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At the root of the action plan is a vision of \"a world in which mental health is valued, promoted and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high quality, culturally-appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatisation and discrimination\".1 Implementation of the action plan will face challenges; in particular, years or decades of inadequate investment into human and financial resources for mental health care need to be quickly reversed.

This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature.

Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO's QualityRights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare. We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO's approach to eliminate coercion and the WPA's goal to implement alternatives to coercion. We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes. Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors. We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.

The authors present this perspective essay which introduces the QualityRights initiative of World Health Organization. The initiative uses a multicomponent framework and strategies to promote mental health systems, services, and practices that prioritize respect for human rights, in line with the United Nations Convention on the Rights of Persons with Disabilities (CRPD). It also describes how the initiative is working to provide practical solutions to promote inclusion, legal capacity, and non-coercive approaches in mental health. Since the adoption of the CRPD in 2006, there has been considerable dialogue, debate, and concerns expressed around the applicability of the Committee on the Rights of Persons with Disabilities' interpretations of certain key provisions of the convention as they relate to the area of mental health. Particularly, these concerns refer to the right to equal recognition before the law and to legal capacity and the right to liberty and security of the person.

Background In 2012, Ghana ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted a Mental Health Act to improve the quality of mental health care and stop human rights violations against people with mental health conditions. In line with these objectives, Ghanaian stakeholders collected data on the quality of mental health services and respect for human rights in psychiatric facilities to identify challenges and gather useful information for the development of plans aimed to improve the quality of the services offered. This study aimed to assess psychiatric facilities from different Ghanaian regions and provide evidence on the quality of care and respect of human rights in mental health services. Methods Assessments were conducted by independent visiting committees that collected data through observation, review of documentation, and interviews with service users, staff, and carers, and provided scores using the World Health Organization QualityRights Toolkit methodology. Results This study revealed significant key challenges in the implementation of the United Nations Convention on the Rights of Persons with Disabilities principles in Ghanaian psychiatric services. The rights to an adequate standard of living and enjoyment of the highest attainable standard of health were not fully promoted. Only initial steps had been taken to guarantee the right to exercise legal capacity and the right to personal liberty and security. Significant gaps in the promotion of the right to live independently and be included in the community were identified. Conclusions This study identifies shortcomings and critical areas that the Ghanaian government and facilities need to target for implementing a human rights-based approach in mental health and improve the quality of mental health care throughout the country.

The World Health Organization has set a target for 75% of member states to have national dementia plans by 2025. These plans should align with human rights standards, such as the Convention on the Rights of Persons with Disabilities. The aim of this study was to complete a review of global national dementia plans and their human rights content according to the convention’s principles. A categorization matrix of preidentified human rights themes was produced prior to data collection and extensive inclusion criteria were adopted to ensure thorough assessment using deductive content analysis. Each dementia plan was reviewed by at least two independent assessors. Forty plans were included in the final analysis. We found that basic human rights were covered by the plans, with community inclusion acknowledged in 39 plans (97.5%). However, there was less coverage of non-coercive practices and the participation of people with dementia in the design and delivery of services or policies, with only 24 plans (60%) mentioning these aspects. This is the first global review of human rights content within national dementia plans. More must be done to ensure that all such plans align with human rights standards so that the human rights of persons with dementia are respected, protected, and promoted.

Background There are currently major efforts underway in Ghana to address stigma and discrimination, and promote the human rights of those with mental health conditions, within mental health services and the community, working with the World Health Organization’s QualityRights initiative. The present study aims to investigate attitudes towards people with lived experience of mental health conditions and psychosocial disabilities as rights holders. Methods Stakeholders within the Ghanaian mental health system and community, including health professionals, policy makers, and persons with lived experience, completed the QualityRights pre-training questionnaire. The items examined attitudes towards coercion, legal capacity, service environment, and community inclusion. Additional analyses explored how far participant factors may link to attitudes. Results Overall, attitudes towards the rights of persons with lived experience were not well aligned with a human rights approach to mental health. Most people supported the use of coercive practices and often thought that health practitioners and family members were in the best position to make treatment decisions. Health/mental health professionals were less likely to endorse coercive measures compared to other groups. Conclusion This was the first in-depth study assessing attitudes towards persons with lived experience as rights holders in Ghana, and frequently attitudes did not comply with human rights standards, demonstrating a need for training initiatives to combat stigma and discrimination and promote human rights.

