Mental health and the right to healthcare
Because of persistent misconceptions about mental illness and intellectual disability, around the world hundreds of thousands of men, women and children with mental health conditions have been chained or locked in confined spaces at least once in their lives. Human Rights Watch (HRW) found evidence of people with psychosocial or intellectual disabilities being shackled in 60 countries.
HRW saw people being detained in homes, state-run or private institutions and in traditional or religious healing centres, often in overcrowded, filthy spaces where they were forced to eat, sleep, urinate and defaecate in the same tiny area. This inhumane practice – called “shackling” – continues due to inadequate support and mental health services as well as widespread beliefs that stigmatise people with psychosocial disabilities.
Globally, HRW estimates that 792 million people, or one in 10 people, including one in five children, have a mental health condition. Depression, which is the most common mental health condition, is reported to be twice as common in women as in men. Women, given the high incidence of sexual violence they suffer, are also disproportionately affected by post-traumatic stress disorder (PTSD).
Yet mental health draws only limited attention from governments around the world. On average, countries spend less than 2% of their health budgets on mental health. The cost of mental health services can be prohibitive, and more than two-thirds of countries do not cover reimbursement for mental health services in national health insurance schemes. Even when mental health services are free or subsidised, distance and transport costs are a significant barrier.
In many cases, mental health services do not comply with international human rights standards because of limited understanding and awareness of mental
health. In many countries there is a widespread belief that mental health conditions are the result of possession by evil spirits or the devil, or of sins, immoral behaviour or a lack of faith. Therefore people first consult faith or traditional healers and often only seek medical advice as a last resort. This constitutes a violation of these patients’ rights.
Of the 60 countries where HRW found evidence of shackling, only a handful had laws, policies or strategies in place that explicitly ban or aim to end the shackling of people with mental health conditions, or adopt measures to reduce stigma against people with psychosocial disabilities, or seek to develop adequate, voluntary, and community-based mental health services.
The HRW report quoted Ridha, a family member with relatives shackled in Oman, as saying: “It’s heart-breaking that two of my cousins who have mental health conditions have been locked away together in a room for many years. My aunt has tried her best to support them but she struggles with stigma and the lack of robust of mental health services in Oman. It’s time for governments to step up so that families aren’t left to cope on their own.”
In a related incident, the Omani Centre for Human Rights (OCHR) reported in December 2020 on the suicide of Zuwaina al-Hinai, a young Omani woman. This event caused considerable controversy within Omani society, because of the message Zuwaina left behind explaining the sense of despair that had led her to take her own life.
Zuwaina’s case raised many questions concerning domestic violence against women and girls in Oman. Meanwhile, recently leaked phone recordings said to be in Zuwaina’s voice show the extent of her mental anguish before she committed suicide, without access to any kind of psychotherapy or discussion. Her desperation was so great that she could only weep hysterically, unable to speak and in a state of total breakdown.
Women often suffer mentally and physically because of a lack of emotional support, along with institutional negligence represented by the absence of laws to protect them, or specialist care facilities, or a hotline through which victims can report domestic violence and get support before it is too late. All of these factors increase the likelihood of women suffering mental and emotional health problems, and deprive them of their right to essential healthcare.
There is a positive association between socioeconomic inequality and poor mental health. Mental and emotional health issues can create an endless list of hardships, while related factors such as working conditions, unemployment, income and social relationships help in their turn to compound and aggravate mental health problems.
The Omani Centre for Human Rights calls on the relevant bodies in Oman to respect the rights of people with mental and Psychological health conditions in the same way that people with physical illnesses are treated, by doing the following:
- provide a hotline and care facilities for victims of domestic violence
- provide, as many countries do, a specialist- or volunteer-run crisis hotline offering callers emotional support, to reduce cases of suicide and prevent cases becoming chronic or untreatable. Callers must be treated with respect; their details must be kept securely and not released to anyone except those involved in helping them obtain any necessary treatment.
- increase awareness of mental health issues and intellectual impairments, and counter misconceptions by including mental health in school curricula.
- implement a comprehensive, multipronged approach to dealing proactively with mental health-related issues such as gender-based discrimination, child abuse and poor working conditions.
- carry out regular research into the impact of social, political and material conditions, within the home and in educational and health settings, on people’s mental and emotional health.
 Human Rights Watch, October 2020: Shackling of People with Psychosocial Disabilities Worldwide
 Omani Centre for Human Rights, December 2020. The Omani feminist movement: Between the hammer of government and the anvil of society