Health Care and Human Rights

At its meeting last month in Arlington, Va., the Board of Trustees unanimously passed a Position Statement on Health Care that reads, “The American Psychiatric Association believes that Health Care, inclusive of mental health care, is a human right.” This concise yet powerful statement reflects a number of important propositions with regard to U.S. health care policy, and the discussion by Board members about it was lively. As a bit of a policy nerd who enjoys exploring the roots of and thinking behind new policies, I can’t resist a brief accounting of some of the Board discussion and asserting my own perspectives on the value of human rights in health care.

The position statement began as an Assembly action paper written by Dr. Eliot Sorel and members of the Washington Psychiatric Society and the Assembly. It was presented by the speaker of the Assembly, Dr. Theresa Miskimen, as part of her report to the Board.

The Council on Psychiatry and Law (CPL) reviewed the deliberations of a special work group that considered input from the council as well as our Ethics Committee and Council on Minority Mental Health and Health Disparities. This work group deliberated the pros and cons of the statement and ultimately recommended that the Board adopt it. They noted that although the statement overlaps somewhat with other APA position statements that are centered on access to effective treatment, it adds a distinctive element to APA policy.

During the Board discussion, one trustee offered the perspective that a statement as concise as this one does not give a clear definition of mental health: Does this statement refer to a narrower human right to mental health treatment or to a broader human right to good mental health, well-being, and happiness?

Another Board member opined that one interpretation of this statement is that it represents an affirmation of mental health parity—that is, that mental health care and health care are supported as services to which people have a human right.

The legal view was that under U.S. law, a human right is distinct from a civil right, and the distinction between the two is extremely important to understand with regard to health care policy. Under certain conditions in the United States, there are clearly established civil rights to treatment. Emergency rooms must treat and stabilize all comers under the Emergency Medical Treatment and Active Labor Act (EMTALA), individuals in correctional facilities have a right to reasonably adequate medical treatment (Eighth Amendment), and institutionalized individuals have a right to treatment in a safe environment under the Civil Rights of Institutionalized Persons Act (CRIPA). Most people in this country have a clearly established right to refuse treatment, but there is no actual right to treatment under most conditions.

In the Declaration of Independence, Thomas Jefferson invoked the Renaissance notion of natural law, which includes the concept that all humans are endowed by their creator to have “certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” (Here “happiness” does not specifically include, for example, treatment for depression; rather, “happiness” is intended as a broad concept that includes a right to live in conditions that promote one’s well-being and be free of fear of tyranny and oppressive governments.) The Declaration of Independence and natural law were the foundations for the development of the Universal Declaration of Human Rights by the United Nations, which was adopted in 1948 in the wake of the tyranny of World Wars I and II.

Admittedly, this delving into the details of rights is a digression from the day-to-day practice of psychiatry in the 21st century. My point, however, and the thesis of the new position statement, is that human rights are an important foundation of our U.S. culture and zeitgeist. People in the United States may not have a legally established civil right to health care; however, there is, encoded in our own Declaration of Independence, a broader, more aspirational human right to live free and well. Access to health care is certainly necessary to live well. Our APA is the largest organization of psychiatric physicians in the world; it is valuable for us and for our colleagues in other nations, especially those in places where human rights are routinely violated, to know that psychiatrists in the United States confirm that health care—which includes mental health care—is a human right. ■