Title:
Rights-Based Approach to Mental Health & Conflict with the Profit-seeking Healthcare Research
Abstract:
While there is an acceptance that a right-based mental health approach is required, there is debate about how effectively to execute and conceptualize it. The supremacy of the corporate investors in medical paradigm and the impact of profit-seeking corporatized industry on healthcare have resulted in an excessive-emphasis on intra-individual solutions, namely the sensitivity of patients to therapeutic therapies, with the result being under consideration for the socioeconomic and behavioural health factors and the requirement for population-based health development. This article suggests that a strong rights-based approach to mental wellbeing is required to address the impact of international interests on the area of mental health. In this article, the guiding principles of equality and empowerment, equal opportunity and non-discrimination, involvement and inclusion, accountability, and openness of the United Nations have been evaluated as the foundation of the human rights-based approach. The author addresses issues facing various occupations during the discussion of obtaining a right-based approach in mental healthcare around the globe. For example, to gain substantive engagement and question the hierarchy of different stakeholders like the investors, medical researchers, and the legislators, their roles, responsibilities and functions have been evaluated. The author has attempted to illustrate how profit-seeking corporatized research — using medicine mainly to satisfy the demands of the healthcare industry — diverts focus away from the socio-political factors of mental health which is essential for the robust upholding of right based approach. However, the author is proposing a change in the fundamental strategies of the corporatized health industry and an effective role of the policymakers so that mental health can be recognized as a fundamental human right.
Table of Contents
International framework for the recognition of the right based approach to mental health 3
How to reform the conflicting practice and the role of policymakers 6
Anticipated global development in the rights-based approach of mental health 8
Introduction
Decent health and wellbeing cannot be characterized by the lack of a psychiatric condition. Still, they must therefore be described by the cultural, behavioural, political, economical, and physical atmosphere that encourages people and communities to live a life of integrity, complete satisfaction of their freedoms, and the equal fulfillment of their capabilities.[1] Non-consideration of these essential aspects in the mental health research with the undue influence of the corporatized, benefit-oriented, commercial medicine-centric health sector has been an undeniable violation of the human rights of the mental health patients. Such a misguiding approach with an apparent avoidance of the accommodation of rights-based strategy is observed worldwide. Restructuring the state policies, well-framed legislations, the participation of the associated stakeholders, and loud voices of the general people can be effective in reducing the influence of profit-seeking corporatized medical research in the appropriate recognition and establishment of mental wellbeing as a human right for all.
International framework for the recognition of the right based approach to Mental Health
Equal treatments towards the people who have been suffering from severe mental health issues are not only their moral and ethical entitlements but also “essential foundations of peace and culture.”[2] The general form of the right to health for every individual was recognized by the United Nations about 20 years ago. The United Nations Committee on Economic, Social, and Cultural Rights (UNCESCR) played the most significant role regarding these issues. Adopting this declaration formally solidified the duty of nations to consider the right to health a necessity. Mental wellbeing has been recognized over the past two decades as a vital part of the right to wellbeing and one that needs to be resolved in order to accept this right. As the World Health Organization (WHO)’s first director-general acknowledged, there can be no real physical health without mental wellbeing.[3]
There are also some other international law principles that recognize mental health as a fundamental right for all and recommend effective measures to exclude conflicts and interference of the corporate industry of medical research. In addition, these documents stress the need for enhanced health and social outcomes through sustainable means, using an approach focused on human rights, in line with the UN Convention on the Rights of Persons with Disabilities (CRPD) and the right to health framework.[4] These normative principles have drawn attention to the interests of people with psychosocial conditions and the right to protection from the force in mental health care, along with ongoing appeals by consumers of care and defenders. It offers an incentive in societies everywhere for appropriate practices for improving and modernizing mental health. However, without recourse to coercive and dehumanizing approaches, the shape and the nature of right-based measures can help mental health care providers, family members, and other involved people remain uncertain. Although promising non-coercive approaches have been piloted in several countries for people with extreme emotional crises, better assessment and study are generally needed to improve their potential for broader adoption as alternatives to compulsory hospitalization. And while recent publications are arguing for such rights-based methods, it is still important to explain how to operationalize this emerging structure.
