Mental Health: Dignity in mental healthcare

Mental health is a state of well-being in which an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a meaningful contribution to their community.

Mental health is a critical component of individual, family, community and national wellbeing and prosperity.

The word dignity is rooted in the Latin words ‘dignitatem’ or ‘dignus’ meaning ‘of worth or value’ or ‘deserving of merit, honour or privilege’.

Every human life has worth and value and is therefore deserving of dignity. When we treat someone with dignity we are respectful in how we speak and address them, we listen when they speak and consider their needs, we accommodate them in our lives and schedules, we don’t bring shame and dishonour to them.

Many people living with mental health conditions are unfortunately not treated with dignity, they are often stigmatised, shamed, marginalised and excluded from society due to their mental health challenges.

As we commemorate World Mental Health Day on October 10, reflecting on this year’s theme, ‘Mental health is a universal human right’, may we consider how we can ensure dignity and respect for people living with mental health conditions.

Have I treated someone with a mental health condition in an undignified way?

Consider the following:

1. Do I fear those with mental illness without cause?
2. Have I used or do I use terms like ‘mad’, ‘crazy’, ‘going nuts’, to refer to people struggling with mental health conditions?
3. Have I treated someone differently once I find out that they have a mental health challenge?
4. Would I employ someone with a history of a mental health challenge who is stable on their treatment?
5. Would I marry or support my child to marry someone with a history of having had a mental health challenge?
6. Do I think people with mental health problems need long stay admissions in mental health institutions?

How are people with mental health conditions treated without dignity in our communities?

1. Stigma: people with mental health conditions are often discredited, devalued and discriminated against because of their conditions. Stigma is often rooted in a lack of knowledge and understanding about mental health conditions, the causes of these conditions, the prevalence of these conditions in our communities, the symptoms and the treatments available for these conditions. Stigma can cause us to treat others in an undignified manner.
2. Ridicule: the words and terms used in our communities to refer to mental illness are often cruel, demeaning and can strip someone living with a mental illness of their dignity and sense of self-worth.
3. Shaming: Sadly those with mental health challenges may be shamed for their symptoms, sometimes accused of pretending, seeking for attention or exaggerating their experiences. This is undignified and dehumanising.
4. Exclusion from work and educational opportunities: When those with mental health challenges disclose this history to potential employers or schools, they may find themselves discriminated against and denied of opportunities to further their education or work productively.
5. Exclusion from marriage and opportunities to build a family: disclosure of a mental health challenge will often result in the end of many intimate relationships and this results in challenges for people living with mental health challenges in forming stable relationships and building families.
6. Unnecessary extended stay in hospital due to social challenges and difficulties reintegrating someone who has had a severe mental health condition into the community
7. Poor quality mental health care: limited access to adequately trained health workers, poor infrastructure for mental health services and limited access to affordable mental health medications can result in slow recovery from mental health problems and feed the vicious cycle of undignified treatment.

How can we ensure dignity for people living with mental health conditions?

1. Increased awareness about mental health problems, the causes and how these challenges are managed. We often fear what we do not understand and increased knowledge and understanding about mental health problems is an effective tool to fight stigma at individual, family and community level. Greater awareness about mental health challenges will lead to earlier identification of problems and normalise seeking of prompt care.
2. Creating psychologically safe families, communities, schools and workplaces that are responsive to emotional and mental distress and that make reasonable accommodations for those struggling with and recovering from mental health conditions.
3. Investing in mental health care services and improving access to quality, dignified mental health care. Access to affordable, acceptable, quality mental health service with decent facilities can help encourage good mental health seeking behaviour in our communities. Quality mental health care will also protect the dignity of those with mental health challenges.
4. Training of health workers in dignified care of people living with mental health conditions. This could involve scaling up of the WHO Quality Rights Training for all health workers.
5. Making deinstitutionalisation a reality and supporting community based care of people with mental health conditions with short hospital stays only when necessary and integration of mental health care into general hospitals
6. Supporting people with lived experience of mental health conditions to tell their stories and empowering them to be advocates for mental health awareness, improving access to quality mental health services and formation of effective mental health support networks
7. Sharing our own story. We are less likely to stigmatise a person we have taken time to know and understand, a person whose story and journey we have been a part of. The power of an individual’s personal story with mental health challenges can help to change attitudes and beliefs about mental health problems. Sharing our story can help others struggling with mental health problems not to feel isolated and alone. Telling our story can help give others courage to reach out and get help.

It has been said that a society is judged by how it treats its most vulnerable members and mental ill health can make us very vulnerable and in need of quality, dignified care.

If you think that you or someone you know may be struggling with a mental health problem or mental health related stigma, please contact your nearest health care provider and get help.

• Dr Chido Rwafa-Madzvamutse is a consultant psychiatrist. Feedback on WhatsApp: +263714987729; LinkedIn: https://www.linkedin.com/in/chido-rwafa-madzvamutse-53529259/  ; Facebook: https://www.facebook.com/chido.rwafa )