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Adopting a Human Rights-Based Approach (HRBA) with Children of

Parents with Mental IllnessChristophe Bedeaux, BA-Applied Human Sciences ,

Research Assistant,Concordia University, Montreal, QC, Canada

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ObjectivesOverall goal: provide an introduction to Human Rights-Based Approaches (HRBA). Focus on children;

1)Explain what constitutes a Human Rights-Based Approach (HRBA);

2)Identify key international human rights conventions and articles relevant to families in which a parent has a mental illness;

3)Discuss the implications of these articles for services and programs for children of parents with mental illness (discussion period).

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Plan of the Presentation1)Definition and principles of a

HRBA;

2)Rights of parents with a mental illness (MI);

3)Rights of children: the UN Convention on the Rights of the Child;

4)Conclusion and implications;

5)Discussion

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What is a HRBA?“A human rights-based approach entails consciously and systematically paying attention to human rights in all aspects of programme development.” (UNFPA and Harvard School of Public Health, 2010, p. 25);

A HRBA is more holistic, empowering, and universal, than traditional needs-based approaches, addresses root-causes, and is more long-term (Desai, 2010);

≠ Evidence Based Approaches.

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Two Key Principles of a HRBA (of 3)1. All programmes “should further the realisation of

human rights”;

2. All the phases of development of a programme should be guided by human rights principles. These principles are:

Universality and inalienability; Indivisibility; Inter-dependence and inter-relatedness; Non-discrimination and equality; Participation and inclusion; Accountability and the rule of law.(Stamford Interagency Workshop on a Human Rights-Based approach in the Context of UN Reform, 2003).

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The Rights of ParentsConvention on the Rights of Persons with DisabilitiesArticle 1 – Purpose

“Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which [...] may hinder their full and effective participation in society [...].” (UN General Assembly, 2006).

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Article 23 - Respect for home and the family2. “States Parties shall ensure the rights and responsibilities of persons with disabilities, with regard to guardianship, wardship, trusteeship, adoption of children or similar institutions [...]; in all cases the best interests of the child shall be paramount. States Parties shall render appropriate assistance to persons with disabilities in the performance of their child-rearing responsibilities.” (UN General Assembly, 2006).4. relates to separation of children from parents : disability in itself not a sufficient basis for separation of child from parents.

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Principle 1 Fundamental freedoms and basic rights “1. All persons have the right to the best available mental health care […]. 2. All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person. 4. There shall be no discrimination on the grounds of mental illness[...].” (UN General Assembly, 1991).

Principle 2 Protection of minors : “Special care should be given [...] to protect the rights of minors [...].”

Principle 11 Consent to treatment (16 articles).

Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care

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The Rights of Children: The UN Convention on the Rights of the Child (UNCRC)Articles can be divided into four categories (UNICEF,

nd.):1. Guiding principles: A2 Non-discrimination, A3 Best

interests of the child, A12 Respect for child’s views;2. Rights of protection: A4 Protection of rights, A19

Protection from all forms of violence;3. Rights of participation: A13 Freedom of expression,

A15 Freedom of association, A17 Access to information; 4. Provision, or survival and development rights:

Define parents and governments responsibilities regarding the upbringing and development of children, health, standards of living, and leisure, play, and culture, among others.

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Guiding PrinciplesArticle 3: the bests interests of children

should prevail in all decisions affecting them;

How can we determine the bests interests of children?

Article 12: “1. States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.” (UN General Assembly, 1989).

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Relevance and ImplicationsChildren of parents with MI need, and have a right,

to give their opinions , share their experiences, and be heard (Gray & Robinson, 2009; Monds-Watson, Manktelow, & McColgan, 2010; Mordoch, 2010);

Possible discrepancies between what children want or need and what parents and professionals may want for them (Gladstone, Boydell, Seeman, & McKeever, 2011);

Children need to be more directly involved in research concerning them (Gladstone, Boydell, & McKeever, 2006);

Professionals should consult children of parents with MI in all decisions that affect them (Gladstone, Boydell, & McKeever, 2006, Mordoch, 2010).

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Rights of ProtectionArticle 19: “1. States Parties shall take all appropriate […] measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation […] while in the care of parent(s), legal guardian(s) or any other person who has the care of the child. 2. Such protective measures should, as appropriate, include effective procedures for the establishment of social programmes to provide necessary support for the child and for those who have the care of the child, as well as for other forms of prevention […].” (UN General Assembly, 1989)

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Relevance: Types of MaltreatmentSample (Studies)Only mothers

Neglect Physical Abuse

Emotional maltreatme

nt

Child protection (Lewin & Abdrbo, 2009). N = 122, % of cases

59 8.2 + 10.7 both

X

Child protection (Kohl, Jonson-Reid, & Drake, 2011) N = 4,895 dyads, % of cases.

