This paper proposes a set of nine critical elements underpinned by human rights principles to support individuals experiencing a serious crisis related to mental health problems or psychosocial disabilities. These elements are distilled from a range of viable alternatives to traditional community mental health approaches and are linked to a normative human rights framework. We argue that crisis response is one of the areas of mental health care where there is a heightened risk that the rights of service recipients may be infringed. We further make the case that the nine critical elements found in advanced mental health care models should be used as building blocks for designing services and systems that promote effective rights-based care and supports.
Over the last two decades, the United Nations and other organizations have released a number of groundbreaking reports documenting widespread, systemic human rights abuses within mental health systems worldwide.1 Overall, these documents emphasize the need to seek better health and social outcomes through sustainable means, using a human rights-based approach in keeping with the 2006 United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the right to health framework. These normative standards, along with persistent calls by service users and advocates, have brought attention to the rights of persons with psychosocial disabilities, particularly the right to freedom from coercion in mental health services. They provide the impetus to find suitable practices to transform and modernize mental health care in communities everywhere.
However, the form and substance of rights-based interventions through which mental health service providers, family members, and other engaged citizens might offer support, without resorting to coercive and dehumanizing interventions, remain unclear. While promising non-coercive interventions for persons experiencing serious emotional crises have been piloted in several countries, usually as alternatives to involuntary hospitalization, better evaluation and research is needed to increase their potential for widespread implementation.2 And although recent publications argue for such rights-based approaches, how to operationalize this evolving framework has yet to be described.3
The present paper fills this important gap by identifying a set of elements that are likely critical to rights-based support for individuals experiencing serious emotional crises, whether or not they use mental health services. The aim of this paper is to help ensure that a rights-based approach to crisis response becomes a distinct and crucial operational component of mental health care. Crisis response is a human rights flashpoint where coercive structures and practices dominate and the human rights threat to individuals is consistently manifest.