can be eradicated.

Finally, mentally ill individuals must be made aware of educational, rehabilitation, employment, and housing opportunities, as well as governmental protections from discriminatory actions aimed at them.

Dr. Reich has stated that "psychiatrists should take an interest in human rights because they are citizens, physicians, members of an important professional group, and human beings. Human rights abuses in any country, including our own, cause mental anguish for patients and families. Psychiatrists should, therefore, help prevent and relieve problems of human suffering caused by such abuses."

Quoting from a report of the APA Task Force on Human Rights, "The problem of human rights violations is a universal one and deserves the concern and response of all human beings. Not least, it deserves the response of psychiatrists. It can benefit from the special response psychiatrists can provide. . . ." The report says that psychiatrists themselves "will benefit morally and professionally" by using their skills to improve the lot of people who are victims of human rights abuses.

Psychiatrists can become involved through participating in human rights missions, becoming involved in the human rights curriculum in their programs, and disseminating literature that addresses these issues.

Changes to improve the quality of life of mentally ill persons cannot occur without the assistance of every psychiatrist, both on the national and international levels.

The APA Committee on Human Rights reaffirms its identification with the Universal Declaration of Human Rights as it celebrates its 50th anniversary and its fundamental commitment to human dignity. Moreover, we advocate an adherence to principles in U.N. Resolution 46/119 for the improvement of the mentally ill individual globally.

Dr. Martinez is executive director of the South Bronx Mental Health Council Inc. in the Bronx, N.Y.