Assignment for Module 5
A. Situations where Juan's rights of access to mental health care were infringed
1. Quality of care 
Juan has been living with serious mental health problems for 20 years, but it was only in the past year that he felt that he was getting back his life. Lack of skilled mental health workers at Primary Health Care level prevented Juan from having his conditions properly treated that led to his poor functioning. Article 25(b) of the Convention on the Rights of Persons with Disabilities (CRPD states that ‘States Parties shall provide those health services needed by persons with disabilities, specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities...’1 Quality of services is recognized in article 12.2(d)of the International Covenant on Economic, Social and Cultural Rights (ICESCR)2, and is further elaborated in General comment No14 of the ICESCR paragraph 12(d) that states: ‘ …health facilities, goods and services must be … of good quality. This requires, inter alia, skilled medical personnel…’3 
 Timely access to health services is also elaborated in paragraph 17 of the General comments No 14 of the ICESCR where it is stated that, ‘..both physical and mental, includes the provision of equal and timely access to basic preventive, curative, rehabilitative health services…3 
2. Availability     
Juan has to be locked up in the hospital, where he used to run away after few weeks. This treatment was not addressing his needs and preferences. Article 25(d) of the CRPD states: ‘States Parties shall require health professionals to provide care .. on the basis of free and informed consent.’ The right to liberty is recognized in article 14.1(a) of the CRPD1, and in Article 9.1 of the International Covenant on Civil and Political Rights (ICCPR)4 United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (MI principle) 7 .2 states ‘where treatment takes place in a mental health facility, a patient shall have the right, wherever possible, to be treated near his or her home or the home of his or her relatives or friends and shall have the right to return to the community as soon as possible’5
General Comment 14 of ICESCR paragraph 12(a) states ‘functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the State party.’3 Article 19(c) of CRDP states ‘Community services and facilities for the general population are available on an equal basis to persons with disabilities and are responsive to their needs.’1
Juan was not provided with the least restrictive alternative as stated in the MI Principle 9, ‘Every patient shall have the right to be treated in the least restrictive environment..’5 
3.  Accessibility
Juan had problems of bus fare to get to the clinic. Accessibility to health services is recognized in General comments No 14 of the ICESCR paragraph 12 (b) that states: ‘health facilities, goods and services must be within safe physical reach for all sections of the population..’3 Access to health services is also recognized in article 9(1), article 3(f) and article 25(c) of the CRPD.1 
MI Principle 7 states ‘Every patient shall have the right to be treated and cared for, as far as possible, in the community in which he or she lives’5
4. Acceptability
One time Juan was tied with a cord by his relatives and taken back to hospital where he was put into a straightjacket and thrown to the floor. The buildings were cold, he was constantly hungry, and staff never gave him his cigarettes and clothes. These constitute inhuman and degrading treatment in violation of UN Convention on Torture6, article 5 of the Universal declaration of Human Rights7, article 7 of the ICCPR4, and article 15.1 of the CRPD1, that states: ‘No one shall be subjected to torture or to cruel, inhuman and degrading treatment..’ MI principle 8, ‘Every patient shall be protected from harm, including unjustified medication, abuse by other patients, staff or others..’5 
Respect for inherent dignity is stated as a general Principe of the CRPD under Article 3(a) and in article on purpose (Article 1). This general right to dignity is also seen in the articles on freedom from exploitation, violence and abuse (Article 16), protecting integrity of the persons (Article 17)1, and in Article 10.1 of the ICCPR4 
Juan lacked secure place in which to keep his personal possessions, a violation of right to privacy.  Article 22 of the CRPD provides protection for the right to privacy of people with mental disabilities, stating ‘no person with disabilities, regardless of place of residence or living arrangements, shall be subjected to arbitrary or unlawful interference with his or her privacy,..’1 The right to privacy is also protected under Article 12 of the UDHR7 and Article 17 of the ICCPR4.
5	Discrimination in access to determinants of health
Juan missed out on better work opportunities, because people feared to recommend him due to his paranoid schizophrenia. Discrimination is defined in article 2 of the CRPD and Article 5.2 requires State Parties to ‘prohibit all discrimination on the basis of disability’1 The right to be free from discrimination is recognized in Article 26 of the ICCPR4, article 2.2 and article 3 of the ICESCR2 and paragraph 18 of the general comment No14 of ICESCR. 3

