Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Health Hum Rights. 2009;11(2):19-31.
Mental disability and mental health care have been neglected in the discourse around health, human rights, and equality. This is perplexing as mental disabilities are pervasive, affecting approximately 8% of the world population. Furthermore, the experience of persons with mental disability is one characterized by multiple interlinked levels of inequality and discrimination within society. Efforts directed toward achieving formal equality should not stand alone without similar efforts to achieve substantive equality for persons with mental disabilities. Structural factors such as poverty, inequality, homelessness, and discrimination contribute to risk for mental disability and impact negatively on the course and outcome of such disabilities. A human rights approach to mental disability means affirming the full personhood of those with mental disabilities by respecting their inherent dignity, their individual autonomy and independence, and their freedom to make their own choices. A rights-based approach requires us to examine and transform the language, terminology, and models of mental disability that have previously prevailed especially within health discourse. Such an approach also requires us to examine the multiple ways in which inequality and discrimination characterize the lives of persons with mental disabilities and to formulate a response based on a human rights framework. In this article, I examine issues of terminology, models of understanding mental disability, and the implications of international treaties such as the United Nations Convention on the Rights of Persons with Disabilities for our response to the inequalities and discrimination that exist within society--both within and outside the health care system. Finally, while acknowledging that health care professionals have a role to play as advocates for equality, non-discrimination, and justice, I argue that it is persons with mental disabilities themselves who have the right to exercise agency in their own lives and who, consequently, should be at the center of advocacy movements and the setting of the advocacy agenda.
精神残疾和精神卫生保健在健康、人权和平等的讨论中被忽视了。这令人费解，因为精神残疾普遍存在，影响着全球约 8%的人口。此外，精神残疾患者的经历是一个在社会中存在多种相互关联的不平等和歧视的特征。为实现形式平等而进行的努力，如果没有为精神残疾患者实现实质性平等的类似努力，就不应孤立无援。结构性因素，如贫困、不平等、无家可归和歧视，会增加精神残疾的风险，并对这些残疾的进程和结果产生负面影响。从人权角度看待精神残疾意味着通过尊重他们固有的尊严、个人自主和独立以及他们做出自己选择的自由，来肯定精神残疾患者的完整人格。基于权利的方法要求我们审查和改变以前在卫生话语中占主导地位的精神残疾的语言、术语和模式。这种方法还要求我们审查不平等和歧视特征存在于精神残疾患者生活中的多种方式，并根据人权框架制定应对方案。在本文中，我探讨了术语、理解精神残疾的模式以及联合国残疾人权利公约等国际条约的含义，这些都对我们应对社会中存在的不平等和歧视提出了挑战——无论是在医疗保健系统内外。最后，我承认医疗保健专业人员作为平等、非歧视和正义的倡导者发挥着作用，但我认为，行使代理权的权利属于精神残疾患者本人，因此，他们应该成为倡导运动和制定倡导议程的中心。
