The essence of international treaties is to ensure world governments adhere to agreed-upon principles with regard to certain areas of interest, in particular, those that impact on human populations or the natural environment, including wildlife. The International Covenant on Economic, Social, and Cultural Rights (ICESCR) is one of the treaties that make up the International Bill of Human Rights. The others are the Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights. The aim of these treaties is to advance the ideal of freedom, where people, wherever in the world, enjoy civil and political freedom as well as freedom from fear and want. To attain this aim, the treaties recognize the need for governments to create conditions that allow every citizen to enjoy their civil and political rights, as well as their economic, social, and cultural rights. From the perspective of ICESCR, the essence of economic, social, and cultural rights is to ensure that populations in countries bound by the treaty are not denied access to the basic necessities for life. These necessities include rights to food and water, rights to decent housing, and rights to adequate healthcare.
Overview of the International Covenant on Economic, Social and Cultural Rights (ICESCR)
The fundamental principle that unites states that are a party to the ICESCR is that to ensure citizens are not bound by fear and want, conditions that allow everyone to enjoy their economic, social, and cultural rights must exist. It is from this background that the goal of the ICESCR, as enshrined in Article 11 of the treaty, is to protect the right of people to an adequate standard of living, underpinned by adequate access to food, clothing, and housing. Other goals of the treaty, as enshrined in Article 12 and 13, is to protect the right of citizens to enjoy the highest possible standard of physical and mental health, and the right to education, respectively. Article 15 protects the right of citizens to participate in cultural life. These goals form the operational framework of the ICESCR treaty and guide state parties in their effort to uphold and promote principles of human rights. For example, under Article 2(1), governments bound by the treaty commit to maximizing available resources to attain, progressively, the rights enshrined in the treaty. What this means is that every party to the treaty is duty-bound to utilize resources justly and effectively in the promotion of the above rights. Adopted by the United Nations General Assembly in 1966, the ICESCR, currently, has 169 member states as signatories.
In summary, states that are a party to the ICESCR accept to promote human rights in three ways: firstly, they commit to respect human rights by not violating the tenets of the ICESCR; secondly, they commit to protecting the enjoyment of rights; and thirdly, they commit to fulfilling the rights of individuals.
Analysis of a Human Rights Issue
As enshrined in Article 12 of the ICESCR, member states undertake to protect the right of citizens to enjoy the highest possible standard of physical and mental health. This goal is particularly important in light of the growing concerns about mental health in both the general population and the prison population. Several reports by human rights organizations and research studies show that mental health in the criminal justice system does not align with the letter and spirit of Article 12 of the ICESCR. Even though prisons are not meant to treat mental disorders, a substantial percentage of inmates have mental health problems, raising questions about the measures put in place to address the physical and psychological wellbeing of the population. The concern about the mental health of prisoners is founded on the notion that the population suffers from multiple and complex problems that exacerbate their psychological wellbeing. While severe major disorders can be treated through medication, there is a need for other approaches to therapy, including counseling, to address social problems impacting the population.
Mental Health as a Human Rights Issue
The historical and current incidence of human rights violations of the mentally ill goes against the tenets of the ICESCR, specifically Article 12. There is evidence of the extent of these violations, including arbitrary detention, inability to access health care, physical and sexual abuse, discrimination and stigma, denial of self-determination in financial and marital matters, and limited vocational and residential resources among other deprivations (Kim, Becker-Cohen, & Serakos, 2015). Mental health is related to human rights in three ways: firstly, people who undergo torture and displacement are denied their human rights and exposed to mental health problems, such as depression; secondly, coercive mental disorder treatment practices and programs impact on human rights; and thirdly, there is synergy when human rights are upheld as it promotes mental health (Asanbe, Gaba, & Yang, 2018). While this relationship concerns mental health, the benefits or suffering thereof extends to individuals’ physical health (Asanbe et al., 2018). On the basis of the relationship between mental health and human rights, it is, therefore, essential for governments, out of moral and legal obligations, to promote mental health in populations, and specifically in those incarcerated.