B.	Situations where Juan's rights of access to mental health care were adequately fulfilled
1.	Quality. 
When mental health services moved to a health centre that was three blocks from Juan’s house, he continued to be assessed by skilled mental health workers - psychiatrist, psychologist as provided for in the General comment No 14 of the  of ICESCR paragraph 12(d).3
2.	Accessibility    
When the mental health services was integrated into primary health care, Juan was able to maintain family relationship and job; all of which helped him to maintain good mental health. This is in agreement with article 25(c) of CRPD, ‘Provide these health services as close as possible to people’s own communities, including in rural areas’ and article 19 of CRPD on living independently and being included in the community.1

3	Access to medication
Juan was given free medications and an injection every month. General comment No14 of ICESCR paragraph 12(a) is relevant to access to essential medicines: ‘Functioning public health and health-care facilities have to be available in sufficient quantity  … will include .. essential drugs..’,and paragraph 12(b): ‘health facilities, goods and services must be affordable for all’3  Article 25(a) of CRPD requires State Parties to ‘provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes..’1
4	Access to information
Juan was given information about the treatment plan, as stated in the MI Principle 9.2 ‘The treatment and care of every patient shall be based on an individually prescribed plan, discussed with the patient, reviewed regularly, revised as necessary and provided by qualified professional staff.’5  Access to information is also recognized in the general comment No 14 of ICESCR paragraph 12(b), and paragraph 11.3 
5	Pension
Juan received pension, in line with article 28 (c) of the CRPD1

C	Accessibility issues in my country
1.	Similar accessibility issues 
a)	Mentally ill patients get free medication as provided for in the  regulations relating to classification of State hospitals, admission of patients, and fees payable by patients receiving treatment in, at or from State hospitals.8
b)	Persons with mental disabilities are provided with pension as stated in the National Policy on Disability.9
c)	Access to employment and other opportunities is compromised in violation of the National Policy on Disability that states, ‘The State shall ensure that persons with disabilities have equal opportunities for a productive and gainful employment in the labour market’9

2.	Different accessibility issues
a)	Mental health services are only available in two health institutions that are about 600km apart. Although the National Policy for Mental Health states ‘Mental health service should be integrated with the existing health care system so that mental and physical health needs are equally met’10, people still travel long distance to receive mental health care.
b)	There is lack of community-based mental health care, contrasting the National Policy for Mental Health that state, ’Mental health services should be community-based, equitable, accessible, affordable and acceptable to the people’. 10
c)	 Lack of skilled mental health workers, prevents persons with mental illness from having their conditions recognized and properly treated. 
d)	Psychosocial intervention programs are restricted to urban centres. Therefore the prevention of disabilities as well as the specific needs of persons with disabilities are not considered at all levels of the health care system as required by the National Policy on Disability. 
e)	 Lack of access to medication. Psychotropic medications are only available at psychiatric institutions and urban centres. 

References
1	International Convention on the Rights of Persons with Disabilities. Adopted by the United Nations General assembly in December 2006. (http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf)
2	United Nations (1966) International Covenant on Economic, Social and Cultural Rights, United Nations General Assembly Resolution2200A (XXI). New York: United Nations General Assembly 
3	General Comment 14 of the U.N. Committee on Economic, Social and Cultural Rights. (www2.ohchr.org/english/bodies/cescr/comments.htm)
4	United Nations (1966) International Covenant on Civil and Political Rights United Nations General Assembly Resolution2200A (XXI). New York: United Nations General Assembly 
5	United Nations (1991) Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (Resolution 46/119) New York: United Nations General Assembly 
6	United Nations (1984) Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. United Nations General Assembly resolution 39/46, annex,39. New York: United Nations General Assembly 
7	United Nations (1948) Universal Declaration of Human Rights  United Nations General Assembly Resolution 217 A (III)). New York: United Nations General Assembly 
8	Republic of Namibia Ministry of Health and Social Services (1994) Regulations relating to classification of State hospitals, admission of patients to state hospitals, and fees payable by patients receiving treatment in, at or from State hospitals: Hospitals and Health Facilities Act, 1994. Government Gazette of the Republic of Namibia No 4459
9	Republic of Namibia. Ministry of Lands, Resettlement and Rehabilitation (1997) National Policy on Disability. 
10	Republic of Namibia. Ministry of Health and Social Services (2005) National Policy for Mental Health