Right to Health Through Education: Mental Health and Human Rights*
Riikka Elina Rantala, Natalie Drew, Soumitra Pathare, and Michelle FunkT

he World Health Organization (who) is a specialized United
Nations agency responsible for providing leadership on global
health matters. At the time of its creation in 1948, health was defined as being “a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.” However, in reality themain focus of global health work has predominantly been on physical healthwith much less focus given on mental and social health. Yet there is compelling evidence that mental health problems are one of the leading causesof sickness, disability, and even premature mortality in certain age groups.1
Indeed hundreds of millions of people worldwide are affected by mental, behavioral, neurological and substance use disorders. For example, estimates
made by who in 2002 showed that one hundred fifty-four million people
globally suffer from depression and twenty-five million people from schizophrenia; 91 million people are affected by alcohol use disorders and fifteen
million by drug use disorders.2 Another who report reveals that fifty million
people suffer from epilepsy and twenty-four million from Alzheimer disease
and other dementias.3 About 877,000 people die by commiting suicide every
year.4
In addition it is well known that the human rights of the poorest andmost marginalized people in society are most often violated or neglected,
and people with mental disabilities are certainly no exception. Indeed, all
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over the world people with mental disabilities experience severe and systematic human rights violation. They are denied employment, education,
housing and access to health care as well as civil liberties such as the rightto vote. Even within the health care context people with mental disabilities experience wide-ranging abuses, with many people being locked away
indefinitely in psychiatric institutions where they are exposed to inhumanor degrading treatment, including physical, sexual and mental abuse andneglect.5
Human rights education can play a significant role in reversing this situation. Human rights and health have strong linkages, and lack of information and knowledge on the former will generally have a negative affect on
the latter. Unfortunately, the potential value of human rights education to
public health has not yet been fully realized.
This article aims to clarify the important synergy between health andhuman rights, give a brief introduction to the work of who in this field andintroduce one successful public health and education initiative in the SouthEast Asia region in which both mental health and human rights have beensuccessfully brought together in the area of human rights education: The
International Diploma in Mental Health Law and Human Rights, offered at
the Indian Law Society (ils) Law College, Pune, India in collaboration with
the World Health Organization. The Diploma is a first of its kind in Asiaand a good example of higher-level human rights education in Asia. The
recent entering into force of the United Nations Convention on the Rights of
Persons with Disabilities (crpd)6 is a significant step forward in the promotion and protection of the rights of people with mental disabilities and will
have an important impact on how relevant policies and laws are formulated
in the future. The establishment of the Diploma, which aims to educate key
national mental health actors on the crpd and other international humanrights standards, is therefore particularly timely.
Synergies between Health and Human Rights
The first reference to “right to health” at an international level was provided
by the Constitution of the who. The who Constitution recognized in 1948
“the enjoyment of the highest attainable standard of health” as “one of thefundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”7 One of the most fun-190

H u m a n R i g h t s E d u c at i o n i n A s i a - Pa c i f i cdamental sources on the right to health is Article 12 of the International
Covenant on Economic, Social and Cultural Rights (icescr) in which theright to health is defined as “the right of everyone to the enjoyment of thehighest attainable standard of physical and mental health.” Article 25 of the
crpd expands this, stating that “persons with disabilities have the right tothe enjoyment of the highest attainable standard of health without discrimination on the basis of disability.” Several other international human rights
treaties also recognize the right to health.8
International human rights law requires governments to ensure thatlegislation and policies, which will lead to accessible and affordable healthcare for all, are put in place in the shortest possible time. The right to healthis not restricted to access to health care, but also extends to other underlying determinants of health, such as access to clean water and food, adequate
sanitation and housing, healthy working conditions and access to healthrelated education and information.
Health and human rights interact in several different ways. Firstly, human rights violations such as torture, gender-based violence or harmful traditional practices can result in poor mental and physical health.
Secondly, the realization of human rights can reduce vulnerability to illhealth. The right to information guarantees that people are aware of theirhealth rights and can access scientifically valid health data on different
health topics. The right to education also indirectly affects health as educated people are generally better informed to make health-related decisions
and are more likely to be able to afford healthier lifestyles.9 Human rights
education is very important in this context. To stand up for their right tohealth and the right of others, people need to know and understand what
their rights are. For example, health policy guaranteeing free antiretroviraldrugs to hiv-positive persons is of little use if people are not aware of thisright. Likewise, a mental health law that aims to promote free and informed
consent to treatment is unlikely to curb coercive treatment practices if neither mental health professionals nor service users are aware of this right.
Thirdly, health and other policies can promote or violate humanrights.10 For instance, national reproductive health policies or programs that
exclude certain groups of people are discriminatory. Similarly health insurance schemes that specifically exclude payment for mental health care oroffer lower levels of coverage for shorter periods of time violates the rightto health as it is discriminatory and creates economic barriers to access-Right to Health Through Education: Mental Health and Human Rights