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Mental health is not limited to the state of mind, but rather embodies the harmonization of psychological, emotional, and social competence and wellbeing (Asanbe et al., 2018). In other words, it encompasses an individual’s quality of life and general wellbeing. As far-fetched as it might seem, deterioration in mental health can be interpreted from the perspective of one’s cultural grounding, including nationality, language, ethnicity, and religion. In society today, being diagnosed with or manifesting symptoms of mental health breakdown is a ticket to being labeled and subsequently being stigmatized by community members (Asanbe et al., 2018). This labeling involves perceiving the mentally ill as socially incompetent, a reality that makes many people with mental health problems to feel ashamed, humiliated, and worthless. Evidence indicates that a majority of those diagnosed with mental health problems in many cultures come from low socioeconomic backgrounds (Rosenfield, 2012). This is to mean that the economic arrangement of a country can be a source of mental health problems, highlighting the rationality of the ICESCR treaty.
Comparison between the United States and the United Kingdom
A wealth of research paints the sorry state of mental health the world over. Statistics from the World Health organization indicate that one in four people are bound to experience mental health problems in their lifetime, with stigma being a significant determinant of quality of care and access to essential treatment for mentally ill populations (Mfoafo-M’Carthy & Huls, 2014). Moreover, the mentally ill population has a reduced life expectancy when compared to the general population, with the life expectancy of mentally ill males and females dropping by 20 years and 15 years, respectively (Mfoafo-M’Carthy & Huls, 2014). Despite this reality, almost two-thirds of people presenting with mental health problems do not seek treatment services. The reality of mental health problems in populations suggests the rationality of the ICESCR treaty and the need for countries to approach mental health as a human rights issue.
Mental Health in US Prisons
Mental health promotion is one of the biggest challenges in the US healthcare system. The country’s correctional system is considered the environment with the highest number of people with mental health problems (Human Rights Watch, 2009). Evidence suggests that care in psychiatric institutions violet to a great extent the human rights violations of mentally ill individuals than correctional facilities (Kim et al., 2015). However, this does not mean that prison settings are any better when it comes to protecting the mental health and subsequently the human rights of inmates diagnosed with mental health disorders. Even though the US criminal justice system is not designed to treat mental health problems, the prison system has increasingly assumed this role due to the rising numbers of mentally ill inmates. The high number of mentally ill prisoners is related to the lack of community-based services after psychiatric hospitals were closed (Human Rights Watch, 2009). It has become the norm that those unable to get mental health treatment in the community are introduced into the criminal justice system once they engage in criminal activities. Data from the Bureau of Justice Statistics show that almost 55 percent of state prisoners and approximately 43 percent of federal prisoners present with symptoms or a recent history of a mental health disorder (Human Rights Watch, 2009). The main disorders high in the population include schizophrenia, bipolar disorder, and major depression, which are almost four times higher than in the general public (Mfoafo-M’Carthy & Huls, 2014). Furthermore, close to 19 percent of mentally ill prisoners present with psychiatric disorders associated with significant functional disabilities (Human Rights Watch, 2009). These findings suggest the need for psychiatric intervention during incarceration.
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Regardless of the environment, mentally ill prisoners need access to psychiatric treatment owing to their unique needs. The ICESCR treaty underscores the need for the US government, as a signatory, to protect the mental health of its citizens, including prisoners. However, a number of issues have undermined the mental health of prisoners in the country and by extension, undermined their human rights. These issues include inadequate professional training for prison staff members, use of disciplinary measures instead of psychiatric support, multiplicity of mental health severities, verbal abuse and neglect from staff, and exacerbation of mental disorders due to confinement (Matejkowski, Caplan, & Cullen, 2010). The problems of mentally ill prisoners, however, are not confined to prison walls but extend to life after release. Studies show that successful reentry into the community is dependent on how well inmates participate in established programs, such as probation and parole (Matejkowski et al., 2010). However, these programs are found to be insufficient in addressing the needs of released prisoners with mental health problems as they fail to consider the additional support needed by the population (Matejkowski et al., 2010). This support includes promotion of life skills that assist the population in coping with their conditions, such as complying with medication among others.
