There are … How the World Bank Is Mitigating the Impacts of COVID-19 in the Health Sector (2020). It has also been noted that refugees and immigrants in detention centers face an increased likelihood of developing post-traumatic stress disorder as many refugees associate economic hardship, food and medicine shortages with a threat to life alongside viewing military presence to enforce restrictions as a threat and not a protection (81). Individuals with mental health conditions – and their families – are subject to stigma, discrimination and victimization, and are vulnerable to violations of their rights. Pfefferbaum B, North CS. Table 3. Psychol Trauma. This research has the potential to inform interventions targeting such elements. Despite the boom in digital health during the COVID-19, no reported studies examined the role of engagement of technology with available services in mitigating the structural barriers to getting mental health care during the COVID pandemic. 73. Available online at: https://www.refworld.org/docid/3ae6b36c0.html. Psychiatry Res. The relationship between mental health and human rights is an integral and interdependent one. Finally, this review also acknowledges the implications for guideline and policies on different populations and therefore, (1) efforts to improve engagement of policy makers may be beneficial to address mental health outcomes during public health emergency and (2) civil society and human rights champions (including lived experience representatives), health care providers, and policy makers should work together to identify the policy, services, and interventions that enforce human rights which have a lasting impact on mental health of key populations during emergencies. Int Orthopaedics. doi: 10.1056/NEJMp2008017, 13. The work of the WHO is informed by the Convention of the Rights of Persons with Disabilities. Available online at: https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_impact_brief_for_UNFPA_24_April_2020_1.pdf. Specifically, pulmonologists and ENT specialists, who are at the frontline of the pandemic, scored higher in depression and anxiety surveys compared to other specialists (36). We are facing a global human rights emergency in mental health. Asian J Psychiatry. Available online at: www.who.int/reproductivehealth/publications/vaw-covid-19/en/, 78. This thinking has been part of the WHO mental health treatment gap action program (mhGAP) framework to champion human rights informed thinking and rally for mental health as a core human right. Psychological well-being among older adults during the covid-19 outbreak: a comparative study of the young-old and the old-old adults. (2020) 7:547–60. Quarantines are successful at limiting the spread of infectious diseases, but they introduce the side effects of increasing people's risk for psychological impact including suicide and other behavioral symptoms. (1989). Chew QH, Chia FL, Ng WK, Lee W, Tan P, Wong CS, et al. Brain Behav Immunity. Mark Heywood. Vigo D, Patten S, Pajer K, Krausz M, Taylor S, Rush B, Yatham LN. This review we hope has provided findings that set the foundation on how to integrate human rights as an integral part of public health response keeping mental health as a core thematic. Available online at: digitallibrary.un.org/record/3861155/files/OHCHRGuidanceCOVID19Migrants.PDF, 19. Available online at: www.un.org/sites/un2.un.org/files/un_policy_brief_on_covid-19_and_older_persons_1_may_2020.pdf, 25. doi: 10.1001/jamanetworkopen.2020.3976, PubMed Abstract | CrossRef Full Text | Google Scholar. Even outside the health care context, they are excluded from community life and denied basic rights such as shelter, food and clothing, and are discriminated against in the fields of employment, education and housing due to their mental disability. (2020) 10:e01730. Also, specific facets of children's rights, such as health care, shelter, and nutrition, were also affected. doi: 10.3332/ecancer.2020.ed99, 42. We have reported findings following the PRISMA guidelines (16). Int Psychogeriatrics. Impact Factor 2.849 | CiteScore 3.2More on impact ›, System level Interventions, Prevention Strategies, Mitigation Policies and Social Responses during COVID-19 that Improve Mental Health Outcomes: Evidence from Lower- and Middle-Income Countries (LMICs) Many people with mental disabilities are assumed to have no capacity to make decisions for themselves and are therefore being detained and treated in psychiatric institutions unjustifiably and against their will, where they are being treated appallingly and inhumanely. Joop T.V., De Jong M. (2002) Public Mental Health, Traumatic Stress and Human Rights Violations in Low-Income Countries. Vol 11:1–10. Available online at: www.worldbank.org/en/news/feature/2020/06/16/how-the-world-bank-is-mitigating-the-impacts-of-covid-19-in-the-health-sector, 2. 66. These violations include denial of employment, marriage, procreation, and education; malnutrition; physical abuse; and negligence. Even though psychiatric patients often experience high levels of social discrimination (67), in this review, a study in China reported that patients with mental illnesses had not been experiencing additional discrimination during the COVID-19 epidemic (44). doi: 10.1017/S1041610220000964, 51. Ms. Patricia Robertson, Administrative Assistant. Available online at: https://nccdh.ca/glossary/entry/vulnerable-populations#:~:text=Vulnerable%20populations%20are%20groups%20and,due%20to%20illness%20or%20disability. (2020) 66:560–5. These studies represented findings from 14 countries (six from HICs and eight LMICs). One out of 13 adult Colombians reported high suicide risk; people experiencing depressive episodes or poor sleep quality including insomnia, had a higher risk for suicidal behaviors than the general population. The definition, understanding and agreement on vulnerable populations might also vary from one country context to the other. Available online at: ohchr.org/en/issues/minorities/pages/internationallaw.aspx. For mental health, literature related to both generic factors such as quality of life, well-being and condition-specific aspects such as symptoms due to human rights abuses were included. (2020) 1–3. 