Abstract
Objective: Insufficient understanding of the reciprocal interactions between health and human rights, mental health and human rights and the realization of all human rights by Indigenous peoples constitute a triple jeopardy in how these topics are currently being addressed and/or openly antagonized. This paper will attempt to show how a combined health and human rights approach to mental health in Indigenous peoples can transform a triple jeopardy into a triple opportunity.
Methods: The vast and growing body of literature on mental health, health as a whole, and human rights as these relate to health and to Indigenous peoples will be used to frame the discussion.
Results: Attention to the complex interactions of health and human rights can guide policy formulation and action by offering a method of analysis, a process of participatory decision and a framework for accountability. In addition, mental health can find its rightful place in the health and human rights discourse through efforts to help policymakers and practitioners broaden their vision of mental illness to holistically encompass aspects of physical, social, emotional and cultural wellbeing. Finally, connecting the role that rights realization plays in determining health and wellbeing will add power to the rightful claims by Indigenous peoples to the promotion and protection of all their human rights – civil, political, economic, social and cultural. Broadening the research agenda by applying systematically a health and human rights analytical framework to the understanding of social determinants of health would minimize the risk of assigning health outcome merely to behaviours, practices and lifestyles, uncovering structural determinants of holistic health entrenched in policies and governmental conduct.
Conclusions: Building the evidence of the negative impact of human rights violation on health and the negative impact of ill-health on the fulfilment of other human rights can help in designing comprehensive interventions, building on the synergy between the promotion of health and the promotion of rights. A way forward is proposed for which it is essential that work be carried out across ethnic lines and professional boundaries to further advance the claim of Indigenous peoples for better health and greater enjoyment of human rights.
Notes
aMuch of the focus of this article being on Indigenous mental health in Australia (see in particular: Hunter E. Aboriginal and Torres Strait Islander mental health, HealthInsite, http://www.healthinsite.gov.au/expert/Aboriginal and_Torres Strait_Islander_mental_health.
bThe foundation of the Health and Human Rights movement stems from a seminal article laying out key principles and concepts of the reciprocal relationships between health and rights. (Mann J, Gostin L, Gruskin S, Lazzarini Z, Feineberg H. Health and human rights. Health and Human Rights 1994; I: 6–23.)
c‘The promotion of mental health is situated within the larger field of health promotion, and sits alongside the prevention of mental disorders and the treatment and rehabilitation of people with mental illnesses and disabilities.’ (Herman H, Saxena S, Moodie R, eds. Promoting Mental Health, Concept-Emerging Evidence-Practice. Geneva: World Health Organization, 2004; 5.)
d‘The holistic approach is one which permits mental health issues to be addressed in the “general health sector”. Mental health must be part of primary health care as well as reflecting Aboriginal values and approaches to mental and general well-being’. (Swan P, Raphael B. Ways Forward Report: National Aboriginal and Torres Strait Islander Mental Health Policy National Consultancy Report. Canberra: National Mental Health Strategy & Australian Government Publishing Service, 1995; 26). ‘This approach requires, for example, that Indigenous and health services be equipped to deal with mental health issues and that Indigenous general health workers be trained to recognize and deal with mental health problems and mental disorders. The general reluctance to pursue this strategy wholeheartedly seems to stem from the continued emphasis on more acute care. A preventive focus would be more conducive to facilitating a holistic approach’. (Human Rights and Equal Opportunity Commission. Bringing Them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families. Sydney: Human Rights and Equal Opportunities Commission, 1997; 387.)
e‘A holistic Aboriginal definition of health includes: mental health; suicide and self-harm; emotional, psychological and spiritual wellbeing; and issues impacting specifically on wellbeing in Aboriginal and Torres Strait Islander communities, such as stolen generation issues or grief, loss and trauma’. (Australian Health Ministers. National Mental Health Plan 2003–2008. Canberra: Australian Government, 2003; 37.)
fA ‘rights-based approach’ provides a convenient framework for policy development and programme planning, implementation and monitoring. A rights-based approach to health can be presented as a conceptual framework for the process of health and human development that is normatively based on international human rights standards and operationally directed to promoting and protecting human rights and health. There is no single, universally agreed rights-based approach, although there may be an emerging consensus on the basic constituent elements, as summarized by the 2003 Common Understanding achieved across UN entities. (United Nations. The Human Rights-Based Approach to Development Cooperation: Towards a Common Understanding Among the UN Agencies. Geneva: United Nations, 2003.)