Mental Health in UK Prisons
The UK prison system, just like that of the US, is inadequately prepared to address the unique needs of mentally ill individuals, meaning it does not uphold the letter and spirit of Article 12 of the ICESCR treaty. Reports have shown how mentally ill prisoners in UK prisons are deprived of autonomy, liberty, and right to self-determination, and when experiencing severity in their disorders, they are denied the freedom to choose whom to consult (National Audit Office, 2017). Bullying from fellow inmates and prisoner staff, loneliness, and fear are a common feature of the life that prisoners with mental health disorders cope within UK prisons (National Audit Office, 2017). Evidence suggests that loss of contact with family members is one of the factors that lead to the severity of mental health problems for incarcerated persons (National Audit Office, 2017). As of September 2016, the number of people in prisons in England and Wales stood approximated 85,000, the largest prison population west of Europe (National Audit Office, 2017). It is estimated that two-thirds of UK prisoners present with personality disorders, with 50 percent of this number suffering from depression and anxiety (National Audit Office, 2017). One in every twelve prisoners suffers from psychosis (National Audit Office, 2017). About 120 prisoners committed suicide in prison in England and Wales in 2016, which is twice as many as the figure for 2012 (National Audit Office, 2017). The report by the National Audit Office also noted that incidents of self-harm increased by almost 75 percent from 2012 to 2016 (National Audit Office, 2017). According to the NHS watchdog, about half of the jails in England are providing mentally ill inmates with inadequate medical care, further exposing them to health deterioration (Campbell, 2018). An investigation of UK prisons done by the Prisons and Probation Ombudsman (PPO) (2016) has established that one in every five prisoners with a mental health disorder cannot access care from a mental health professional. Further, the PPO (2016) established that in about 29 percent cases of self-inflicted deaths in the mentally ill population in the prison system was not referred for further mental health treatment despite the need having been identified. The report also found that in about 40 percent of prisons inspected between 2016 and 2017, there was inadequate or no training for prison staff to empower them with knowledge about when it is necessary to refer a prisoner for mental health support (Prisons and Probation Ombudsman, 2016). In summary, the findings of the PPO among other organizations, including government agencies, show that the UK prison system undermines the human rights of mentally ill prisoners, which goes against the tenet of the ICESCR treaty to which the UK government is a signatory.
Recommendations for Social Work Response
Given the high population of mentally ill persons in US and UK prisons, and the inadequacy of care that they receive to meet their unique needs, there is a need for the countries to be held responsible for perpetuating social injustice towards this population. Despite both countries being signatories to the ICESCR treaty, whose Article 12 calls for member states to protect the right of citizens to enjoy the highest possible standard of physical and mental health, their prison systems undermine the human rights of mentally ill prisoners. Looking at evidence of the extent of this violation, it is clear that the social work fraternity must be given the opportunity to intervene and safeguard both the psychological wellbeing and human rights of mentally ill prisoners and ex-prisoners. The uniqueness of social work is premised on its ethical obligation to promote social justice and human dignity, particularly with respect to disenfranchised and vulnerable populations (Dunn, 2018). This professional obligation aims at promoting the tenets of human rights as enshrined in various international treaties, including the ICESCR.
