Women’s Mental Health and Well-Being: (How) Does a Human Rights Perspective Help?

An introduction to the conference at Suffolk University. January 11, 2007.

By Amy Agigian
Associate Professor, Department of Sociology
Director, Center for Women's Health and Human Rights
Director, Master of Arts in Women’s Health Program
Suffolk University

Many scholars, activists, clinicians, and advocates seem to intuit the connection between health and human rights. Few people, however, seem to intuit the connections between diverse women’s mental health and human rights. In this talk I attempt to flesh out and elaborate those connections, and explain why they’re important for all women’s mental health and well being.

Why look at women and mental health?
One reason is that lower social status makes diverse women and girls vulnerable to a host of assaults on their mental health and well being. In the United States:

• Violence against women is epidemic, and is both the leading cause of Emergency Room admissions for women and the leading cause of death for pregnant women.
• Child molestation is rampant, with one out of four girls estimated to be violated before the age of eighteen.
• Women still earn lower pay for equal work, earning approximately seventy-six cents to a man’s dollar. Regardless of socio-economic status, this adds up to a substantial deficit for women over a lifetime.
• Women have greater responsibilities than men for family well being: single parent families are almost all headed by women; women have primary caregiving roles and experience the “double shift.”
• The cult of youth and thinness pervades the culture, exerting huge pressure on women and girls to attain unrealistic standards of attractiveness.
• Women suffer disproportionately high rates of depression, anxiety/panic/agoraphobia, eating problems such as anorexia and bulimia, and high rates of post-traumatic stress syndrome (PTSS or PTSD).

While all women face multiple challenges to our mental health and well being, those challenges are not evenly distributed. Inequalities among women by factors such as race, social class, disability status, and gender expression all correlate with greater vulnerability to mental health problems.

Why focus on human rights?
The answer to this can be summarized in one sentence: the United States is in the midst of a human rights crisis.

• From human-made global warming to hurricane Katrina.
• From Guantanamo Bay to Abu Ghraib.
• From the health care crisis to the incarceration crisis.
• From homelessness to the loss of habeas corpus.

We are living in a time of rampant human rights violations.

One of the basic elements of the human rights perspective is that all human rights are interconnected. Human rights violations in any one area affect our ability to exercise and enjoy our human rights in others.

We can see this clearly in women’s mental health and well being. Human rights violations damage women’s physical and mental health. For example, ample evidence exists that discrimination, poverty, and violence have a devastating impact on women’s mental health. In turn that impact makes it difficult to exercise or enjoy other human rights, such as the right to participate in civic life.

On the other hand, full human rights support mental and physical health. For example, when your right to bodily integrity is respected, it enhances your mental health, which in turn makes you better able to exercise your human rights (such as your right to education), which in turn enhances your mental health, which in turn…

The human right to mental health
International human rights laws and norms assert that health (including mental health) is a human right.

The International Covenant on Economic, Social and Cultural Rights (ICESCR) provides the central international protection of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. This human right is also enshrined in other international treaties, including the Convention on the Rights of the Child; regional treaties of the Americas, Europe and Africa; and over sixty national constitutions worldwide.

The Universal Declaration of Human Rights (UDHR) states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. UDHR, Article 25.

The human right to mental health is not the same as a human right to be mentally healthy; Some of us will have mental health challenges regardless of whether our human rights are violated or not. But the human right to health includes both health care and the rights to the underlying determinants of mental (and physical) health, including access to potable water, adequate and safe food, sufficient sanitation and housing, healthy occupational and environmental conditions, and access to mental health-related information and education.

Respect, protect, fulfill
Human rights are traditionally about the relationship between the individual and the state.
The obligations of states under international human rights law are often summarized under three categories: “respect, protect, fulfill.” This means that the state, and state agents, have the obligation to respect, protect, and fulfill the full range of women’s human rights.

The full range of human rights includes civil, political, economic, social and cultural rights. In the current discussion, that means that women’s human right to the highest possible standard of mental health and well being is to be respected, protected, and fulfilled.

What does this mean?
To respect women’s human right to mental health is to:
• Stop psychiatric abuse,
• End sexual and other forms of discrimination within the mental health system,
• Abolish state violations of women’s bodily and family integrity.

To protect women’s human right to mental health is to:
• Provide social structures and services that protect women from violence, poverty, racism, homophobia, and other human rights violations that negatively affect mental health and well being.

