An editorial was recently published in the British Journal of Psychiatry to address concerns some psychiatrists have raised regarding the World Health Organization’s (WHO) QualityRights initiative. The editorial, titled “The WHO QualityRights initiative, building partnerships among psychiatrists, people with lived experience, and other key stakeholders to improve the quality of mental healthcare,” addresses the role of psychiatry in promoting human rights in mental healthcare globally.
“In a recent editorial in BJPsych, Hoare & Duffy expressed concerns that the QualityRights training and guidance tools may ‘marginalize’ psychiatry and compromise the rights of persons with mental health conditions,” the authors write.
“It is important to address these concerns and other misperceptions and to highlight how QualityRights is making a major impact improving the quality of psychiatric care in different countries, building partnerships and collaboration among psychiatrists, people with lived experience of mental illness, and other key stakeholders.”
The primary goal of the World Health Organization’s QualityRights initiative is to change both mindsets and practices to promote rights and recovery for individuals with psychosocial, intellectual, and cognitive disabilities. The WHO has already implemented the QualityRights initiative in alignment with the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in countries across the globe via a comprehensive training that utilizes distinct educational approaches and modules that illustrate both the need for rights-based approaches in mental healthcare as well as its urgency.
The authors of the editorial, Maria Francesca Moro, Soumitra Pathare, Martin Zinkler, Akwasi Osei, Dainius Pūras, Rodelen C. Paccial, and Mauro Giovanni Carta, are all psychiatrists; their primary intention behind this editorial is to reassure their fellow psychiatrists that the QualityRights’ initiative was designed with psychiatrists in mind.
“Psychiatrists were involved at every stage of the production of the QualityRights materials, and their collaboration was fundamental for this initiative’s success. In total, 8 of the 26 international experts who contributed to drafting the modules and 31 of the 151 reviewers were psychiatrists. Furthermore, when delivering the training to psychiatrists, at least one psychiatrist is involved as a trainer and helps lead the discussion on the most challenging topics.”
Although some vignettes do not shine the best light on psychiatry, they do shine an accurate one. One that does justice to the lived experience of those who have been harmed by their country’s mental healthcare system and its overreliance on psychiatry, medication, and other coercive mental healthcare practices. With that being said, the authors note that QualityRights still recognizes the importance of psychotropic drugs in treatment but that these treatment options ought not to come without alternatives.
In particular, the authors urge psychiatrists to seek out and advocate for alternatives to involuntary practices and be cautious of the danger of criminalizing people with mental health conditions, even in systems with limited resources. They write:
“There is mounting evidence that involuntary practices are deleterious and undermine the dignity and well-being of people with mental health conditions. Involuntary practices often also have negative impacts on trust, including an unwillingness to seek help and engage with practitioners.”
The authors clarify that psychiatrists have played an essential role in the continued realization of the CRPD and are necessary to further the realization and promotion of the QualityRights initiative.
However, they are also apparent that frank discussions concerning the coercive and abusive realities of the field, science, and profession need to be discussed and learned from as the lack of conversation is most likely more harmful than the potential consequences of the marginalization of psychiatry.
Moro, M. F., Pathare, S., Zinkler, M., Osei, A., Puras, D., Paccial, R. C., & Carta, M. G. (2021). The WHO QualityRights initiative: building partnerships among psychiatrists, people with lived experience and other key stakeholders to improve the quality of mental healthcare. The British Journal of Psychiatry, 1-3. (Link)