There are still, several obstacles in putting to life a right-based strategy for mental wellbeing. This approach includes a careful appraisal of the mental condition theories and conventional treatment models. The medical model’s monopoly and over-reliance on institutional psychiatry as the primary decision-maker have eroded mental health policy development as a vigorous cross-sectorial problem.[5] As a result, over-emphasis has been put on therapeutic treatments that are targeted at the person rather than population-based health management. At the same time, the latter is just as critical as personal medical services.[6] The emphasis on pharmaceutical treatments is especially problematic as it has undermined the scientific knowledge base of medicine of ways in which market control has.
This article suggests that a right-based mental health solution is required to address the impacts of business pressures on the area of mental wellbeing. In particular, it demonstrates how corporatized medicine — the exploitation of research solely to satisfy the demands of the business — distracts focus from the psychosocial and socio-political factors of wellbeing and contradicts some core aspects of a rights-based approach to mental wellbeings, such as the freedom to access, the right to adequate health services and the value of population-based health care management.
Profit-seeking health industry & benefit-oriented scientific research: how it threatens a right-based mental health strategy
The combination of science and industry threatens to erode research’s ethical principles and undermine the public interest in its findings.[7] Academic-industrial partnerships are credited with fostering creativity and have resulted in gains for human health (for example, malaria care and meningitis prevention vaccine). Yet the stresses of capitalism have culminated in a distortion of the scientific knowledge base, the structure of medical education, and even the prism by which human wellbeing and disease are perceived.[8] Indeed study has repeatedly demonstrated that market influence in all healthcare systems is a pernicious concern. Although there is controversy about the degree of prejudice, there is acceptance among academics, physicians, science institutions, and medical organizations that the scientific knowledge base has been undermined. Research has repeatedly shown that financial conflicts of interest form prescription procedures, patient education, policy, and editorial decision making.[9] In 2009, Conflicts of Interest in Medical Science, Practice, and Education were released by the National Academy of Medicine, which provided guidelines for restoring academic ethics. A decade later, an independent group of academics and professionals evaluated the advancement made and found that a pervasive financial reliance on the industry that brings economic influence to scientific data, medical literacy, and clinical treatment continues to exist.[10]
The public health consequences of the prejudice emerging from the impact of excessive business, especially when taken on average, are overwhelming. While all healthcare areas of research tend to deal with market prejudice and the resultant damage to patients, development of right based approach in psychiatry is especially vulnerable to any mental health condition due to the absence of an effective evaluation of social, political, biological and financial indicators.[11] In the world of neuroscience, commercialized research blocks out an understanding of epistemic complexity (i.e., an awareness of different idioms of distress) through promoting a reductive paradigm of pathological illness. This, in essence, results in the “professionalization of pain,” which upholds the superiority of psychologists and other mental healthcare providers on individuals who have suffered. The right to autonomy and independent decision-making, and the ability to reject a recommended procedure, is all too conveniently glossed over in the name of improving ‘treatment conformity.’ The highly promoted mental illness paradigm has led to many structural influences that have unintentionally enshrined segregation in health care facilities, such as compulsory hospitalization Rhetoric of disease and metrics of illness (for instance, the disability-adjusted year of life) is used to highlight the economic cost of mental illness, especially in low- and middle-income nations.[12] The following segment briefly explores the promotion of psychological research in four main areas: psychological taxonomy, psychotropic treatment studies, recommendations for clinical treatment, and medical research.
The conceptualization of psychiatric distress allows individuals to be seen as patients with recognized and quantifiable mental disorders. This change in the paradigm promoted standardization (for example, are the signs met for a mental illness?), but also distracted focus from examining how systemic measures at the population level could improve the wellbeing of the person. The implementation of an illness model has reinforced the structured position of psychiatry in the area of mental health.[13]
Corporatized influence on mental health policies arises when researchers have financial conflicts of interest or when a research process is funded (explicitly or implicitly) by the business of pharmaceuticals. Fraternity preferences can also affect the research group if it is not multidisciplinary enough. If the group does not involve methodologists, who can help ensure that the analysis of evidence is not affected by the concerns of a professional organization.