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ing mental health services. Conversely, health or mental health policies thatencourage autonomy, as well as social, health and other support services
for people with mental disabilities are likely to promote a number of fundamental rights enshrined in the crpd and other human rights instruments,
such as the right to health, to liberty and security of person, to protection ofphysical and mental integrity, to exercise legal capacity, and to live independently and be included in the community. It is thus of utmost importancethat those in the position of planning and implementing laws and policies
have a profound understanding of human rights.
Work of WHO in Health and Human Rights
Although human rights are still somewhat neglected in development cooperation efforts, they have slowly started to emerge in the global development
arena since the 1990s and are increasingly being integrated into programsof work of the different UN organizations. Within who, human rights werefirst integrated into hiv/aids work, where linkages to human rights wereparticularly apparent. In 2003 who, along with other UN organizations,signed a document entitled “UN Common Understanding on a Human
Rights-based Approach to Development Cooperation”,11 which states thathuman rights must constitute the objective and guiding principle of all development cooperation, and that the capacities of duty-bearers (governments, local authorities) to meet their obligations and of rights-holders (individuals) to claim their rights must be strengthened.
Today the human-rights-based approach is employed in a number ofprojects and programs within who headquarters, regional offices and at thecountry level.12 In short, who aims through its human rights work to:• Strengthen the capacity of who and its Member States to integratea human-rights-based approach to health• Advance the right to health in international law and international
development processes• Advocate for health-related human rights.
At the regional and country levels who supports governments in theimplementation of the human-rights-based approach to national healthpolicies and programs. Who can, for instance, provide human rights training to ministries of health and to other stakeholders such as national humanrights institutions. Health and human rights training is also offered to pub-192

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lic health and human rights practitioners, representatives of government
ministries, national institutions, civil society and UN staff members throughan e-learning course organized by who and InWEnt Capacity Building
International Germany. Human-rights-related advocacy materials havealso been produced and research conducted on specific health and humanrights topics. In the South-East Asia Region, who human rights advocacy
has focused on environmental health, hiv/aids and maternal and neonatal
health.
Who also has plans to support health and human rights education insecondary schools in the region, using dvd Health - My Right and publishedcartoons Right to Health and HIV/AIDS, Stand up for Human Rights asteaching materials in the classroom.
Another important initiative in the area of human rights education is
the launch of the International Diploma in Mental Health Law and Human
Rights at the ils Law College in Pune. The one-year diploma course is organized with the support of the ils in collaboration with who Geneva.
Legislation and Education to Pave Way for Human Rights
Although education is largely recognized as one of the key ingredients fordevelopment, the value of human rights education specifically as a tool fordevelopment has not yet been fully understood or utilized. Through human rights education, which raises awareness on the rights of persons withmental disabilities as well as government obligations to respect, protect andfulfill these rights under international law, we can first and foremost change
people’s attitudes and eradicate prejudices and ignorance that are the root
cause of violations and non-realization of human rights. A fully fledged human rights approach is not just about focusing on state action or taking
steps based on an understanding of human rights violations. A profound human rights approach also means addressing the actions of non-state actors,
addressing cultural and social practices, gender perceptions and economic
inequalities.13 Since education plays a significant role in handing down values and attitudes, human rights education is of utmost importance in the
promotion and realization of the right to health and other human rights.
Human rights education can also ensure that national decision makers and other influential stakeholders are better equipped to draft, adopt
and implement national legislation and policies that reflect international

