Physical health as a human right

‘People should not receive variable quality of care [for their physical health] because they have a mental health diagnosis, are disabled by mental distress, or for any other reason,’ Dr Chris Maylea, mental health lawyer, social worker and lecturer at RMIT University, told newsGP.

‘Everybody should receive the same quality of care.’
 
Dr Maylea is acutely aware, however, that the health system does not always put this belief into practice – which amounts to a breach of human rights, as enshrined in the United Nations’ Convention on the rights of persons with disabilities.
 
Dr Maylea believes taking a legalistic, human rights perspective on the right to physical health, particularly in the case of people with mental health issues, can help GPs and other health professionals more effectively advocate for their patients.
 
‘It’s about providing GPs with the tools and the language to frame the problem in a way that means we will actually address it rather than just being upset and distressed by it,’ he said.
 
And the problem is not a minor one – research has clearly shown patients with mental health conditions often experience significant gaps in physical health when compared to patients without.
 
Dr Maylea believes much of this gap stems from the different treatment patients with mental health concerns often receive within the health system. This sometimes manifests in very subtle, hidden ways, such as ‘diagnostic overshadowing’.
 
‘People often find their concerns about their physical health are not being met because they’re passed off as delusions or paranoia,’ he said.
 
‘We get this issue, for example, with people talking about medication side effects and those being written off as part of the mental illness rather than part of the treatment.
 
‘That’s a pretty clear example of people not getting the same quality of care, because they’re not being listened to and believed.’

Another issue – one that is well-known and a common source of frustration to GPs – is a lack of resourcing for the treatment of patients with mental health conditions, who often need a more holistic approach.

Dr Chris Maylea believes taking a human rights approach to physical health for patients with mental health concerns can make a huge difference to their quality of life.
  
Dr Maylea argues both of these issues constitute breaches of patients’ human rights and should be named as such in order to better combat the problems they cause.
 
‘What we’re seeing is people’s physical health not being attended to because of the diagnosis or the symptomology that they are presenting with,’ he said.
 
‘If [lack of resourcing] means people are being discriminated against on the basis of their diagnosis, they’re having their human rights breached.
 
‘And so we have the same problem of identifying something as a resourcing or prioritisation issue, but we need to start calling it a human rights violation so we can give it the attention it deserves.’
 
Patients with mental health problems are also often faced with a lack of free and informed consent. This can take the form of patients receiving prescriptions for medication without fully understanding potential side effects, which can include problems such as weight gain, sexual dysfunction and extreme drowsiness, all of which can have a strong negative impact on physical health.
 
‘Often, people tell us they were prescribed something by their GP, while in distress, and it wasn’t until much later they began to understand the side effects from that medication,’ Dr Maylea said.
 
Funding and resourcing problems are often a broader advocacy issue that can’t necessarily be addressed at a GP’s day-to-day practice level. But Dr Maylea has some suggestions that can help preserve patients’ rights and improve physical health outcomes.
 
‘The standard explanation of side effects you might give to somebody who doesn’t have any cognitive impairment or extreme distress, where you might be able to just explain it once – that’s not necessarily going to be enough,’ he said.
 
‘So if a GP needs to prescribe something that is going to have long-term side effects, they need to not only explain it when they give it to the person so they are making an informed decision, but also ensure they’re doing so every time afterwards and checking the person still understands.
 
‘Also, if they are seeing somebody who does have a diagnosis of mental illness, just spend a reflective moment to think how they might treat that person if that wasn’t the case.’
 
Dr Maylea has found many patients with mental health issues have positive relationships with their GPs, and believes GPs can be very effective advocates for this patient group.
 
‘In a very real way, GPs are the good guys at the pointy end of the mental health system and that’s where a lot of people want to get to, where they can work with their GP to manage the experience and get out of the public health system,’ he said.
 
‘GPs have a real advantage there, in being based in the community, in not using coercive approaches that public mental health uses.’

funding human rights mental health