Mental health workers' perceptions and perspectives on the right to health and a human rights-based approach to mental health: A case study of the Chitwan District in Nepal

Abstract

Over the last decade, there have been increasing calls for respecting and integrating human rights into health, including into mental health policies, plans, and programmes. The convergence of mental health and the right to health has implications for health workers, as they are the key translators of policy- and programme-related decisions into practice. This thesis is a qualitative research study which follows a case-study approach situated in the Programme for Improving Mental Health Care in Nepal. It aims to explore the perceptions and perspectives of health workers in the Chitwan district in Nepal on the use of a human rights-based approach (HRBA) to mental health. The specific objectives are to (1) examine existing evidence on the use of an HRBA to advance health; (2) explore perspectives on the right to health among mental health workers in Nepal; (3) explore health workers’ perceptions of the application of an HRBA to mental health in planning and service provision; and (4) develop a conceptual framework regarding the use of an HRBA to mental health. The literature review identified some plausible positive evidence on the use of an HRBA to advance health, but also highlighted the very limited quantity and quality of the evidence and the difficulty in determining with certainty the direct influence of an HRBA to health. No studies were identified that explored an HRBA to mental health in low- or middle-income countries. The qualitative research highlighted that participants were aware of human rights, but faced difficulty in understanding their meaning and application, including an HRBA. An HRBA to health and related plans requires an understanding of both the health system context and involvement of health workers. A conceptual framework was developed of an HRBA to mental health to help guide the application of an HRBA in mental health planning and service provision. Recommendations are provided.