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human rights laws and principles. As noted above the presence of mental
health legislation or policy in itself does not guarantee respect for humanrights. In some countries, for instance, legislation is extremely outdated andviolates rather than promotes or protects human rights. The WHO 2005
Mental Health Atlas, for example, indicates that only 16.7% of countries in
the South-East Asia Region have enacted legislation since 1990.14 Against
this backdrop human rights education is imperative for the formulation ofhuman rights oriented mental health policies and laws. Indeed, progressive
policies and laws can: prevent violations and discrimination and promote
human rights; encourage autonomy and liberty of people with mental disabilities; promote access to mental health, social and other support services
to enable people to lead fulfilling lives in the community, and; ensure thatpeople with mental disabilities have access to legal mechanisms to exercise
and protect their rights.
The entry into force of the crpd is an important milestone for public
mental health work from a human rights perspective. Its rapid and ongoing
ratification by Member States points towards an increasing empathy andinvolvement with mental health policy and law reforms at the country level.
In this context the International Diploma in Mental Health Law and Human
Rights comes at a crucial time and represents an important resource foradvocacy and learning.
The International Diploma in Mental Health Law and Human Rights
The International Diploma in Mental Health Law and Human Rights,
launched in October 2008, is a result of collaboration between who headquarters and the ils in Pune, India. In 2005, who published the Resource
Book on Mental Health, Human Rights and Legislation to guide countries inamending and adopting human-rights-based mental health legislation forthe promotion and protection of rights of persons with mental disabilities.
Early experience suggested that while many countries found the Resource
Book a useful guide for this purpose, the lack of trained professionals wasa significant barrier to effectively converting guidance into action. In addition, in the light of the coming into force of the crpd in 2008, there was anurgent need to raise awareness on the Convention and provide guidance on
its implications in relation to future national mental health policy, legislation, services and practice.

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The ils Law College, affiliated to the University of Pune, is recognized
as one of the premier institutions for quality legal education in India since
its inception in 1924. Its prime objective is to impart socially relevant legal
education in order to promote the principles of justice, liberty and equality.
The College is known for the innovative teaching methods it has employed
for many decades. As early as 1949, the College established its Moot Court
Society which aimed to impart practical legal education to students. Mockparliamentary sessions were held to provide law students training in political leadership and parliamentary procedure. The College also initiateda program known as ‘Towards Conscious Legal Education’ (tcle) withthirteen Diploma Courses such as on Human Rights and Law, Feminist
Jurisprudence, as well as Child and Law. Considering the role of law andlawyers as instruments of social reform, the College lays emphasis on providing students with a first-hand experience of social realities. In 1976 it
established its Legal Aid Center with a view to imparting practical training
skills to students and creating awareness about social issues. The activities of
the Legal Aid Center include providing advice to disadvantaged clients, legal
literacy, and undertaking research on various socio-legal issues.
The purpose of the ils’s International Diploma Course on Mental
Health Law and Human Rights is to build capacity of key actors in countries
to promote the rights and improve the lives of people with mental disabilities. The course equips students with the knowledge and understanding of
the cprd and other international human rights standards as they relate topeople with mental disabilities, enabling them to contribute to internationaland national advocacy efforts, create increased attention to mental healthand human rights issues on the national agendas and also influence national
legislative and policy reform processes to bring them in line with international human rights law.
The course is targeted at mental health professionals, law professionals,
mental health service users, policy-makers and planners, government officials, lawyers, human rights defenders, and family members of people withmental disabilities.
The one-year Diploma Course includes two short residential sessions.
The first residential session is at the start of the course and lasts two weeks
while the second residential session is at the end of the course and lasts one
week. In between residential sessions students are required to complete a
series of course modules, and assignments online and also undertake a sub-

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stantial project under the supervision of an assigned faculty member. The
modules cover the following topics:• Basic understanding of mental health and mental health conditions• Basic understanding of law and legal systems• Cprd and other key international human rights standards relating
to mental health• Policy and legislative framework for mental health• The Right to Health—promoting access to mental health care
• Key rights of mental health service users, families and carers• Involuntary admission and treatment in the context of the crpd
• Criminal law and mental disability• From exclusion to inclusion: Rights in the community• Drafting, adopting and implementing mental health legislation.
The Diploma Course is taught by a faculty of renowned international
experts in the area of mental health and human rights. Experts include mental health professionals, lawyers, mental health service users, experts in thearea of disability rights and human rights defenders from around the world.
The Experience So Far
The inaugural class of 2008 comprised twenty-three students from seventeen (mainly developing) countries. Students from this first intake graduated in October 2009 at a ceremony presided by Mr. Anand Grover, UN
Special Rapporteur on the Right to Health. October 2009 also marked thefirst residential session for the nineteen students from fifteen countries who
registered for the 2009-2010 academic year of the Diploma Course. Course
participants have included health and mental health professionals, government officials, lawyers, social workers, policy-makers and legislators, mental health service users/survivors and their families. The Course has enjoyedvery high approval ratings from the students with 80% saying the Course exceeded their expectations and the rest stating that it fully met expectations.
Some student-graduates made the following comments on the Diploma
Course:I enjoyed, learned, thought about what I learnt, reconfirmed,
discussed... It opened my vision to areas I had never seen, lookedat many issues and ideas differently. I changed many of my beliefs... I am thankful to the faculty and co-coordinators for giving

