Human rights and mental health in Zambia: Recommendations for Action

The report “Human rights and mental health in Zambia” is the outcome of a three-year investigation conducted by the Mental Disability Advocacy Center (MDAC) and the Mental Health Users Network of Zambia (MHUNZA). It is the first such investigation based on international human rights standards in the country, and the report can be downloaded at www.mdac.org/zambia.
The report documents the testimonies of over 100 people with mental health issues and their family members around the country and lays out findings from human rights monitoring in five psychiatric facilities, including the only national tertiary care psychiatric facility, Chainama Hills Hospital.
Key findings
Zambia ratified the UN Convention on the Rights of Persons with Disabilities in 2010, thereby committing to upholding the rights of all people with disabilities, including people with mental health issues. However MDAC and MHUNZA found that abuse and ill-treatment against people with mental health issues are widespread and based on stigma and discrimination. The Mental Disorders Act 1951 entrenches state discrimination against people with mental health issues and is in urgent need of repeal. The report documents serious human rights violations in the community, in traditional healing settings, in conventional psychiatric facilities, and in respect of the justice system. 

Families bear the brunt of caring for their relatives with mental health issues with very little support, but this can also result in abuse in the home without any investigation.

Community-based mental health services were found to be virtually non-existent, particularly in rural communities.

Traditional healers operated across the country. While some people said traditional healers could be helpful, reports were uncovered of abusive practices including financial exploitation. The President of the Traditional Health Practitioners’ Association of Zambia raised concerns that almost half of registered traditional healers were ‘quacks’.
Serious overcrowding was evident on psychiatric wards visited, where people were warehoused in dilapidated and unhygienic conditions.  There was no access to therapy neither on psychiatric wards nor in the ‘mental health settlement’ visited. Only Chainama Hills Hospital offered minimal and insufficient occupational therapy to a minority of people there.  Seclusion rooms and high doses of strong psychiatric drugs were found to be default options of mental health practitioners. These practices are harmful and do not help with a person’s recovery.   The Mental Disorders Act 1951 allows for prolonged and unlawful detention.
Developing recommendations
On 6 August 2014, the Mental Disability Advocacy Center (MDAC), Mental Health Users Network of Zambia (MHUNZA) and the Zambia Federation of Disability Organisations (ZAFOD) presented the findings from the “Human rights and mental health in Zambia” report in Lusaka. A wide range of people who are influenced by and can influence mental health law in Zambia discussed the findings.1
Participants jointly developed a set of recommendations to tackle abuses. Recognising that systemic action is required, the event brought together key stakeholders from across civil society and government. 
Recommendations
Participants at the roundtable developed recommendations which they agreed to contribute to implementing, within the competences of their organisations. The Zambian government should:
1. Repeal the Mental Disorders Act 1951, and enact new legislation which harmonises Zambian law with the standards set out of the UN Convention on the Rights of Persons with Disabilities (CRPD), particularly in relation to the provision of community-based services, and providing access to health services on the basis of informed consent on an equal basis with others.

2. Ratify the Optional Protocol to the United Nations Convention against Torture, and take action to establish systemic independent monitoring of all places where people may be deprived of their liberty, including psychiatric hospitals.

3. Designate the Zambian Human Rights Commission as the independent monitoring body required by Article 33 of the CRPD, and establish systemic monitoring of all services and facilities for people with mental health issues.

