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Mental Health in MDG, CEDAW & Human Right ： Current Development and Challenges in Taiwan

Mental Health in MDG, CEDAW & Human Right ： Current Development and Challenges in Taiwan. Chueh Chang 張珏 Associate Professor, Institute of Health Policy and Management, School of Public Health, National Taiwan University

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Mental Health in MDG, CEDAW & Human Right ： Current Development and Challenges in Taiwan

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  1. Mental Health in MDG, CEDAW & Human Right：Current Development and Challenges in Taiwan Chueh Chang 張珏 Associate Professor, Institute of Health Policy and Management, School of Public Health, National Taiwan University Board Member, World Federation for Mental Health 1997- 2003 Committee Member, Committee of Gender Equality, Executive Yuan (EY) Board Member, Mental Health Association in Taiwan Consultant: Human Right Committee to the President Committee Member: Suicide Prevention and Mental Health Promotion,EY Coordinator, Healthy Life Alliance Coordinator: Mental Healthy Action Alliance President, Taipei Twin Association

  2. Physical & Mental Health and Human Right

  3. Mental Health as a Human Right: Sources • Indivisibility of health • 1946 WHO Constitution, preamble: • 1948 UDHR, article 25(1) • 1966 ICESCR, article 12 • 1984 CAT, article 1 • 1988 ICCPR • 1989 CRC, article 24

  4. Mental Health as a Human Right: Sources 2 • Non-discrimination -1965 ICERD, article 5(e)(iv) -1979 CEDAW Article 11(1)(f) Article 12: Article 14(2)

  5. Mental Health as a Human Right: Definition • The “right to health” is interpreted by the CESCR as “a right, containing freedoms and entitlements, to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health.” (See CESCR, General Comment No. 14: The right to the highest attainable standard of health (article 12), 11 August 2000, 22nd session, E/C.12/2000/4, paragraph 9)

  6. Mental Health as a Human Right: Rights • The right to the enjoyment of the highest attainable standard of mental health contains “the freedoms and entitlements of the underlying determinants of mental health” and “the freedoms and entitlements in mental health care”. (See OHCHR, Fact Sheet No. 31: Right to Health (2008), p. 3)

  7. Mental Health as a Human Right: Rights • The right to “mental health” actually indicates two phases of the notion of mental health, namely (1) promotion of mental health and prevention of mental disorders, and (2) access to basic mental health. (See WHO, Mental Health Care Law: Ten Basic Principles (1996), WHO/MNH/MND/96.9)

  8. From Marginal to Mainstream Gender Mainstream Gender statistics Gender analysis Gender budget Gender Impact assessment Gender awareness training Gender national machinery Public Mental Health Mainstream Mental health statistics Mental health analysis Mental health budget Mental health impact assessment Mental health awareness training Mental health national machinery

  9. 世界女性心理健康會議 世界婦女健康大會三年一次

  10. 世界心理衛生聯盟

  11. Origin of male and female differences in Health/illness profiles WHO(2002). Gender Analysis in Health. & Mental health

  12. UN Women Actions of Empowerment • Decent Work (economic independent) • Participation in Decision Making - Voice been heard (speak out) - Positions in decision making • Violence Against Women (VAW) • Enhancing Abilities

  13. WHO: Mental Health 2001 April WHO Health Day Issue [ Stop Exclusion, Dare to Care] 2001 WHO Report [New Understand, New Hope] 2003 National Mental Health Policy 2004-5 Promoting Mental Health 2009 Primary Health Care and Mental Health 2010 Chronic Physical Health and Mental Health 2011 The Great Push – Investing in Mental Health 2012 Mental health: a new agenda 2013 Mental Health and Older Adult WHY Mental Health Mainstream? Public Mental Health Mainstream!!

  14. WHO Landmark Report • WHO, 2000 Women Mental Health • WHO, 1997 Focus Women WHO, 2004 • WHO, 2010

  15. Mental Health is for People and Nations • There is no health without mental health (psychological wellbeing) • Mental health is more than the absence of mental/physical disease, It is vital to individual, families, and societies. (WHO,2004)

  16. Mental health is determined by SES & Environment. • Mental health can be enhanced by effective public health intervention • Collective action depends on shared values as well as the quality of scientific evidence • A climate that respects and protect basic human civil, political, economic, social and cultural rights is fundamental to the promotion of mental health (mental health as human right) • Inter-sectoral linkage is the key for mental health promotion • Mental Health is everybody’s business!