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H u m a n R i g h t s E d u c at i o n i n A s i a - Pa c i f i cme an opportunity to learn and interact with them. I learnt withthe belief that I can make changes even if small and change
lives and help people... we can do it.
thank you so much for this great experience, it was stressful
but incredible informing (sic)This course has exceeded my expectations. I have learnt animmense amount and made wonderful contacts and friends.
Thank you for its creation - I will spread the word on its highstandards and quality.
Extremely well supported program. Impressed with all aspects. Learning was interactive, high quality and fun.
The course, which receives more than seventy applications each year,
has a capacity to admit thirty students per year. The majority of applications are from applicants who have the potential to make effective use of thecourse and act as agents of change in their own countries. The ils runs thecourse on a non-profit basis and the costs of the course to date have been
met entirely by student fees.
The course organizers actively encourage international agencies to fundstudents to attend this course. In the past two years, international agencies
such as the osi Mental Health Initiative, the Government of New Zealand,
who Country Offices in Jordan and Palestine territory, who Regional
Office for the Eastern Mediterranean (emro) and the Pan American HealthOrganization (paho) have sponsored students to attend this course.
Conclusion
In recent years, both mental health as a public health issue and human rights
as a cross-cutting issue affecting public health have slowly captured the attention of many governments, donors, international institutions and civilsociety. The entry into force of the crpd also represents an important step
forward in the promotion and protection of people with mental disabilities.
In spite of this progress, many countries still have extremely outdated
mental health legislation, and this, in addition to the general lack of awareness on human rights, has meant that the rights of persons with mental
disabilities still fail to get the required attention. In order to realize humanRight to Health Through Education: Mental Health and Human Rights

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rights for them, fundamental changes in society are needed to bring abouta profound understanding and respect for the human rights of all persons.
This needs to be supported and reinforced by the development and enforcement of a corpus of human rights compliant legislations and policies.
While the rapid ratification by States of the crpd certainly point to a commitment in this direction, many countries still lack trained professionals toraise awareness and provide guidance on mental health policy, legislation,
services and practice.
The International Diploma on Mental Health Law and Human Rights,
which is offered at the ils College in Pune, India since 2008, is significant
both because it is one of the pioneering human rights education curriculums at an advanced level in the region, and because it focuses on thismuch neglected area of mental health. Ultimately, there is the hope that the
Diploma will help to establish an ever-increasing skilled pool of experts thatare able to bring about positive and meaningful change in the area of mental
disability rights in countries across the world.
The International Diploma is a good example of higher-level humanrights education in the field of mental health and is one of the first of its
kind to be supported by who in the South-East Asia Region. Recognizing
the importance of human rights education, and the need to expand this toother areas of health and to all levels of society, the who Regional Officefor South-East Asia is supportive of the efforts of its Member States in bolstering public health efforts with relevant human rights education. Healthrelated human rights education is indispensable to public health, as healthgoals can only be realized if people are aware of their rights and if healthprofessionals, policy-makers, and other influential stakeholders are able tounderstand and promote these rights.
*DISCLAIMER: The authors alone are solely responsible for the views expressedin this publication. The views expressed in this publication do not necessarily represent the decisions, policy or views of the World Health Organization.

Endnotes1
Miranda J.J and Patel, V., Achieving Millennium Development Goals:
Does Mental Health Play a Role?, www.pubmedcentral.nih.gov/articlerender.
fcgi?artid=1201694
2
Revised Global Burden of Disease (GBD) 2002 estimates (Geneva: World HealthOrganization, 2004), www.who.int/healthinfo/bodgbd2002revised/en/index.html
3
Neurological disorders: public health challenges (Geneva: World HealthOrganization, 2006)