11. Findings underscore the impact of systematic human rights violations, targeted violence, and daily stressors on the mental health of Rohingya in Bangladesh. http://digitallibrary.un.org/record/3860124/files/COVID19Guidance.PDF, 9. MR and RA along with MK wrote the manuscript. The understanding, development and functioning of public mental health systems might also vary in different geopolitical contexts. RA helped edit the protocol. This resulted in adverse outcomes in children's mental, social, and behavioral health. UN General Assembly. Key UN human rights protocols and policy documents for diverse populations. p. 3. doi: 10.1080/07481187.2020.1784312, 30. Individuals with mental illness are experiencing human rights violations on a global scale both within and outside of psychiatric institutions. Healthcare workers suffered negative mental health consequences due to stigma and lack of personal protective equipment and stigma. (2020). Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. COVID19 and Minority Rights: Overview And Promising Practices (2020). Human rights (2016). doi: 10.1016/j.jagp.2020.04.010, 80. This joint WHO/Gulbenkian publication provides guidance on services and supports required to end institutionalization of children and ensure that they can live and thrive in the community. Systematic reviews, meta-analysis or scoping reviews were excluded if the analysis did not include one of the primary outcomes. Up to 2.2 million people experiencing disability suffer collateral damage each day of COVID-19 lockdown in Europe. 43 The available evidence suggests that campaigns lead to … Other vulnerable groups such as the elderly, children, and refugees also experienced negative consequences. J Community Health. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). (2020). Minorities Under International Law (2020). This is consistent with the fact that the health emergency measures in response to COVID-19 were declared worldwide in March 2020 and therefore most relevant studies for this review would take place in the following months. Reported frequencies of abuse, self-harm, thoughts of suicide, and self-injurious behavior were higher among women, black, Asian and minority ethnic groups, people experiencing socioeconomic disadvantage, unemployment, disability, chronic physical illnesses, mental disorders and COVID-19 diagnosis. discourse on human rights in mental health usually revolves around SMDs, where the most frequent and visible violations of human rights take place, other violations such as the right to health and health care are also relevant to CMDs. United Nations. Shoib S, Nagendrappa S, Grigo O, Rehman S, Ransing R. Factors associated with COVID-19 outbreak-related suicides in India. In India, ~63.6% of psychiatric patients reported that they were experiencing verbal and physical aggression from others and 30.3% of their caregivers expressed a feeling of the excessive burden of taking care of patients in addition to the burden related to other reasons, like financial issues related to the lockdown (45). Specifically, in India, a study of severely mentally ill patients during lockdown found 80% of patients missed their appointments and failed to contact their mental health professionals, 30% showed features of relapse of symptoms during the lockdown, and 22% stopped their psychiatric medication with patients from lower socioeconomic status, low literacy levels, and with inadequate social support showing less knowledge related to COVID-19 (45). In addition, the review provides pointers to ethical guidance when dealing with vulnerable populations especially during public heath crises (see Table 3 for further recommendations and overview of prominent findings). The UN recommendations and guidance around COVID stipulates a public health approach to managing the pandemic impact based on equal rights, opportunity, and valuing freedoms especially of the most-at risk populations. Office of the High Commissioner for Human Rights. View all Office of the United Nations High Commissioner for Human Rights. p. 195. But one of the most pressing and overlooked issues to come out of my report is that failings in mental health care can involve violations of the most basic human rights of patients. United Nations, Treaty Series, vol. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. doi: 10.1007/s00787-020-01541-4, 53. Similar findings were reported in India where suicide cases increased as COVID cases increased, especially among individuals with pre-existing mental illness and those in poor socio-economic conditions (31). Three reviewers evaluated the eligibility criteria and extracted data. We summarize the agreements and global or national policies that enforce human rights during emergencies as a reminder of what we ought to be looking out for and values countries need to hold themselves accountable to. J Med Internet Res. However, there needs to be more emphasis on strategies that would address lockdown, public health action associated impacts and their mental health outcomes, and the need to prioritize mental health and well-being holistically. There was a wide variation in the included studies between methodology, the study