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

Challenges in TaiwanChueh 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- 2003Committee Member, Committee of Gender Equality, Executive Yuan (EY)

Board Member, Mental Health Association in TaiwanConsultant: 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

Physical & Mental Health and

Human Right

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

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)

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)

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)

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)

From Marginal to MainstreamGender 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

世界婦女健康大會三年一次

世界女性心理健康會議

世界心理衛生聯盟

Origin of male and female differences in Health/illness profiles

WHO(2002). Gender Analysis in Health. & Mental health

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

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!!

WHO Landmark Report

• WHO, 2000

Women Mental Health

• WHO, 1997

Focus Women

WHO, 2004

•WHO, 2010

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)

• 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!

 

Social Pathology

Drug abuse Violence

Women abused

AIDS children

Health ProblemsHeart diseaseDepressionPressure ProblemsBehavior & chronic disease

Coercive Situations

High unemployment ratePovertyHigh IlliteracyWorking stress Sex discriminationRural area discriminationEthnic discrimination Age discrimination

World Mental Health

Harvard Report,1995

WHO Mental Health Promoting

Goal：Physical,Psychological,and Social Well Being

 

19

Mental HealthPromotion

Good mental health is critical to personal and physical well-being, family and interpersonal relationships, community and societal engagement

• 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

International Development of Women Health (UN & WHO)

(Chang,2004, 2010; Wu,2007)

1975 1985 1990 1995 2000 2005 2011Women decade(76-85)

1985 WHO

「 women health and

development 、」

1995 UNGender

mainstream

1998 WHO[healthEquity:

gender, ethnicitypoverty]

2000 WHODepartment

OfGender, and

Women Health(GWH)

WHO: All projects need to examinegender issues. Gender equality and Empowerment as well as culture and biology

Gender perspective and gender equality

All policies development,Researches,legislation

1999WHO

Depart’m Of women

health

1992 WHO

CommitteeOf women

health

2009 WHOWHO WH

WHO Gender, Women

and Health Network

Policy tools

Development of Women Health Policy,Taiwan

1985 1990 1995 1997 2000 2005 2008 2012

1990 NTUWRP

Conf.of

WH

19951. TAWR AdvocateFor women Health right

2. KMT Division ofWomenWhite paperOf WH

2002WRPF

Report onWomen

Right

2000WRPproposeWH principleDOHInitiateWH policy

2004 WRP re-proposedPrinciples on WH and DOH begin to revise the WH policy

2008National

WH Policy2008

Medicaleducation

NGO

Gov

1995:milestone of WH in Taiwan1997:Committee of Women Right promotion, Executive Yuan (national machinery)

1995:milestone of WH in Taiwan1997:Committee of Women Right promotion, Executive Yuan (national machinery)

WomenStudy

Scholar

WomenStudy

Scholar

1985 NTUWomen

ResearchProgram

2011StrategyGE Policy

2012Dept GE

Executive Yuan

2005TaiwanWomen LinkageSet theWH web

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.

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

Physical &

Mental HealthPromotionApproach

Empowerment&

CommunityParticipation

充權＆參與

Holistic &Lifelong ＆Sustainable

全人、生命週期、永續

Gender Based Approach

啟蒙 ! 覺醒 ! 充權！ 實踐 ! 伙伴 ! 行動 !

Gender AnalysisGender Impact assessment

性別影響評估

Steps for conducting a gender diagnosis

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

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.

Depression as an ExampleGender 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.

Gender based approach

Mental Health PromotionDeconstruct

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

neglect

Aware but some bias

conflict

People center

people collaborate

Support

The process of Mental Health & Gender Mainstream From individual to Nation

Human Right as Basic

Mental health study

diversity 、dialogue 、challenge 、creativity

Protest 、Discover problemsDecrease discrimination

innocent 、 awakening

Consciousness Raising PartnershipEmpowermentParticipationDecision MakingAlternative ChoicesPolicy Formation and EvaluationNational Machinery