Purpose - This paper, which builds on the findings of WHO's Report on Mental Health and Development, aims to highlight the health, social, economic, and human rights effects of unaddressed mental disorders in low and middle income countries (LMICs) and to propose effective strategies to address mental disorders and their impacts as part of an overall development strategy.Design methodology approach - The paper first reviews the findings of relevant research on mental disorders and poverty and then proposes solutions that can be adopted by countries to promote development.Findings - This evidence of strong links between poverty and mental disorder supports the argument that mental disorders should be an important concern for development strategies. Mental disorders have diverse and far-reaching social impacts, including homelessness, higher rates of imprisonment, poor educational opportunities and outcomes, lack of employment and reduced income. Targeted poverty alleviation programmes are needed to break the cycle between mental illness and poverty. These must include measures specifically addressing the needs of people with mental health conditions, such as the provision of accessible and effective services and support, facilitation of education, employment opportunities and housing, and enforcement of human rights protection.Originality value - The paper highlights that four out of every five people suffering from mental disorders are living in LMICs. Many LMICs have identified mental health as an important issue, yet lack the finances and technical expertise to address the problem. Having mental health on the agenda of development organizations will be a critical step for overcoming the negative development consequences of mental disorders.

Although recent reports suggest that service users in West African psychiatric facilities are exposed to poor quality of care and human rights violations, evidence is lacking on the extent and profile of specific deficits in the services provided to persons with mental health conditions. To evaluate the quality of care and respect of human rights in psychiatric facilities in four West African countries, The Gambia, Ghana, Liberia and Sierra Leone, using the World Health Organization QualityRights Toolkit. Trained research workers collected information through observation, review of records and interviews with service users, caregivers and staff. Independent panels of assessors used the information to assign scores to the criteria, standards and themes of the QualityRights Toolkit. The study revealed significant gaps in these facilities. The rights to an adequate standard of living and to enjoyment of the highest attainable standard of health were poorly promoted. Adherence to the right to exercise legal capacity and the right to personal liberty and security was almost absent. Severe shortcomings in the promotion of the right to live independently and be included in the community were reported. Inadequate appreciation of service users' rights, lack of basic approaches to protect them and the non-promotion of rights-based services in these facilities are major problems that need to be addressed. Although it recognises the resource constraints and need for more human and financial resources, the study also identifies critical areas and challenges that require significant changes at the facility level.

Background Despite growing recognition of essential human rights, people with mental health conditions and psychosocial, intellectual, or cognitive disabilities’ rights are known to be frequently violated in mental healthcare worldwide, with common use of coercive practices and limited recognition of people’s right to exercise their legal capacity and make decisions for themselves on treatment and other issues affecting them. To tackle this issue, Ghana adopted the WHO QualityRights Initiative in 2019. This aims to introduce a right-based, person-centred recovery approach within the mental health care system, protecting and promoting the rights of people with mental health conditions, psychosocial, cognitive, and intellectual disabilities in the healthcare context and community. Methods E-training (capacity-building) was provided in Ghana across a broad array of stakeholder groups including healthcare professionals, carers, and people with lived experience. The training covered legal capacity, coercion, community inclusion, recovery approach, service environment, and the negative attitudes commonly held by stakeholder groups; it was completed by 17,000 people in Ghana as of December 2021. We assessed the impact of the e-training on attitudes through comparing trainees’ pre- and post-questionnaire responses on 17 items, each measured on a 5-point Likert scale (strongly disagree to strongly agree), such that higher scores indicated negative attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders. Analyses were conducted on two main groups: matched pairs (417 pairs of baseline and follow-up questionnaire responses matched to a high degree of certainty), and the unmatched group (4299 individual completed questionnaire responses). Results We assessed the impact of the WHO QualityRights e-training on attitudes: training resulted in highly significant attitude changes towards alignment with human rights, with scores changing by approximately 40% between baseline and follow-up. In particular, attitude changes were seen in items representing treatment choice, legal capacity, and coercion. This change was not affected by age, gender, or background experience. Conclusions The QualityRights e-training programme is effective in changing people’s (especially healthcare professionals’) attitudes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities: this is a step towards mental healthcare being more with human rights-based worldwide.