design, and location. Human rights restrictions and violations have significant impacts on treatment outcomes, but higher impacts on patients with mental disorders given pre-existing mental health condition and social ostracization due to stigma. All people and professionals who have an impact on the lives of people with mental disabilities should receive training on human rights issues. Such campaigns have already been used widely to advance public understanding on mental health, reduce stigma and discrimination, and promote human rights in high-income countries. Amnesty International. Policy and frameworks to address different aspects of human rights can complement the various form of health services to enhance the mental health well-being during pandemics. Furthermore, home confinement can increase child abuse as pre-pandemic the vast majority of abuse was reported by staff working at institutions which were temporarily closed raising concerns that child abuse will go unnoticed, leading to higher child morbidity and mortality and long-term negative developmental consequences (70). United Nations, Treaty Series, 1577. United Nations. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary (2007). Given that the pandemic is going to take us through several waves of infection spread and containment, it is critical for this rights based approach to embrace short and long term mental health consequences and mitigation strategies. 95. Available online at: https://www.ohchr.org/Documents/Issues/Racism/COVID-19_and_Racial_Discrimination.pdf, 27. Available online at: http://digitallibrary.un.org/record/3861153/files/CivicSpaceandCovid.PDF, 24. (2019) 17:280. doi: 10.3390/ijerph17010280, 68. Office of the High Commissioner for Human Rights. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Civil, political, ... the right to education, and the right to physical and mental health. Studies reported that fear in communities about the exposure to infection through interaction with HCWs expose them to fear-driven shunning and outright discrimination and persecution (38, 57). Int J Soc Psychiatry (2020). doi: 10.1016/j.ajp.2020.102223, 32. According to the Declaration of the Rights of the Child (58), children's rights include protection, education, health care, shelter, and good nutrition. The review highlights human rights violations influencing the mental well-being in impacted population. After these efforts, many people began to understand how interconnected human rights law and mental law really were: (1) mental health policy affects human rights; (2) human rights violations affect mental health; and (3) positive promotion of both mental health and human rights are mutually reinforcing 15. doi: 10.1111/jpm.12644, 79. Convention on the Elimination of All Forms of Discrimination Against Women. The relationship between mental health and human rights is complex and bidirectional. A cursory search of Google Scholar was also conducted to identify any possible missed studies that meet the inclusion criteria. Regarding elderly's rights, two studies examined the association of human rights violations and mental health outcomes among elderly people in developed countries (48, 50). In our review, three studies reported rise in suicide incidence in several countries due to mobility restriction and lockdown. These are consistent with what is reported by WHO (73), as existing gender inequalities are exacerbated by COVID-19 which affect both genders differently (74). 660. WHO/2019-nCoV/SRH/Rights/2020.1). Front. See Table 2 that enlists Key UN human rights protocols and policy documents for diverse populations. WHO works to raise awareness and advocate for the rights of people with mental disabilities and collaborates with international organizations to disseminate international human rights standards. Brain Behav. The evidence highlights that vulnerable populations, including those living in abusive families, individual with disabilities, children, elderly, domestic caregivers, health care workers (HCWs), and ethnic and marginalized communities, are especially at risk for mental health distress (9–11) with the psychological needs of these populations not likely to be fulfilled without meaningful legislation and intervention (9, 12). Mental Health of Communities during the COVID-19 Pandemic. (2016) 75:40–6. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? In a study conducted in Egypt, HCWs reported that crowded and ill-equipped workplaces and widespread shortages of PPE during COVID-19 pandemic increased their fear of getting a serious infection (39). Mobility restrictions were also found to be correlated with poor mental and social well-being in developed countries. doi: 10.1177/0020764020937716, 44. (2020) 53:e102223. Moitra M., Rahman M., Collins P., Gohar F., Weaver M., Kinuthia J., et al. In our review, a study has revealed an additional model of ecology of health and sickness based on social determinants of health among migrant workers which are one of most marginalized and stigmatized population in LMICs (35). Disasters: Core Concepts and Ethical Theories. (2011). Human rights are at the core of Mental Health Europe’s work. The mental stress and trauma associated with such events would become subject of further inquiry as time moves on but sensitivity training and ethical psychosocial response needs to be embedded within judicial and armed services assisting emergency response. Given the current evidence, we believe that it is important to broaden our understanding of what rights violations entail in the context of this global pandemic and learn critical lessons in mitigation and prevention of these abusive and unethical situations and mental distress emanating from these. United Nations Human Rights, Office of the High Commissioner (2013). Lancet Infect Dis. Vol. doi: 10.1016/S0140-6736(20)30460-8, 69. (2000) 21:75–90. their rights and are therefore particularly predestined to become victims of human rights violations. A cross-sectional study in Lebanon reported that quarantined HCWs suffered adverse mental effects such as anxiety, stress, and depression that increase under self-isolation because suspected COVID-19 infection (37). