Natalie Schuck, LLM, PhD Candidate, Global Health Law Groningen Research Centre, n.s.schuck@rug.nl

“Although the COVID-19 crisis is, in the first instance, a physical health crisis, it has the seeds of a major mental health crisis as well, if action is not taken”, as per the policy brief by the United Nations published in mid-May.[i] Months earlier, the WHO and other organizations already outlined the danger of COVID-19-related psychological distress and published information on how to take care of one’s mental health and well-being.

The mental health dimension of COVID-19 is twofold: the pandemic has negative effects on the mental health of whole societies, and the pandemic has created barriers to access mental healthcare for people who are already affected by mental health conditions. This article focuses on the latter.

Accessing mental health facilities, goods and services falls within the scope of Article 12(2)(d) of the International Covenant on Economic, Social and Cultural Rights, which provides the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Meaning that everyone with a mental health condition has the right to medical attention and medical services. Whilst in many parts of the world accessing mental healthcare is already difficult in normal circumstances, COVID-19 further aggravated access to necessary care. With a focus on tackling the new outbreak, many governments scaled down their support for mental health institutions and services, creating a deficiency in equipment, medicine and food, amongst others. In many places, ongoing treatments were abruptly ended. Shanta Barriga, Director of the Human Rights Watch Disability Rights Division, explained that the pandemic caused mental health centres to close down fully, sending people with mental health conditions back into their communities, where no healthcare is available.[ii]

On the other hand, COVID-19 has increased the cases of non-consensual interventions. The topic of involuntary admission and treatment of persons with mental health conditions, especially in emergency situations, has been critically discussed in mental health and human rights scholarship. The Convention on the Rights of Persons with Disabilities (CRPD) and its Committee, the body of independent experts, which monitors implementation of the Convention, generally urge states to eliminate non-consensual interventions in mental healthcare in line with Articles 12 (equal recognition before the law), Article 14 (liberty and security of the person), and Article 17 (protecting the integrity of the person). Whilst this debate goes beyond the limits of this article, I want to underline that an increase in demand for involuntary admission and treatment during the lockdown has begun to surface.[iii] Dainius Puras, UN Special Rapporteur on the Right to Health, also expressed his concerns regarding the overuse of medication to treat persons with mental health conditions in times of COVID-19.[iv]

I would like to draw attention to one specific problem that the inaccessibility of mental health services during lockdown has caused. When persons affected by mental health conditions were sent home from institutions or when mental health services (in communities) stopped operating, domestic and sexual abuse increased.[v] Although women are generally at particular risk of domestic violence, women with mental health conditions are known to be extremely vulnerable to abusive conduct at the hand of family members or caregivers at home. Sexual abuse of persons with (severe) mental health conditions is a violation of the right to be free from exploitation, violence and abuse (Article 16 CRPD). The Article explicitly obliges states parties to protect individuals from abusive conduct also within the home.

In addition to barriers in accessing mental healthcare due to COVID-19 and the related human rights concerns, I want to highlight the specific danger COVID-19 poses for persons who cannot access adequate mental healthcare. Many mental health facilities around the world are overcrowded and the conditions can be extremely unhygienic. People with mental health conditions are often locked up or even chained, including in state-run psychiatric hospitals or traditional and faith-based rehabilitation centres.[vi] That in itself already raises human rights concerns. International jurisprudence has found that such living conditions may breach the right to be free from inhumane and degrading treatment (Article 15 CRPD).[vii] But the important question that emerges is: How can these people, crowded together with often no access to soap and water, protect themselves against COVID-19 infections?

To address these issues, UN Secretary-General António Guterres declared that mental health services must be seen as an essential part of government responses to COVID-19. He added that they must not only be fully funded, but also expanded, to protect the human rights and dignity of affected individuals.[viii] This clearly echoes the human rights and mental health research of recent years. Nevertheless, the situation of COVID-19 once more shows that a vast majority of mental health needs remain unaddressed. And to reduce immense suffering among hundreds of millions of people due to the social and economic costs of this pandemic, change in the response to mental health conditions is urgently required – maybe now more than ever.

[i] United Nations, Policy Brief: COVID-19 and the Need for Action on Mental Health (13 May 2020).

[ii] See United for Global Mental Health Webinar Series on Mental Health & Human Rights in the time of COVID-19 https://www.unitedgmh.org/news/webinarseriescovid19.

[iii] See eg World Federation for Mental Health, Mental Health and COVID-19 (22 April 2020) https://wfmh.global/mental-health-and-covid-19-appeal/.

[iv] See United for Global Mental Health Webinar Series on Mental Health & Human Rights in the time of COVID-19 https://www.unitedgmh.org/news/webinarseriescovid19.

[v] See United for Global Mental Health Webinar Series on Mental Health & Human Rights in the time of COVID-19 https://www.unitedgmh.org/news/webinarseriescovid19.

[vi] Human Rights Watch, COVID-19 Poses Extreme Threat to People Shackled in Nigeria (30 March 2020) https://www.hrw.org/news/2020/03/30/covid-19-poses-extreme-threat-people-shackled-nigeria.

[vii] See e.g. Purohit and Moore v The Gambia (2003) AHRLR 98 (ACHPR 2003); Stanev v Bulgaria, App no 36760/06 (ECtHR, 17 January 2012; or Ximenes-Lopes v Brazil (Merits, Reparations, and Costs) IACtHR Series C no 149 (4 July 2006).

[viii] António Guterres, "Mental health services are an essential part of all government responses to COVID-19", https://www.un.org/en/coronavirus/mental-health-services-are-essential-part-all-government-responses-covid-19.