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 PAHO and the Reformulation of Mental Health in the Americas

Mental Health and Human Rights in Latin America and the Caribbean:
"There is a fundamental unresolved problem with admission procedures at psychiatric hospitals"

Since the early 1990s, the Pan American Health Organization (PAHO) has consistently and systematically provided technical cooperation and training in mental health and human rights. PAHO's human rights expert, Dr. Javier Vásquez, said that these efforts are gradually endowing the ongoing regional mental health reform with one of the most important components of the Caracas Declaration of 1990: human rights. However, he cautioned that the pace of progress in Latin America and the Caribbean has not kept up with the demands of this reform process.

In keeping with the Regional Conference on the Restructuring of Psychiatric Care in Latin America (1990) and especially, its most frequently mentioned document, the Caracas Declaration, PAHO has been using the human rights conventions of the Inter-American and United Nations systems as binding instruments for implementing mental health reform under the terms of the consensus reached that year in Caracas and buttressed with subsequent documents, declarations, and standards on health and human rights. However, according to PAHO experts closely linked with the development of these programs, real implementation in the countries of the Region appears to have been timid or meager.

At an event held October 13, 2006 at Georgetown University Law School in Washington, D.C., PAHO Director, Dr. Mirta Roses Periago said that PAHO and the World Health Organization (WHO) view these human rights principles, conventions, and standards not as an optional tool for promoting and protecting public health but as an essential strategy for improving public health worldwide.

Dr. Roses said at the time, the 1990 Caracas Declaration was a critical "seed" for helping to understand a new approach in using the international human rights law in all health interventions.

The WHO Regional Office for the Americas has sponsored many technical workshops on promoting human rights and fundamental freedoms with regards to mental health, HIV/AIDS, disabilities, the health of indigenous populations and older persons, sexual and reproductive health, smoke-free spaces, and immunization, among other issues.

National mental health programs have also been reinforced by these technical-cooperation activities in the Region. But still, this human rights approach adopted by explicit consensus in Caracas and in international human rights conventions has still not been developed or implemented as rapidly as it has in other health disciplines or areas.

"There is a fundamental unresolved problem with admissions procedures at psychiatric hospitals, and in general -except for United States and Canada- the Region still lacks specific standards for due process to safeguard and guarantee civil, political, economic, social and cultural rights and fundamental freedoms of people with mental disabilities," said Dr. Javier Vásquez, a PAHO human rights expert, in Washington, D.C.

 Dr. Javier Vásquez
Dr. Javier Vásquez

The preamble to the final 1990 text of Caracas recognized that psychiatric hospitals isolated patients from their environment, increasing social disability and creating adverse conditions that undermined respect for the patients' human rights. However, 17 years later, many countries in the Region have not moved beyond the psychiatric hospital as close to the only option for care. According to Dr. Vásquez, many have not yet introduced widespread, consistent processes for decentralizing mental health services as called for in international guidelines and standards and delivering such services in primary health centers and networks.

"The Region laws and policies have not led to hospitalization procedures consistent with international human rights standards and conventions, and with them, the periodic review of hospitalizations by multidisciplinary bodies guaranteeing the freedom of movement and other health-related rights," Dr. Vásquez said. "In many countries, these institutions [psychiatric hospitals] continue to house large numbers of people whose freedom of movement and other rights are constrained." This is the crux of the problem," he said, since "without the exercise of personal freedom we cannot even begin to speak of other fundamental freedoms and rights."

Dr. Vásquez considers that the impact of the Caracas Declaration, however, is now greater than ever, since it was the first inter-American standard to make international human rights conventions directly applicable to violations of these rights at psychiatric hospitals. Moreover, PAHO's efforts are gradually paving the way for regional reform, with several countries assuming leadership and groundbreaking positions.

Key Elements

The Caracas Declaration, Dr. Vásquez noted, states that resources, care, and treatment for mental disorders and illnesses should now invariably ensure the personal dignity and human rights of the users of these services.

"In conclusion, it can be said that the Caracas Declaration has in a certain way 'guided' or 'outlined' a human rights protection system for people with mental illness that did not exist prior to its formulation and whose legal foundations are the international and regional conventions ratified by PAHO/WHO Member States," Dr. Vásquez said. He added that the basic pillars of this protection system can be summarized in five basic points:

  • Dissemination of regional and international human rights guidelines and standards that protect persons with mental disabilities;
  • Incorporation of these guidelines and standards into mental health policies, plans, and laws;
  • Empowerment of users to demand respect for their fundamental freedoms and human rights under national and international legal mechanisms;
  • Technical collaboration with human rights ombudsmen; and
  • Technical collaboration with international and regional human rights organizations such as the Inter-American Commission on Human Rights and the human rights bodies created by the conventions that are an integral part of the United Nations system.

Dr. Vásquez added that thanks to PAHO cooperation programs and the human rights protection mechanisms that are part of the Inter-American and United Nations systems, PAHO and the Region have accorded greater importance to the linking of health and human rights, and this is the case not only for mental health but for many other areas, including HIV/AIDS, older adults, and people living with physical disabilities.

"Through PAHO human rights initiatives and the actions of other government and private agencies, it can be said that comprehensive reform of mental health systems (laws, policies, judicial procedures, and public health services) is underway in Latin America and the Caribbean. And all of this is rooted in the restructuring of psychiatric care called for in 1990 by the Caracas Declaration."

Dr. Vásquez concluded that today, no Ministry of Health in the Region can claim to be unaware of the duties and responsibilities of its employees and of governments to safeguard and guarantee the human and civil rights of health system users.

The most recent proof of how these issues have been addressed and been the focus of political commitments at the highest levels came on September 25, 2006, when at PAHO annual Directing Council, 35 Member States discussed and adopted a resolution presented by the First Lady of Panama, Vivian Fernández de Torrijos, titled "Disability: Prevention and Rehabilitation in the Context of the Right to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health and Other Related Rights."

"There can be no doubt that through this resolution, the Ministers of Health of the Americas officially recognized that human rights conventions and standards are an essential tool for restructuring health systems," PAHO Director Dr. Roses said.


Lecturas de interés

Part 5: A conversation with... Dr. Hugo Cohen, PAHO's Sub-regional Advisor on Mental Health for South America
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