Post on 12-Jan-2016
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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