Plotting a Research Path to a New Model of Mental Health Care

Both the World Health Organization and the United Nations, through the Office of the Special Rapporteur on Health, have urged that psychiatry’s biomedical model be replaced by one that centers on human rights, with an understanding that social determinants—poverty, race, violence, and environment—are factors that greatly influence mental well-being. This is a model that combines safeguarding rights for the individual with collective solutions for improving the social determinants of health, and in a in a recent article in Psychiatry, Psychology and Law, Yvette Maker and Bernadette McSherry, both faculty at law schools in Australia, argue that an “interdisciplinary research collaboration”  is needed to further develop this model of care. They write:

“Limited attention has been paid to the connection between social determinants of mental health as matters of human rights. This paper explores the potential for incorporating elements of both social determinants and human rights approaches to provide a new framework for mental health research, policy and practice.”

The authors provide a succinct recap of the history that led to this human-rights model for mental health. In 2000, the United Nationals Committee on Economic, Social and Cultural Rights stated that the enjoyment of the “right to health requires governments to take action on a range of ‘underlying determinants’ of health,” but at that time, didn’t address the “mental health” element in that right to health. However, in 2008, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) stated that those with physical and mental disabilities “enjoy the right to the highest standard of physical and mental health without discrimination on the basis of disability,” and this can be seen as the founding document for a “human rights” model of mental health care.

During his tenure as U.N. Special Rapporteur on Health (2014-2020), Dainius Pūras told of how a convergence of the two discourses—on the right to health and the social determinants of health—was crucial to developing this new paradigm of care. The authors write:

“He was particularly concerned that rights-based approaches to mental health tend to adopt ‘a narrow, individual focus on the prevention of mental health conditions’ through influencing individuals, meaning inadequate attention is given to wider social, economic, legal, political and other structural factors that affect mental health and well-being.”

The World Health Organization, in its 2021 “Guidance on Community Mental Health Services,” echoed this theme. That document, Maker and McSherry write, “observed that social determinants such as poverty, discrimination, violence and unemployment are often overlooked or ignored in relation to mental health, which they characterized as a hindrance to the realization of a human rights approach to mental health for people living with mental health conditions and psychosocial disabilities.”

A synthesis of human rights and social determinants perspectives, the authors write, can provide compelling evidence for implementing social policy that furthers both a human rights agenda and mental health goals. They cite two examples: research from eight European cities that showed a connection between poor housing quality (dampness and mold) and depression, and research in the United States that found a reduction in psychological distress when adults experiencing homelessness were placed in permanent housing.

Access to decent shelter is the human right here, and it helps provide a remedy to one of the social determinants of mental health: poor housing or no housing at all.

The prevailing biomedical model, the authors note, presents a conceptual barrier to remaking mental health care in this way. That model focuses on “locating problems and solutions within individuals [which] obscures the need to address the structural factors that make lives unliveable.”

The authors note that “interdisciplinary research has been defined as a ‘collaboration of [researchers] with largely non-overlapping training and core expertise to solve a problem that lies outsides the grasp of the individual [researcher].” What is needed is a collaboration that brings together service users, mental health practitioners, human rights lawyers and sociologists, which admittedly will “involve wrestling with competing cultures, values and priorities.”

The way forward, they conclude, will “include developing a common research agenda, working to articulate concrete measures that can be taken at local, national and global levels to advance health equity and the right to health in relation to mental health, and research to develop models for the implementation of such measures in mental health systems and beyond.”

 

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Maker, Y. & McSherry, B. (2023). Human rights and the social determinants of mental health: Fostering interdisciplinary research collaboration. Psychiatry, Psychology, and Law, p. 1-15. (Link)