Mental health is one of the biggest challenges of our time. An increasing number of people are struggling with depression, anxiety, and other mental disorders. These not only negatively impact individuals but also society as a whole. People with mental health problems are part of our community. We are all touched by mental health issues, whether personally or through our families, friends, or colleagues. Most often, it's the loved ones of those affected who fight for their rights. However, societal misunderstandings, stigma, and sometimes inhumane treatment in healthcare institutions make this journey difficult.
Mental disorders place a significant economic burden on society. They often affect a person's ability to learn, work, build relationships, and participate fully in society. While some mental disorders, like intellectual disabilities, are congenital, others develop over time due to brain injuries, illnesses, or traumatic experiences. Regardless of the cause, mental disorders can significantly hinder a person's ability to live a fulfilling life. For instance, depression is a major reason why people are unable to work or care for themselves and their loved ones.
While various treatments are available for mental disorders, the methods and approaches used in Latvia are not always suitable for patients' needs. Often, the practices in healthcare institutions do not align with human rights, ethical standards, or modern psychiatric knowledge. Therefore, this research project explored ways to implement a human rights-based approach to mental healthcare, especially for patients with impaired decision-making capacity.
Research on human rights in mental healthcare is crucial as it sheds light on what happens behind the closed doors of psychiatric hospitals and identifies the barriers to patient-centered and rights-based treatment. By examining mental healthcare processes, we can not only uncover systemic flaws but also develop proposals to improve the quality of care and achieve better health outcomes. Quality healthcare does not tolerate discriminatory or stigmatizing attitudes towards people with mental disorders. Disrespect for patient dignity and autonomy, especially forced treatment, are long-standing issues that harm individuals and must be eradicated. The study contributes to a more inclusive and supportive society by promoting understanding of the needs of people with mental health disorders and the available options to address them, both within healthcare and society.
A study funded by the Latvian Council of Science and conducted by the University of Latvia, titled " Towards a human rights approach for mental health patients with a limited capacity: a legal, ethical and clinical perspective" identified key human rights violations in the treatment of people with mental health disorders. The study revealed shortcomings in the legal framework, the rights protection system, healthcare organization, and daily clinical practices. For instance, the study uncovered discriminatory attitudes towards patients in both hospitals and courts, as well as a lack of knowledge and understanding of the rights of people with disabilities in healthcare and related fields. Based on the collected data, the researchers developed proposals to improve the situation in Latvia.
Human Rights in Mental Healthcare: The Need for Change
The study collected and analyzed data on various aspects of treatment, including Latvian laws and court practices, the experiences of patients and healthcare professionals, the latest scientific findings, and the experiences of other countries. Particular attention was paid to whether and how patients can exercise their right to informed consent for treatment and whether there is any informal or formal coercion in healthcare institutions. For patients, the right to participate in decision-making and choice is a prerequisite for quality, human rights-based treatment.
For those unfamiliar with the treatment of people with mental health disorders, it may be difficult to understand why forced treatment, without the patient's consent, is such a serious issue. Persuasion with the force in psychiatry is a widespread and long-standing practice. Many psychiatrists, judges, and prosecutors believe that coercion is in the patient's best interest and may be beneficial. Scientific evidence does not support this, but it does demonstrate negative impacts.
A study of court cases involving coercion in psychiatry revealed several human rights violations:
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Laws permit and psychiatric hospitals, even with court approval, practice the confinement of patients in healthcare institutions and the administration of medication or other forms of patient restriction without providing the patient with appropriate and understandable information, without the patient's consent, or against the patient's will.
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Laws and practices reflect a discriminatory and stigmatizing attitude towards people with mental disorders.
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A lack of respectful and patient-centered attitudes. Patients' opinions and wishes are often ignored, decisions are made and imposed by healthcare professionals, and courts subsequently authorize such actions.
Based on the analysis of legal acts, court case materials, interviews with patients and their relatives, and collaboration with Latvian and foreign doctors, lawyers, and other experts in the field of mental healthcare, including international patient organizations, the project developed recommendations that could improve the situation in Latvia. These recommendations have already been submitted and will continue to be submitted to relevant state institutions.
Teamwork to Transform Mental Healthcare
The study was led by Solvita Olsena, a leading researcher at the University of Latvia. She has a deep understanding of human rights in medicine. Under her leadership, the team brought together experts from various fields to work on this important project. The team consists of Latvian and Baltic lawyers, psychiatrists, social scientists, and other specialists who share a vision and interest in human rights-based mental healthcare. Their work was challenging and fruitful, as the jointly collected results and proposals have been submitted and will continue to be submitted to state institutions and lawmakers.
One of the biggest challenges was the reluctance of psychiatric hospitals to cooperate. Hospitals cited various, often unfounded, reasons for not allowing the research to be conducted in a part where the researchers planned to study the hospitals' actions in the human rights field. They did not agree to a proposal to conduct interviews with hospital patients to learn about their experiences and assess their decision-making capacity regarding treatment. Therefore, during the research, it was necessary to adapt and change the research approaches to obtain the necessary interview data and documents, including court cases, which demonstrate what is happening.
Continued Efforts
This research is just the beginning. Much remains to be done to ensure that people with mental health problems receive the support they need and are treated with dignity. However, with each step forward, we move closer to a future where mental health is valued and protected as seriously as physical health, where the patient is always a respected individual.
The project " Towards a human rights approach for mental health patients with a limited capacity: a legal, ethical and clinical perspective " (lzp-2020/1-0397) is implemented under the Fundamental and Applied Research program, funded by the Latvian Science Council.