67 26 X

Hospitalized mothers(Dipple, Smith, Andrews, & Evans, 2002) N = 65 children separated, %

54 emotional50 physical

22 18.5

Child protection, (Westad & McConnell, 2012) % of cases reported

MMI, n = 2,272 47 22 36

NMMI, n = 9,290 39 35 21*MMI = Maternal Mental Illness; NMMI = No Maternal

Mental Illness

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Implications Increased risk of emotional and behavioral problems in

children of parents with MI importance of early interventions to support mothers with MI (Westad & McConnell, 2012);

Three issues facing professionals working with families with parental mental illness (Monds-Watson, et al., 2010):

1. unpredictability of mental illness, 2. psychological impacts on children,3. stigma and fear associated with child protection

interventions; Importance of adequate training of child protection

professionals and of adequate assessment procedures;UNCRC as a basis for improving child maltreatment

prevention (ex. participation) (Reading et al., 2009).

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Rights of participationArticle 13: “1. The child shall have the right to

freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, […] .” (UN General Assembly, 1989);

This freedom can be restricted by the rights or reputations of others;

Article 17: Governments “shall ensure that the child has access to information and material from a diversity of national and international sources, especially those aimed at the promotion of his or her social, spiritual and moral well-being and physical and mental health.” (UN General Assembly, 1989).

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Relevance and ImplicationsChildren of parents with MI want to talk about their

experience (Gladstone, et al., 2011), preferably not to a mental health professional (Cooklin, 2011);

They also need (and want) information regarding their parent’s MI (Cooklin, 2011, Gladstone, et al., 2011);

They usually don’t receive such information (Cooklin, 2011, Gladstone, et al., 2011, Monds-Watson, et al., 2010);

Children don’t get an adequate and accurate understanding of their parent’s MI (Gladstone, et al., 2011).

Need to develop and provide information adapted to children!!

Ex: itisallright.org, SANE Australia : http://itsallright.org/

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Survival and Development Rights in BriefParenting: A5: Respect of the rights, responsibilities,

and duties, of parents; A 18: Parents primary responsible for upbringing and development of children, and obligation of assistance from Gov’ts to parents (material, programmes);

Separation from parents and placement: A9: no separation except if necessary for bests interests of the child; A20 & A25: rights concerning placement of children;

A24: right to the “highest attainable standard of health”;

A27: right to an adequate standard of living;A31: Children’ right “to rest and leisure, to engage in

play and recreational activities appropriate” to their age.

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ImplicationsGovernments’ responsibility to support parents

with mental illness;Separation of child from parent: least preferable

option, children and parents fear of family separation;

Importance of family preservation services and other tertiary prevention interventions such as: case management (giving information and advice, teaching psychosocial skills, natural support systems and self-help groups), and psycho-educational group work (Desai, 2010).

Right to leisure and play: services needed for children of parents with mental illness who are young carers.

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Comments on the UNCRCDichotomy between children’ and parents’ rights? Not if parents rights include responsibilities toward their children, or serve the rights of children (Reynaert, Bouverne-de Bie, & Vandevelde, 2009), parenting = process;

Rights of children and parents complementary.

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Conclusion and ImplicationsHRBA = comprehensive (legal) framework for

services and programmes for families with parental mental illness;

UN Human Rights Conventions address many, if not most, of the challenges, needs, and opportunities, of families in which a parent has a mental illness;

Those Rights should to be ensured and protected by all professionals involved with families in which a parent has a mental illness, in the different settings where they can apply (mental health services, family services, schools), and in the different phases or steps of programmes and services (research, consulting, planning, delivery, and evaluation).

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Examples of ApplicationsOne root/basis of the COPMI Initiative in Australia:

the Report of the National Inquiry into the Human rights of People with Mental Illness (1993). See Findings And Recommendations (Inquiry chapters 30 and 31) Children of Parents with Mental Illness (Chapter 16);

Charter of Children’s and Young People’s Rights in Healthcare Services in Australia (Children’s Hospitals Australasia): http://www.awch.org.au/pdfs/Charter-Children-Young%20People-Healthcare-Au-version-FINAL-210911b-web.pdf;

SA Carers Charter (Government of South Australia, 2006): http://www.sa.gov.au/upload/franchise/Community%20Support/Final%20Carers%20Charter.pdf

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Suggested Reading

A Rights-Based Preventative Approach for Psychosocial Well-being in Childhood (Children's Well-Being: Indicators and Research)Murli, Desai, Springer, 1st Edition.,

2010, XXIII, 400 p.http://www.springer.com/social+sciences/well-being/book/978-90-481-9065-2

United Nations Population Fund (UNFPA) and Harvard School of Public Health, (2010). A Human Rights-Based Approach to Programming: Practical Information and Training Materials, United Nations Population Fund

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Discussion QuestionsHow could a HRBA be adopted or implemented in the services and programmes offered to children of parents with mental illness and to their parents?