The use of a human rights perspective resurrects the ethical debates on the research of mental wellbeing since the compulsion to suppress the socio-political approach of mental wellbeing is based upon a moral justification rather than an economic one. The definition of a human right as an economic good contradicts its contents and places it as part of a financial function rather than as an essential part of our life. [14] In comparison, a greater understanding of the correlation of human rights with social variables of health is provided by the positioning of wellbeing within a normative context. The immediate psychosocial setting out of which the symptoms arise must be understood. A robust approach to human rights will also resolve crucial aspects of the partnership to improve people’s mental wellbeing.
How to reform the conflicting practice and the role of policymakers
The capability approach of Amartya Sen is a moral paradigm that recognizes that capacity-building is fundamental to human freedom and dignity. It demonstrates specifically that rights and capability must be regarded as interdependent entities.[15] Capability refers to the set of valuable functionings that a person has effective access to. Thus, a person’s capability represents the effective freedom of an individual to choose between different functioning combinations – between different kinds of life – that she has reason to value. (In later work, Sen refers to ‘capabilities’ in the plural (or even ‘freedoms’) instead of a single capability set, and this is also common in the wider capability literature. This allows analysis to focus on sets of functionings related to particular aspects of life, for example, the capabilities of literacy, health, or political freedom).[16]
There has been a lack of sophistication in determining what constitutes a ‘good outcome’ for people experiencing mental health difficulties. Even though health is defined and understood as a state of ‘wellbeing’ and not merely an absence of illness, mental health interventions tend to narrowly focus on reducing symptoms of mental illness. The need to also focus more broadly on enhancing subjective wellbeing is highlighted.[17] The author presents the following recommendations to respond to this interdependence and to recognize that access to health care and equality is not misconstrued.
To establish policies, programs, and standards of treatment that appreciable different idioms of distress, more integrated are required first and foremost in people with a psychiatric disorder or who identify as persons with psychosocial disabilities. Participation should not be seen as an add-on, but as a “simple and successful approach to enhance the processes and facilities of health care;” it will allow proposed solutions to be broadened beyond biomedicine. This is why the decision-making, creation, and distribution of the research and practice guidelines on mental health should be essential to people with professional experience.[18] Such inclusion would also help ensure that corporate interests do not compromise the credibility of the standards. The involvement of appropriate stakeholders and researchers concerned with establishing a right-based approach in mental health research is required to establish mental health as a human right by incorporating the socio-political considerations of this paradigm.
Besides, to combat the stigma, increased stakeholder engagement will help us better recognize the societal mechanisms that continue to stigmatize people with psychosocial disorders and question it.[19] A more complex social interpretation of stigma, which considers it social, emotional, and systemic, must be a foundation for the avoidance of counter-stigma approaches.[20] The Queensland Mental Health Commission in Australia, for example, has reviewed legislation and defined potentially stigmatic legislation, explained why and made concrete suggestions for alteration or disposal.[21] The stigmatization process can thus be prevented by a right-based approach as it relies on the universality of human rights. This approach should be followed by the law-makers of every country of the world to ensure an effective establishment of mental health as a human right.
Evaluations of enforcement between states and consumers with a rights-based approach should not, also, be limited to the distribution of psychiatric drugs. Profit-seeking medical researchers and the investors that do not take into account social determinants of health will also not comply with, or adhere to, the right to health in such circumstances.[22] Intra-individual interferences must be positioned on a level playing field with population-based health, as the changes to communities’ mental health cannot only be improved by growing access to a physician and psychiatric care.[23] The Special Rapporteur on the Right to Health, for example, has repeatedly called on states to promote health promotion activities rather than to increase access to psychiatry and care, urging them to take steps on systemic factors that cause mental distress.[24]
Finally, the policymakers must examine the essential position of power of the state and legislators on the broader concept of health, which will deepen the understanding and drawbacks in the right-based approach of mental health. Early on, it was found out that the discourse and policy on mental wellbeing need to change, from talking about chemical imbalances to coping with power imbalances. The power asymmetries resulting from decision-making staying based on financially competing psychiatry and industry disempower the people who need the most treatment from the health professionals, the concentration of the medical researchers, and the care of other people around them.
Anticipated global development in the rights-based approach of mental health
The root of mental health issues and crises also lies in social exclusion and restricts empowerment, and interferes with the basic human need for social relations. Social exclusion Essential elements should also not be an inhibition of social integration and, where appropriate, the deterioration of people with psychosocial disabilities.