4. Closely involve civil society, and specifically people with mental health issues and their representative organisations in ongoing law and policy reform, as set out in Article 4(3) of the CRPD. 5. Collect and publicise disaggregated data on the rights of people with mental health issues and use this to develop human rights compliant services, as set out in Article 31 of the CRPD.
In addition to these recommendations, participants at the consultation event also called on the government to take measurable steps to advance the rights of people with mental health issues.
The right to independent living in the community
1. Develop a plan for the roll-out of community-based support services with the purpose of ensuring the inclusion of people with mental health issues into their communities, ensuring their right to live independently in line with Article 19 of the CRPD. This should be based on a multidisciplinary approach across government and service providers. 2. Adapt social welfare and protection programmes to be inclusive of people with mental health issues. 3. Introduce psychosocial counselling and support for families and other care-givers of people with mental health issues. 4. Increase income-generating and community empowerment programmes for people with mental health issues to break the cycle of poverty and discrimination. 5. Ensure availability and access to mental healthcare services at the primary healthcare level which specifically address the rights and needs of people with mental health issues.
1. Ensure that all allegations of abuse and ill-treatment against people with mental health issues are promptly and effectively investigated, whether the abuse is alleged to have taken place in the community, traditional health settings, psychiatric facilities or within the justice system. 2. Strengthen the referral system to investigate human rights violations in the community with the participation of community members. This should include developing awareness of third party referrals to the Human Rights Commission. 3. Develop and roll out a training programme for police and other professionals in the criminal justice system on the human rights of people with mental health issues. This should include neighborhood or village watch committees who can minimise abuse. 4. Ensure that the Traditional Healers Bill is enacted into law promptly, and thereafter take enforcement action against abusive traditional healers who practice without certification. 5. With the participation of people with mental health issues, develop professional guidelines for medical and nursing personnel on minimising seclusion and restraint in psychiatric facilities. Where seclusion or restraints are used, ensure there are accessible and effective accountability, appeals and redress mechanisms. This should be conducted in a reasonable timeframe with the ultimate aim of ending the use of seclusion and restraints.  6. Abolish “detention at His Excellency’s Pleasure (HEPs)” in the criminal justice system for people with mental health issues. 7. Harmonise all criminal legislation with the requirements of the Persons with Disabilities Act and the UN Convention on the Rights of Persons with Disabilities. 8. Promote alternatives to retributive justice through strengthening informal/restorative justice systems. Encourage the judiciary to use restorative justice wherever possible.  9. Ensure that disaggregated statistics about the rights of people with disabilities in the criminal justice system are collected and made available. 
Capacity building and awareness-raising
1. Ensure that people with mental health issues are provided with information in accessible languages to increase their understanding of their human rights.

2. Roll out education, advocacy and sensitisation programmes in communities across Zambia based on human rights standards to challenge myths about mental illness, lead by people with mental health issues themselves. This should include training for community leaders, traditional healers, families and carers.

3. Introduce and support the development of peer-support groups for people with mental health issues in their communities.

 4. Facilitate collaboration and dialogue between traditional practitioners, conventional medicine practitioners and people with mental health issues.

 5. Roll out a compulsory training programme for all medical, nursing and social work staff on mental health issues and human rights standards.

 6. Put in place education and awareness raising programmes for policy makers across government on human rights and mental health.

 7. Roll out training for professionals who work in the criminal justice system on human rights. 
Legislative reform
1. Establish a legal framework for the regulation of traditional health practitioners which incorporates human rights standards, including the right to freedom from torture, exploitation, abuse and violence. 2. Carry out research into mental health detention orders, their use and misuse, and develop a policy of reform based on evidence collected.  3. Coordinate and monitor human rights standards across government for people with mental health issues across the justice system (as per Article 33(1) of the CRPD). 
Health services
1. Ensure all treatment provided to people with mental health issues is based on the principle of free and informed consent, whether this takes place in psychiatric facilities or traditional healing settings. 2. Establish mental health services within primary healthcare and community support programmes, and provide training to all general healthcare professionals on mental health and human rights.

 3. Develop a national referral process between traditional and conventional medicine practitioners. 4. Ensure that each district hospital provides mental health services to the community and ensure that services are not solely pharmacological-based.

 5. Ensure that a patients’ rights charter, developed with people with mental health issues, is displayed in all mental health facilities, and translated into local languages. 6. Prosecute medical and nursing professionals who neglect to provide general healthcare to people with mental health issues. 7. Introduce supported decision-making for people with mental health issues to ensure that their will and preferences are respected in healthcare decisions, including mental health treatments. 8. Develop advance directives to ensure that the will and preferences of people with mental health issues are respected in relation to the care they receive at times of crisis. 9. Ensure that each health facility provides information about rights to patients and family members, and establishes an effective complaints mechanism.  

Advocacy Working Group in Action

We are grateful to the embassy of Finland for supporting the work of the advocacy working group for the rights of children with disabilities spearheaded by their parents. Here the working group meeting in Lusaka's George Compound to review progress on its work and develop new strategies.

