WHO urges mental-health policy review

WASHINGTON, Jun 22, 2005 (United Press International via COMTEX) -- The World Health Organization has released a legal guidebook to help governments develop mental-health legislation, as societies in many parts of the world debate ways to treat the mentally ill.

The "WHO Resource Book on Mental Health, Human Rights and Legislation," features experts from law, psychiatry and other fields suggesting ways to develop legislation to meet the needs of the mentally ill.

"We have a moral and legal obligation to modernize mental health legislation," Lee Jong-Wook, the WHO's director general, said in a news release. He added that his agency strives to fulfill this obligation by offering countries "technical support and expert advice."

Composed of 192 member states, the WHO is a United Nations agency headquartered in Geneva, Switzerland.

According to WHO statistics, more than 450 million people worldwide live with some form of mental illness. The agency also estimates that 25 percent of the world's countries have not enacted mental-health legislation.

The resource book also advocates updating existing mental-health legislation, stating that such laws in one-sixth of member countries date back before 1960. The stigma and superstition that remain attached to mental illness across the globe results in inhumane treatment of the mentally ill, the book adds.

The book cites "a vast number of examples that could constitute inhuman and degrading treatment," including "a lack of adequate food and clothing" and "systems of restraint that leave a person covered in his or her own urine or (feces)" when discussing treatment of the mentally ill in many countries -- many of which maintain few resources devoted to treatment of psychological disorders.

Eric Rosenthal, executive director of Mental Disability Rights International, told United Press International his organization has documented "very serious human-rights abuses" committed against the mentally ill in 23 countries -- most of which are mid-level developing nations.

Rosenthal, who provided analysis to the WHO for the guidebook, said legislation is only the first step in improving the situation of the mentally ill. "Legislation is necessary but not sufficient," he said.

He cited Mexico and Hungary as examples of countries in which model mental-health legislation exists but is largely ignored and rarely enforced.

Rosenthal said the nearly "universal fear of people with mental illnesses" is a result of the detention and forced isolation experienced by the mentally ill in many developing nations. He suggested it is the responsibility of these governments to work to incorporate the mentally ill into their societies instead of locking them away.

Even in countries such as the United States, where such practices do not constitute the norm, mental-health issues still need to be addressed, he said. The mentally ill in the United States live in a decidedly less threatening environment than many of their worldwide counterparts, but they largely are not being treated.

On June 6 the National Institute of Mental Health, in collaboration with researchers from Harvard University and the University of Michigan, published a study in the Archives of General Psychiatry concluding that nearly half of the U.S. population suffers from mental disorders.

The study, which made headlines worldwide, found that people in the United States with mental illnesses tend not to seek treatment until years after experiencing initial symptoms, because of the shame that often accompanies psychological problems.

According to the study, 10 years is the median amount of time people wait to seek treatment, with many waiting more than 20 years before getting help.

Dr. Ronald Kessler, a professor of healthcare policy at Harvard Medical School in Boston, told UPI that hesitations about seeking professional help persist because of years of discrimination against the mentally ill.

Kessler, who directed the NIMH-Harvard-Michigan study, said past healthcare-provider practices, such as requiring larger co-payments for mental-health patients, promoted the perception that a disorder "such as depression was not a real illness."

Such perceptions, he said, prevented people from seeking help and encouraged the mistaken assumption they could handle the problem themselves. Though Kessler thinks this reality is changing because of increased public awareness, lack of treatment in the United States remains a major problem.

"The kind of treatment in America is not working," Kessler said, adding that he does not think legislation is the immediate answer to solving shortcomings in domestic mental healthcare.

Instead, he said, "the marketplace has to sort this out."

Kessler said this could be accomplished by reorganizing the mental-healthcare system in a way that is cost effective for both patients and for their employers, who pay for health-insurance coverage.

This, according to Kessler, would be the first step in increasing access to mental-health treatment.

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Renee Williams is an intern for UPI Science News. E-mail: sciencemail@upi.com