Article 5 of the CRPD maintains a complex substantive equal opportunities model that addresses systemic and indirect discrimination, values various identity strata, and admits discrimination between parts. In line with this clear concept of non-discrimination, the essential elements of mental health services and programs should agree that everyone is equal, ban any discrimination on the grounds of disability, and take reasonable measures to ensure sufficient accommodation. Psychosocially disabled people must be assisted and not limited to the exercises of rights.[25]
The autonomy theory means that people should decide for themselves about their lives by having sufficient assistance, where possible, to prevent alternative decision making. Respect for autonomy supports the rights of people to determine the forms and components of treatment and help and to decide as individually as possible about their lives. The basic elements of crisis responsiveness have to be taken into account. Every individual, with the right to autonomy and the intrinsic integrity of the free person, with the same rights as every other person, should be valued. Persons with psychosocial disorders are entitled to determine that others feel unwise or not.[26]
Enhanced engagement of concerned stakeholders has proven crucial in improving treatment by protecting and strengthening the rights of people with psychological disabilities, to name some of the best-recorded examples in countries that suffer from deinstitutionalization, such as the USA, Italy, Portugal, and Brazil. In the USA, empowerment became an essential organization, arising from the era of deinstitutionalization amongst the consumer/survivor / ex-patient movement that strengthened the treatment of people with the most extreme illness, reduced the inhumane practices, and unnecessary use of seclusion and retention. Consumer/survivor advocates suggest empowerment and inclusion as mental wellbeing initiatives. In our view, empowerment offers those with mental illness a virtuous cycle of greater equality and security. Instead of promoting or limiting engagement and empowerment, all main elements should.[27]
Conclusion
Scaling up the level of psychiatry in low-income South Asian countries runs the risk of becoming a medical administration whose main aim is to prescribe psychotropic medications and alleviate symptoms instead of addressing social and mental health and rehabilitation causes.[28] It is important to recognize that the fragile clinical foundations enable the industry to exploit the field of mental health. Although it is apparent that many individuals worldwide do not receive the treatment they require and deserve, it is also obvious that the uncritical export of a biomedical disease paradigm does not provide maximum effectiveness in individuals or communities.[29] In reality, it can very well lead to intentional or unintentional abuses of human rights (for example, involuntary treatment for the patients) if treatment of mental health is deficient of conceptual and institutional capability. However daunting it may be, it is vital to resolve the ingrained issue of commercial impact on the scientific basis of evidence to achieve a rights-based approach.
[1] Dainius Puras, ‘Report Of The Special Rapporteur On The Right Of Everyone To The Enjoyment Of The Highest Attainable Standard Of Physical And Mental Health’ (2019).
[2] Sebastian Porsdam Mann, Valerie J. Bradley and Barbara J. Sahakian, ‘Human Rights-Based Approaches To Mental Health: A Review Of Programs’ (2016) 18/1 Health and Human Rights Journal <https://www.hhrjournal.org/2016/05/human-rights-based-approaches-to-mental-health-a-review-of-programs/> accessed 20 September 2020.
[3] Chisholm Brock, ‘Outline For A Study Group On World Health And The Survival Of The Human Race: Material Drawn From Articles And Speeches’ [1951] Geneva: World Health Organization <https://apps.who.int/iris/bitstream/handle/ 10665/330666/MH.276.51-eng.pdf> accessed 19 September 2020.
[4] Piers Gooding, Bernadette McSherry and Flick Grey, ‘Alternatives To Coercion In Mental Health Settings: A Literature Review’ [2018] Melbourne Social Equity Institute, University of Melbourne.
[5] Ibid n (1)
[6] Julie Hannah and Tasneem Sadiq, ‘Relationships Are Human Rights Determinants In Mental Health’ [2019] Health and Human Rights Journal <https:// www.hhrjournal.org/2019/06/relationships-are-human- rights-determinants-in-mental-health> accessed 19 September 2020.
[7] Sheldon Krimsky, ‘Science In The Private Interest: Has The Lure Of Profits Corrupted Biomedical Research?’ [2004] Lanham, Maryland: Rowman and Littlefield.
[8] Eric G. Campbell, Joel S. Weissman and Susan Ehringhaus, ‘Institutional Academic−Industry Relationships’ (2013) 298/15 Journal of the American Medical Association.