Disability Rights Watch toasts release of persons with mental disabilities from Chainama East Prison

For Immediate Release I

August 11, 2014

This statement is released following the release of five persons with mental disabilities from prison by the Lusaka High Court last week.

Disability Rights Watch is pleased with the bold decision of the High Court to declare the long detention of the five mentally disabled persons illegal. In our view, this is a landmark judgment which will build up the portfolio of judgments which promote and protect the rights of persons with disabilities. The judgment has established a precedence in Zambia’s jurisprudence.

Disability Rights Watch DRW wishes to congratulate the Lusaka High Court for this landmark judgment. The organisation feels that it takes judicial activism to pass such judgments. DRW further congratulates the Legal Resources Chambers (LRC) for representing the petitioners with mental disabilities. We appeal to LRC to continue to take up more cases concerning persons with disabilities

Persons with mental disabilities who have been declared not fit to undergo trial and needed treatment have been detained for many years in our prisons. The conditions under which they are detained are not pleasant at all. Today, many more are still in prison without a fair trial and there is no one to stand for the protection of their rights to be only when found guilt after a fair trial.

The Convention on the Rights of Persons with Disabilities indicates that “States Parties shall ensure that persons with disabilities, on an equal basis with others: enjoy the right to liberty and security of person; are not deprived of their liberty unlawfully or arbitrarily, and that any deprivation of liberty is in conformity with the law, and that the existence of a disability shall in no case justify a deprivation of liberty”.

Therefore, the continuous detention of persons with mental disabilities in prisons for long periods of time is in contradiction with international human rights law.

We wish to state here that the Zambian government ratified the Convention on the Rights of Persons with Disabilities and is bound to stick to its principles. Furthermore, the government enacted a progressive law which requires the courts to provide support for persons with disabilities to access court proceedings on an equal basis with other persons. The Persons with Disabilities Act of 2012 says that the judicature shall take necessary measures to ensure that persons with disabilities have equal and effective protection and equal benefits of the law without discrimination. This includes persons with mental disabilities. The Act in part 2, section 8.(3) further states that there a person with disability is a party in any legal proceedings, the adjudicating body shall take into account the condition of the person with disability and provide procedural and other appropriate facilities to enable the person with disability to access  justice and participate effectively in the proceedings. In this case, the courts should now shape themselves to provide reasonable accommodation for persons with mental disabilities rather than detaining them for many years as they wait for psychiatry assessment.

An argument may be raised here that such people may be a danger to the community. This is a justifiable argument. It must however be realised that most of the people who commit crimes while in a state of mental crisis are usually triggered by social factors. It is the responsibility of the state and the citizenry at large to ensure factors that trigger mental crisis in many of the persons with mental disabilities are controlled. Steps should be taken to progressively develop community support services that will act as a measure to reduce mental disabilities. Such services include community based mental health services and community based rehabilitation. Families and communities should be educated on issues related to mental disability. Such education programmes should be supported by the state in such a way that the support is equated to that given to HIV/AIDS.

Now that the five persons were released from Chainama East Prison, a big question arises: is the family and community ready for them? This is why we are calling for a serious consideration to develop comprehensive community based support services for persons with mental disabilities.

We wish to congratulate the Lusaka High Court for the landmark judgment. It takes judicial activism to pass such judgments. We also congratulate the Legal Resources Chambers for representing the petitioners with mental disabilities. Will LRC continue to take up more cases concerning persons with disabilities.

 

Wamundila Waliuya,

August, 2014.

Submission to the legal and justice sector reform commission

Disability Rights Watch Zambia

Nexus Building

Malambo, Road

Lusaka, Zambia

 

The Chairperson,

Judicial and Legal Reform Commission,

Zambia.

 

Re: Submission to the Judicial and Legal Reform Commission

1.0 INTRODUCTION

1.1 Disability Rights Watch

The Disability Rights Watch (DRW) is a non-profit making organization registered under the Patents and Companies Registration Agency as a company by guarantee. It was formed and registered in 2011. The aim of DRW is to ensure the promotion and protection of the rights and fundamental freedoms of persons with disabilities through strengthening the work of disabled persons’ organizations. Its work is premised on the principles of the Convention on the Rights of Persons with Disabilities (CRPD).