In the United States, social work can play a significant role in looking after the welfare of mentally ill persons in the criminal justice system. As a start, social workers should be primary stakeholders in the diversionary mechanisms established by the justice system to address the needs of mentally ill offenders, particularly the mental health courts (Freudenberg & Heller, 2016). Since the intention of these mechanisms is to divert mentally ill offenders to community-based mental health treatment programs instead of incarceration, social workers can help to keep mentally ill offenders off the prison system. In the diversionary system, social workers would coordinate treatment for mentally ill offenders by maintaining continuous contact during the period that they are in such programs. Through their professional training in tackling social issues, social workers would help these people to develop competencies necessary to live a productive life outside prison walls, including considering psychiatric and substance abuse treatment options. More importantly, social workers would provide ex-offenders with structured guidance and support to help them stay healthy and crime-free in the community, thereby avoiding reoffending.
Similarly, social workers can play a significant role in furthering social justice with regard to the human rights of mentally ill individuals in the UK prison system. These can be achieved by emphasizing on social recovery and satisfaction of the most basic survival needs, which can happen in several ways (Dunn, 2018). By making themselves available to mentally ill prisoners, social workers can help to meet the need to maintain interaction with the outside world and thus minimize incidences of loneliness that lead to severity of mental illness. Ideally, this interaction would allow social workers to offer to counsel these individuals (Dunn, 2018). Another important duty that social workers would undertake is to prepare these prisoners for life after release. Here, social workers would help prisoners to develop competencies that would make their reentry into community life smooth and offer them support to avoid recidivism. These competencies and support include learning how to look for a job, getting a place to live, and accessing substance abuse and psychiatric treatment.
References
- Asanbe, C., Gaba, A., & Yang, J. (2018, December). UN Matters: Mental Health is a Human Right. Retrieved from https://www.apa.org/international/pi/2018/12/mental-health-rights
- Campbell, D. (2018, October 27). Poor Healthcare in Jails is Killing Inmates, Says NHS Watchdog. Retrieved from https://www.theguardian.com/society/2018/oct/27/prisoners-dying-poor-care-services-prisons-mental-health-care-quality-commission-report
- Dunn, K. (2018). Introduction to the special issue on radical social work with people living in and exiting correctional systems. Journal of Progressive Human Services, 29(3), 153-156
- Freudenberg, N., & Heller, D. (2016). A review of opportunities to improve the health of people involved in the criminal justice system in the United States. Annual Review of Public Health, 37, 313-333.
- Human Rights Watch. (2009, September 22). Mental Illness, Human Rights, and US Prisons. Retrieved from https://www.hrw.org/news/2009/09/22/mental-illness-human-rights-and-us-prisons
- Kim, K., Becker-Cohen, M., & Serakos, M. (2015). The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System: A Scan of Practice and Background Analysis. Retrieved from https://www.urban.org/sites/default/files/publication/48981/2000173-The-Processing-and-Treatment-of-Mentally-Ill-Persons-in-the-Criminal-Justice-System.pdf
- Matejkowski, J., Caplan, J. M., & Wiesel Cullen, S. (2010). The impact of severe mental illness on parole decisions: Social integration within a prison setting. Criminal Justice and Behavior, 37(9), 1005-1029.
- Mfoafo-M’Carthy, M., & Huls, S. (2014). Human rights violations and mental illness: Implications for engagement and adherence. SAGE Open, 4(1), 2158244014526209.
- National Audit Office, UK Government. (2017). Mental Health in Prisons. Retrieved from https://www.nao.org.uk/wp-content/uploads/2017/06/Mental-health-in-prisons.pdf
- Prisons and Probation Ombudsman, UK Government. (2016). Learning from PPO Investigations: Prisoner Mental Health. Retrieved from http://www.ppo.gov.uk/app/uploads/2016/01/PPO-thematic-prisoners-mental-health-web-final.pdf
- Rosenfield, S. (2012). Triple jeopardy? Mental health at the intersection of gender, race, and class. Social Science & Medicine, 74(11), 1791-1801.
- United Nations. (1967). International Covenant on Economic, Social, and Cultural Rights. Retrieved from https://treaties.un.org/doc/Treaties/1976/01/19760103%2009-57%20PM/Ch_IV_03.pdf
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