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. World Health Organization. Many of the identified studies were conducted in developed countries and there may be variation in the understanding of human rights and legislations across countries. (2020) 56:361–5. A study in Spain of community-dwelling older adults with mild cognitive impairment or dementia found that enforced lockdowns, curfews, and social isolation had more significant adverse psychological effects and exacerbated sleeping problems for elderly living alone (48). Lancet Psychiatry. Ecancermed Sci. In many countries people do not have access to basic mental health care and treatment they require. doi: 10.1037/tra0000881, 100. Violations often occur behind closed doors and go unreported - unless people know that they are going on, action cannot be taken to stop them. To help strengthen mental health systems researchers should focus on developing robust information systems able to be enhanced by linking with other data sources to run predictive models using robust informatics methodology. Office of the High Commissioner for Human Rights. For LMICs, it is critical for the service provision be focused on accessible and equitable evidence-based community care models corresponding with the existing mental health capacity to deliver care, train existing primary care staff to cater to increased mental health needs, implement prevention and promotion programs tailored to local needs, and support civil societies and employers to address the increased burden of mental illness. Iob E, Steptoe A, Fancourt D. Abuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic. In accordance with the UN Pact on civil and political rights, national, ethnic, religious, or linguistic minorities (61) are meant to freely receive health services without any discrimination (62). What are my rights? In a group of patients with OCD who had completed an evidence-based therapeutic path for OCD before the quarantine, there was significant worsening of OCD symptoms compared to the pre-quarantine period. (2020) 174:898–900. Evolutionary origins of stigmatization: the functions of social exclusion. Addressing human rights as key to the COVID-19: response. Article 11 of the Convention on the rights of individuals with disabilities (CRPD) stipulating that all necessary measures to ensure protection and safety of persons with disabilities in situations of risk should be pursued (87). This results in a detrimental impact on the health well-being of disadvantaged minority populations and indirectly denies them access to medical care (66). It also included studies that reported mental, social, and behavioral health outcomes of the violations according to DSM/ICD classifications diagnostic categories or as ascertained using psychometric instruments. Many share similar recommendations such as advising for more investment into these vulnerable populations to ensure the negative impacts of the lockdown—including quarantine, social distancing, economic fallout—are lessened and disproportionate limitations around access to services and rights due to structural inequities are addressed. Available online at: https://www.apa.org/international/pi/2018/12/mental-health-rights, 8. Office of the High Commissioner for Human Rights. doi: 10.2196/19434, 49. No identified study examined old age discrimination or factors that directly contributed to autonomy of elderly individuals. This review does have some limitations, however. A similar study in Jordan found depression and anxiety to be more prevalent among HCWs than the general population. We recommend nations focus both on minimizing fatalities and protecting human rights. We are facing a global human rights emergency in mental health. According to the UNICEF and WHO, it is estimated that the majority of HCWs provide services and work in environments that lack basic infrastructure to support water, sanitation, hygiene and basic health care-related waste management (56). There has been little-to-no scholarly work on this subject though police brutality has been on the rise in context of enforcing stay-at-home and mask-guidelines (82). BMC Med. In: De Jong J. • Human rights violations span basic civil, cultural, economic, political, and social rights • In the health-care context, two major concerns are lack of access to mental health care, and ill treatment and abuse by health workers • Issues central to human rights violations are the denial of Available online at: www.who.int/publications/i/item/addressing-human-rights-as-key-to-the-covid-19-response, 105. Available online at: https://www.ohchr.org/EN/NewsEvents/Pages/int-day-torture.aspx, 86. Vulnerable Populations. There have been long standing concerns within the field of mental health that the human rights of psychiatric populations and individuals and communities under psychosocial distress tend to be ignored. (1989). Available online at: www.un.org/en/un-coronavirus-communications-team/we-are-all-together-human-rights-and-covid-19-response-and, 4. We strongly recommend global efforts toward focusing both on minimizing fatalities, protecting human rights, and promoting long term mental well-being.
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