[9] Andreas Lundh, Joel Lexchin and Barbara Mintzes, ‘Industry Sponsorship And Research Outcome’ (2017) 2 Cochrane Database of Systematic Reviews.
[10] Ray Moynihan, Lisa Bero and Sue Hill, ‘Pathways To Independence: Towards Producing And Using Trustworthy Evidence’ [2019] BMJ 367
[11] Heather B. Perry, ‘Understanding Financial Conflict Of Interest: Implications For Information Literacy Instruction’ (2018) 12 Communications in Information Literacy.
[12] Arthur Kleinman and Joan Kleinman, ‘Moral Transformation Of Health And Suffering In Chinese Society’ [1997] New York: Routledge.
[13] Lisa Cosgrove, Sheldon Krimsky and Manisha Vijayaraghavan, ‘Financial Ties Between DSM-IV Panel Members And The Pharmaceutical Industry’ (2006) 75 Psychotherapy and Psychosomatics.
[14] Gillian MacNaughton and Diane Frey, ‘Challenging Neoliberalism: ILO, Human Rights, And Public Health Frameworks On Decent Work’ (2018) 20 Health and Human Rights Journal.
[15] Thomas Pfister, ‘Citizenship And Capability? Amartya Sen’s Capabilities Approach From A Citizenship Perspective’ (2012) 16 Citizenship Studies.
[16] Amartya Sen, “Sen’s Capability Approach” (Internet Encyclopedia of Philosophy) <https://iep.utm.edu/sen-cap/#H3> accessed October 15, 2020.
[17] Ross G White, Maria Grazia Imperiale and Em Perera, “The Capabilities Approach: Fostering Contexts for Enhancing Mental Health and Wellbeing across the Globe” (2016) 12 Global Health Journal.
[18] Kristi Heather Kenyon, Lisa Forman and Claire Brolan, ‘Deepening The Relationship Between Human Rights And The Social Determinants Of Health: A Focus On Indivisibility And Power’ (2018) 20 Health and Human Rights Journal
[19] Faraaz Mahomed, ‘Stigma On The Basis Of Psychosocial Disability: A Structural Human Rights Violation’ (2016) 32 South African Journal on Human Rights.
[20] Flick Grey, ‘Benevolent Othering: Speaking Positively About Mental Health Service Users’ (2016) 23 Philosophy, Psychiatry, and Psychology.
[21] Kari Lancaster, Kate Seear and Prof. Alison Ritter, ‘Reducing Stigma And Discrimination For People Experiencing Problematic Alcohol And Other Drug Use’ [2017] A report for the Queensland Mental Health Commission.
[22] Dainius Puras, ‘Challenges In Promoting The Interdependence Of All Human Rights’ [2019] Health and Human Rights Journal <https://www. hhrjournal.org/2019/12/challenges-in-promoting-the-interdependence- of-all-human-rights/> accessed 19 September 2020.
[23] Audrey Chapman, ‘Global Health, Human Rights, And the Challenge Of Neoliberal Policies’ [2016] Cambridge: Cambridge University Press.
[24] Ibid n (1)
[25] Thereisa Degener, ‘Disability In A Human Rights Context’ (2016) 5 Laws.
[26] Mohammad Minhazur Rahman, ‘Recognition Of Mental Health As A Human Right In Bangladesh: COVID 19 Highlights The Necessity More Than Ever’ [2020] Bdlawnews.com <https://www.bdlawnews.com/recognition-of-mental-health-as-a-human-right-in-bangladesh-covid-19> accessed 20 September 2020.
[27] Peter Stastny, Julie Hannah and Daniel Goulart, ‘Crisis Response As A Human Rights Flashpoint: Critical Elements Of Community Support For Individuals Experiencing Significant Emotional Distress’ [2020] Health & Human Rights.
[28] Ross White and China Mills, ‘‘Global Mental Health Spreads Like Bush Fire In The Global South’: Efforts To Scale Up Mental Health Services In Low- And Middle-Income Countries’ [2017] The Palgrave handbook of sociocultural perspectives on global mental health.
[29] Helena Hansen, ‘Structural Competency In The U.S. Healthcare Crisis: Putting Social And Policy Interventions Into Clinical Practice’ [2016] Journal of Bioethical Inquiry.