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In a final day of plenary discussions, Salzburg Global Fellows consider how to bolster mental health patients' human rights and overcome resistance in the community

How can we view mental health care as an extension of basic human rights? And in liberal democracies, how does the legal system either support or challenge that objective? These were the central questions posed during a panel discussion on the third day of the Salzburg Global Seminar program New Paradigms for Behavioral and Mental Health Care.

One Fellow from Uganda has been working to empower service users in her country through the lens of human rights. Patient training sessions aim to transform basic mindsets, encouraging patients to view themselves not as victims but as agents for change. Patients learn to speak up about their preferences and challenge the institutions that serve them. This involves literacy courses, public speaking training, and civics lessons about local government and methods to enact political change. Ugandan officials are often awed at how clearly patients can articulate their wishes.

In the UK, one Fellow is working to ensure human rights by fighting the discrimination and stigma surrounding mental health. Time-to-Change leads campaigns that target specific populations, spreading patients’ stories and exposing the traumatic effects of discrimination. One powerful video begins like a horror film, flashing messages about the dangerous “schizos” living among us, before cutting to the reality, just a man in his kitchen living a peaceful life. Other videos target students and urge them to treat classmates with respect and compassion.

Meanwhile, another Fellow spoke about the intersection of human rights and the law. While most would agree on the value of promoting human rights and championing shared decision-making from a moral or theoretical perspective, the issues become much hazier when considering their legal application. For example, there’s a fine line between promoting human rights around the world and imposing values on a community. Does practising shared decision-making mean that patients are giving an enforceable interest to their doctors and practioners?

Many such legal questions need further, careful deliberation.

How can we overcome resistance to better mental health care?

Multi-national panel discusses human rights challenges in their countries.As much as we can herald integrated, community-based mental health care, there remain innumerable challenges in both developed and developing economies in enacting lasting, positive change.

The United States’ system, as one Fellow pointed out, is riddled with major, systemic issues, including issues with cost, the failure to treat large populations, the inadequate communication between patients’ doctors, the little emphasis on substance abuse treatment, and the fact that most de facto mental health providers are US prisons.

The situation isn’t much brighter in other countries. During the discussion, Fellows listed the major issues operating as barriers to better care. Those include lack of clear political leadership, change fatigue among medical professionals, segregated physical and mental health treatments, and enormous cost for access.

But there is hope. One bright example is Dual Diagnosis Anonymous, a peer group in Oregon that bypassed government failures and set up a joint mental health/substance abuse support community that thrives today.