To fulfill women’s human right to mental health is to:
• Provide high quality mental health services for everyone in need (including high quality drug detox and rehab services),
• Do appropriate outreach to populations that are vulnerable to mental health problems,
• Provide crucial education:
• Educate the general population about the causes and contours of women’s mental health and well being,
• Educate girls and women about threats to their mental health and well being as well as about treatment options and side effects.

While the state bears responsibility to respect, protect, and fulfill human rights, mental health and social services providers, as well as those in law enforcement and corrections, can also respect, protect, and fulfill human rights.

The human right to mental health care
Large numbers of women need and deserve appropriate care and treatment for our mental and emotional anguish, illness, and/or disabilities. Such mental health care is crucial to countless women’s mental health and well being. Women all over the world experience psychological distress that they need help to deal with. Further, it seems that most of us face challenges to our mental health and well being at some points in our lives.

Yet, unfortunately, as women, we have reason to be suspicious of the mental health system. Psychiatry and the mental health establishment have been sexist and misogynist from its inception. From hysteria to penis envy. From the idea that “refrigerator mothers” caused schizophrenia in their children, to involuntary ECT and lobotomies. Feminists have resisted this situation in both waves of the women’s movement.

As far back as 1899, The Yellow Wallpaper (C.P. Gilman) described a fictionalized account of a wealthy woman being driven completely mad by the “rest cure” of complete immobilization that was standard at the time, and to which the author had herself been subjected. Later, second wave feminists made similarly devastating critiques of the psychiatric establishment that labeled women “crazy” for almost any deviation from prescribed femininity. In tandem with these critiques women starting in the 1960’s have developed entire bodies of mental health theory and practice that are powerfully helpful, and even necessary, to countless women with mental health problems.

Another reason women have to be skeptical of receiving mental health care has to do with stigma. As sociologists, we know that labeling is a powerful act, and calling someone “mentally ill” or “mentally disabled” can have a profound effect on how a person sees herself and is seen—and treated—by others. Stigma is unfortunately still a major issue for people suffering from minor and major psychological challenges. For example, women who have been diagnosed and labeled “crazy” are that much more easily dismissed, particularly if they are already stigmatized by virtue of their gender, race, immigrant status, social class, or chemical dependencies.

Official, secondary, inadvertent, and collateral abuses by the mental health system are human rights violations from which women need to be protected. But the positive aspects of mental health care are aspects of women’s human rights that need to be fulfilled.

Available, accessible, and acceptable
I want to introduce one last concept that is crucial to fulfilling women’s human right to mental health. According to human rights norms, all aspects of mental health care must be “available, accessible, and acceptable.”

Availability means:
• There need to be enough trained people to provide diagnosis, treatment, medication, rehabilitation, counseling,
• There need to be enough facilities to provide these services, as well as acute/crisis facilities, detox programs and beds, methadone programs.

Accessibility means:
• People need to be able to access the available resources,
• They need to be geographically and economically accessible.

Acceptability means:
• Services need to be culturally competent,
• Services need to be relevant to the needs of diverse women being served (whether they prefer to be called patients, clients, or consumers) including:

• Chemically dependent women,
• Immigrants,
• Incarcerated or otherwise involved with the criminal justice system,
• Lesbians,
• Mothers with family responsibilities,
• Pregnant women,
• Trauma survivors,
• Women of various religions,
• Youth or elderly women.

Further, acceptability requires sufficient human rights training of providers at all levels, including training in various issues for their client populations.

Pathways to mental health for diverse women
Currently there are two tracks for women with major mental health issues: the psychiatric/mental health establishment or the criminal justice and correctional establishment. We don’t tend to think of the criminal justice system as a track for women with serious mental health issues. However, women involved with the criminal justice system have exceptionally high levels of diagnoses of major mental illness, addictions¹, trauma histories, and disproportionately suffer from poverty, homelessness, prostitution, and recent domestic violence.

While human rights can help guide and shape practice and policy for policy-makers and workers in both the criminal justice system and the mental health system, human rights also represents the possibility for a third way, that transforms and even transcends these systems. That is, human rights can be a third way that has to do with human dignity and social justice, with the highest attainable standard of physical and mental health for all women and for all people.

For this potential to be realized, however, we need to build a culture of human rights, with the participation of people in all sectors. Human rights have never been and will never been self-enforcing; rather, we need to learn, know, and claim our human rights and those of the people we work with and for. And finally, to realize the promise of human rights we must demand that the state live up to its human rights obligations under international law. 

 ¹Chemical dependency is considered an illness by the American Medical Association, and a disability by the Americans with Disability Act.