  17. Health Problems Heart disease Depression Pressure Problems Behavior & chronic disease Social Pathology Drug abuse Violence Women abused AIDS children • Coercive • Situations • High unemployment rate • Poverty • High Illiteracy • Working stress • Sex discrimination • Rural area discrimination • Ethnic discrimination • Age discrimination World Mental Health Harvard Report,1995

  18. WHO Mental Health Promoting Goal：Physical,Psychological,and Social Well Being

  19. Good mental health is critical to personal and physical well-being, family and interpersonal relationships, community and societal engagement Mental Health Promotion 19

  20. COMMUNITY-BASED INTERVENTIONS FOR IMPROVING HEALTH AND PSYCHOSOCIAL OUTCOMES • Participatory Decision Making for Programs of Mental Health Promotion • RECOGNITION/IDENTIFICATION OF MENTAL HEALTH NEEDS and PROBLEMS in Rural Areas

  21. International Development of Women Health (UN & WHO) (Chang,2004, 2010; Wu,2007) 19751985 1990 1995 2000 2005 2011 Women decade(76-85) 1985 WHO 「women health and development、 」 1999 WHO Depart’m Of women health 1995 UN Gender mainstream 1992 WHO Committee Of women health 1998 WHO [health Equity: gender, ethnicity poverty] 2000 WHO Department Of Gender, and Women Health (GWH) 2009 WHO WHO WH WHO Gender, Women and Health Network Policy tools Gender perspective and gender equality All policies development, Researches, legislation WHO: All projects need to examine gender issues. Gender equality and Empowerment as well as culture and biology

  22. NGO Women Study Scholar Development of Women Health Policy,Taiwan Gov 1985 1990 1995 1997 2000 2005 2008 2012 1990 NTU WRP Conf. of WH 1995 1. TAWR Advocate For women Health right 2. KMT Division of Women White paper Of WH 2008 National WH Policy 2008 Medical education 1985 NTU Women Research Program 2000 WRP propose WH principle DOH Initiate WH policy 2002 WRPF Report on Women Right 2005 Taiwan Women Linkage Set the WH web 2011 Strategy GE Policy 2012 Dept GE Executive Yuan 2004 WRP re-proposed Principles on WH and DOH begin to revise the WH policy 1995:milestone of WH in Taiwan 1997:Committee of Women Right promotion, Executive Yuan (national machinery)

  23. Women’ s Mental Health 2012 • gender based violence (GBV) most pressing public health, human rights and human development, the dire consequences of exposure to violence which damages the capacity of the individual to deal with stress and predisposes to mental and physical ailments, • perinatal mental health • alcoholism as a public health issue • life cycle and across the different areas of development, which have biological, social and psychological contributing factors. • More research: etiology and epidemiology of disorders, the gender perspective in the management of alcohol and substance related disorders and the impact of social determinants on women’s mental health • the evaluation and management of psychiatric disorders in women across the life cycle with topics related to the wellbeing of children and older adults and the perinatal period were explicitly included in the program. • Medical professional should pay attention to Gender on women’s mental health which encompasses the whole array of concerns of women along the entire life long.

  24. Gender and Mental Health Mainstream主流化 • Promoting mental health is a global health priority 促進心理健康是全球健康促進的優先議題 • A public health framework is well suited for promoting mental health 是公共衛生重要議題，國健局和其他CDC等都責無旁貸 性別同樣要考量 • Mental health has specific value in itself, is integral to health and is the foundation for well-being and effective functioning for individuals and populations • Adverse social, economic and political conditions cause serious risks of mental ill-health, and are also likely to compromise mental health • Interventions need to be developed and evaluated locally • Promoting mental health needs to be undertaken with community participation • Intersectoral collaboration is the key to effective programmes for mental health promotion

  25. Gender Based Approach啟蒙 ! 覺醒 ! 充權！ 實踐 ! 伙伴 ! 行動 ! Physical & MentalHealth Promotion Approach Holistic & Lifelong ＆ Sustainable 全人、生命週期、 永續 Empowerment & Community Participation 充權＆參與 Gender Analysis Gender Impact assessment 性別影響評估

  26. Steps for conducting a gender diagnosis

  27. Gender Based approachMental Health & Human Right • Understand the discrimination and violence toward women and girls from social, cultural, national system in family, workplace etc. (Mental and Physical Illness) • Find solutions. • 瞭解並分析和解套 社會與家庭/文化與制度對女性歧視、暴力（家暴、性暴力等、制度暴力等），導致身心的不健康 （恐慌、焦慮、憂鬱、精神/心理疾病、壓力創傷反應、不安全、自卑、求完美等） • 疾病的診斷治療缺少性別視野導致的傷害

  28. Suicide prevention does not equal to mental health promotion • Mental health promotion will be the key to decrease the violence behaviors toward self (self harm behaviors i.e suicide, smoking, alcoholic) and others (bully, VAW). • Cautions: Medicalization Problem.

  29. Depression as an Example Gender difference • Early attempts to provide explanations for the prevalence of depression in women were sought from biologically based sex differences, but associations are now made with social factors and context of living. • Women’s depression can be linked to their exposure to social determinants of health, which differ to men’s. • Women exposed to stressors associated with those determinants experience a higher incidence of depression than men. • Stressors unique to women may include negative life events, such as violence and abuse, discrimination and the denial of or limited access to education and occupation opportunities, which lead to fewer options when confronted with economic or social difficulties.

  30. Gender based approach Mental Health Promotion Deconstruct 解構過去性別盲 Construct 建構性別敏感度指標 Implement & Proactive 擴散與倡議具性別敏感的政策

  31. The process of Mental Health & Gender Mainstream From individual to Nation Human Right as Basic Consciousness Raising Partnership Empowerment Participation Decision Making Alternative Choices Policy Formation and Evaluation National Machinery people collaborate Support People center diversity、dialogue、challenge、creativity conflict Mental health study Aware but some bias Protest、 Discover problems Decrease discrimination neglect innocent、awakening

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