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World Health Report 2003. Shaping the future (Geneva, World HealthOrganization, 2003).
5
Mental Health and Development: Targeting People with Mental Health
Conditions as a Vulnerable Group (World Health Organization, available in 2010)
and Human Rights and Health, Persons with Mental Disabilities (Washington: Pan
American Health Organization, 2008)
6
Convention on the Rights of Persons with Disabilities, adopted by the United
Nations General Assembly in December 2006, www.un.org/disabilities/documents/
convention/convoptprot-e.pdf
7
The Constitution of WHO was approved by the International HealthConference in New York in July 1946 and ratified by a majority of UN member states
on April 7, 1948. This marked the official establishment of WHO.
8
International treaties and conventions (in chronological order) relevant tohealth & human rights
1. ILO Convention (No. 29) concerning Forced Labour (1930);
2. United Nations Charter (1945);
3. Convention on the Prevention and Punishment of the Crime of Genocide(1948);
4. Convention for the Suppression of the Traffic in Persons and of the
Exploitation of the Prostitution of Others (1949);
5. Geneva Convention for the Amelioration of the Condition of the Wounded
and Sick in Armed Forces in the Field (1949);
6. Geneva Convention for the Amelioration of the Condition of Wounded,
Sick and Shipwrecked Members of Armed Forces at Sea (1949);
7. Geneva Convention relative to the Treatment of Prisoners of War (1949);
8. Geneva Convention relative to the Protection of Civilian Persons in Timeof War (1949), and the Protocol Additional to the Geneva Conventions relating
to the Protection of Victims of International Armed Conflicts (Protocol 1) (1977)
and the Protocol relating to the Protection of Victims of Non-International Armed
Conflicts (Protocol II) (1977);
9. Convention relating to the Status of Refugees (1950) and its Protocol(1967);
10. Convention (No. 105) on Abolition of Forced Labour (1957);
11. International Convention on the Elimination of All Forms of Racial
Discrimination (1963);
12. International Covenant on Economic, Social and Cultural Rights (1966);
13. International Covenant on Civil and Political Rights (1966) and its two
Protocols (1966 and 1989);
14. Convention on the Elimination of All Forms of Discrimination Against
Women (1979) and its Protocol (1999);
15. Convention against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment (1984);
16. Convention on the Rights of the Child (1989);
17. Convention (No. 169) concerning Indigenous and Tribal Peoples in
Independent Countries (1989);
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18. International Convention on the Protection of the Rights of All MigrantWorkers and Members of their Families (1990);
19. Convention (No. 182) on the Prohibition and Immediate Action for the
Elimination of the Worst Forms of Child Labour (1999);
20. Maternity Protection Convention (No. 183, 2000);
Source: 25 Questions and Answers on Health and Human Rights (Geneva:
World Health Organization, 2002), page 29.
9Better Health is Linked to Education, AORN Journal, (September 2002) http://findarticles.com/p/articles/mi_m0FSL/is_3_76/ai_91805685/
10
Gostin L. “Human Rights of Persons with Mental Disabilities: The European
Convention of Human Rights,” International Journal of Law and Psychiatry. Volume23(2), 2000/125-159 at 127.
11
The “UN Statement on Common Understanding on Human Rights-based
Approach to Development Cooperation and Programming” was adopted by the
UNDG in 2003 to ensure that all UN agencies consistently apply human rights-based
approach to development work at global, regional and country levels. http://www.
undp.org/governance/docs/HR_Guides_CommonUnderstanding.pdf
12
WHO has headquarters in Geneva, Switzerland, six regional offices and 145
country offices that cover 159 Member States. In the Asia-Pacific Region there are
two regional offices. The Regional Office for South-East Asia is based in New Delhi
and covers eleven countries. The Regional Office for the Western Pacific is based in
Manila and covers twenty-seven countries.
13
Claiming the Millennium Development Goals: A Human Rights Approach(New York and Geneva: The United Nations, 2008) p. 11.
14
Mental health atlas 2005 (Geneva, World Health Organization, 2005)

Note
Admissions for the academic year 2010-11 opened in January 2010. The organizers hope to encourage more international agencies and governments to sponsor
students to attend the course in the coming year.
Prospectus for the International Diploma is available online at www.mentalhealthlaw.in/content/international-diploma-mental-health-law-human-rights.
The website also has an application form which prospective students cancomplete online. More information can also be obtained from the course coordinator, Dr. Soumitra Pathare (incarnapune@gmail.com).
Links to publications and learning materials:
The Convention on the Rights of Persons with Disabilities www2.ohchr.org/
english/law/disabilities-convention.htm
WHO MIND Mental Health and Human Rights website www.who.int/mental_health/policy/legislation/en/index.html
International Diploma in Mental Health Law and Human Rights website: www.
mentalhealthlaw.in/
WHO publications on health and human rights www.who.int/hhr/activities/
publications/en/index.html