Are there any rights that are not being fully implemented in services and programmes?

What would need to be changed?Any challenges/benefits?

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ReferencesCooklin, A. (2001). The impact of parental mental health

on children. Gresham College, available at: http://www.gresham.ac.uk/lectures-and-events/the-impact-of-parental-mental-health-on-children.

Desai, M., & SpringerLink. (2010). A rights-based preventative approach for psychosocial well -being in childhood. Dordrecht; New York: Springer.

Dipple, H., Smith, S., Andrews, H., & Evans, B. (2002). The experience of motherhood in women with severe and enduring mental illness. Social Psychiatry and Psychiatric Epidemiology, 37(7), 336-340.

Gladstone, B., Boydell, K., & McKeever, P. (2006). Recasting research into children's experiences of parental mental illness: Beyond risk and resilience. Social Science & Medicine, 62(10), 2540-2550.

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Gladstone, B. M., Boydell, K. M., Seeman, M. V., & McKeever, P. D. (2011). Children's experiences of parental mental illness: A literature review. Early Intervention in Psychiatry, 5(4), 271-289.

Gray, B., & Robinson, C. (2009). Hidden children: Perspectives of professionals on young carers of people with mental health problems. Child Care in Practice, 15(2), 95-108.

Human Rights and Equal Opportunity Commission, (1993). Report of the National Inquiry into the Human rights of People with Mental Illness. Canberra, Australian Government Publishing Service, available at: http://www.hreoc.gov.au/disability_rights/inquiries/mii.htm#ch16 [accessed 22 April 2012].

Kohl, P. L., Jonson-Reid, M., & Drake, B. (2011). Maternal mental illness and the safety and stability of maltreated children. Child Abuse & Neglect, 35(5), 309-318.

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Lewin, L., & Abdrbo, A. (2009). Mothers with self-reported axis I diagnoses and child protection. Archives of Psychiatric Nursing, 23(3), 200-209.

Monds-Watson, A., Manktelow, R., & McColgan, M. (2010). Social work with children when parents have mental health difficulties: Acknowledging vulnerability and maintaining the “Rights of the child”. Child Care in Practice, 16(1), 35-55.

Mordoch, E. (2010). How children understand parental mental illness: "you don't get life insurance. what's life insurance?: Journal of the Canadian Academy of Child & Adolescent Psychiatry, 19(1), 19-25.

Reading, R., Bissell, S., Goldhagen, J., Harwin, J., Masson, J., Moynihan, S., . . . Webb, E. (2009). Promotion of children's rights and prevention of child maltreatment. The Lancet, 373(9660), 332-343.

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Reynaert, D., Bouverne-de Bie, M., & Vandevelde, S. (2009). A review of children's rights literature since the adoption of the united nations convention on the rights of the child. Childhood-a Global Journal of Child Research, 16(4), 518-534.

Stamford Interagency Workshop on a Human Rights-Based approach in the Context of UN Reform, (2003). Statement on a Common Understanding of a Human Rights-Based Approach to Development Cooperation. United Nations.

UNICEF, (nd.). Convention on the Rights of the Child, Rights under the Convention on the Rights of the Child, available at: http://www.unicef.org/crc/index_30177.html [accessed 18 April 2012].

UN General Assembly, (1989). Convention on the Rights of the Child. General assembly resolution 44/25 of 20 November 1989. Geneva: Office of the High Commissioner for Human Rights, available at: http://www2.ohchr.org/english/law/crc.htm [accessed 18 April 2012].

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UN General Assembly, (1991). Principles for the Protection of Persons With Mental Illness and the Improvement of Mental Health Care,  A/RES/46/119, available at: http://www2.ohchr.org/english/law/principles.htm  [accessed 18 April 2012]

UN General Assembly (2006), Convention on the Rights of Persons with Disabilities, available at: http://www.un.org/disabilities/convention/conventionfull.shtml  [accessed 18 April 2012]

United Nations Population Fund (UNFPA) and Harvard School of Public Health, (2010). A Human Rights-Based Approach to Programming: Practical Information and Training Materials, United Nations Population Fund.

Westad, C., & McConnell, D. (2012). Child welfare involvement of mothers with mental health issues. Community Mental Health Journal, 48(1), 29-37.