1.2 Persons with Disabilities in Zambia

According to the World Report on Disability (WHO, 2011), every population of a country comprises 15% of persons with disabilities. In a population of around 13 million people, this is translated to close to two million people in Zambia have disabilities. Currently these people still face problems in accessing justice on an equal basis with other persons.

2.0 CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES

2.1 Zambia ratified the CRPD in 2010 but is yet to ratify its optional protocol. After ratifying the CRPD the government went ahead to domesticate it by enacting the Persons with Disabilities Act of 2012.

2.2 Article 4 (General Obligations( of the Convention states that States Parties will undertake “to adopt all appropriate legislative, administrative and other measures for the implementation of the rights recognized in the present Convention”. The Article goes on to state that States will undertake to take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs and practices that constitute discrimination against persons with disabilities; to take into account the protection and promotion of the human rights of persons with disabilities in all policies and programmes; and to refrain from engaging in any act or practice that is inconsistent with the present Convention and to ensure that public authorities and institutions act in conformity with the present Convention.

2.3 Article 5 of the CRPD says: “States Parties recognize that all persons are equal before and under the law and are entitled without any discrimination to the equal protection and equal benefit of the law”.

2.4 Article 12 of the CRPD says, “States Parties reaffirm that persons with disabilities have the right to recognition everywhere as persons before the law”. It goes on to state that “States Parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and that “States Parties shall take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity”.

2.5 In Article 13, the Convention states that “States Parties shall ensure effective access to justice for persons with disabilities on an equal basis with others, including through the provision of procedural and age-appropriate accommodations, in order to facilitate their effective role as direct and indirect participants, including as witnesses, in all legal proceedings, including at investigative and other preliminary stages”.

2.6 This Article goes on to state that “in order to help to ensure effective access to justice for persons with disabilities, States Parties shall promote appropriate training for those working in the field of administration of justice, including police and prison staff.

 

3.0 PERSONS WITH DISABILITIES ACT OF 2012

3.1 The government enacted the Persons with Disabilities Act in 2012. This Act domesticates the CRPD. It provides for the rights of persons with disabilities in Zambia. Part ii section 4 provides for the general principles that would apply to all persons with disabilities and these include respect for inherent dignity of persons with disabilities, individual autonomy including the freedom to make one’s own choices, and independence of persons; non-discrimination; recognition as persons before the law. The principles also include respect for physical and mental integrity; independent living; full and effective participation and inclusion in society; respect for difference and acceptance of persons with disabilities as part of human diversity and humanity and equality of opportunity. Other general principles are accessibility; gender equality; respect for the evolving capacities of children with disabilities; and respect for the right of children with disabilities to preserve their identities.

3.2 The Persons with Disabilities Act in its section 8(1) states that “a person with disability shall enjoy legal capacity on an equal basis with others in all aspects of life”. Section 8(2) of the Act states that “the judicature shall take necessary measures to ensure that persons with disabilities have equal and effective protection and equal benefits of the law without discrimination”.

3.3 The Act, in section 8(3) goes on to state that where a person with disability is a party in any legal proceedings, the adjudicating body shall take into account the condition of the person with disability and provide procedural and other appropriate facilities to enable the person with disability to access  justice and participate effectively in the proceedings.

 

4.0 ISSUES WE ARE RAISING

4.1 There are still some laws which are not in harmony with the Persons with Disabilities Act of 2012. These include laws like the Penal Code, Criminal Procedures Code, Mental Disorders Act, Electoral Act and other laws pertaining to access to justice and participation in public and political life. This includes the Constitution of Zambia which discriminates persons declared of “unsound mind”. These laws are not even in harmony with the spirit of the CRPD when Zambia ratified this piece of internal human rights law.

4.2 Zambia ratified the CRPD but has not ratified its optional protocol. This is in an event where the Persons with Disabilities Act provides for the ratification of the Optional Protocol.

4.3 Many laws do not recognize the right to exercise legal capacity by persons with disabilities, including those with mental and intellectual disabilities. Section 8(1) of the Act of 2012 provides for the right to legal capacity.

4.4 The court buildings are not physically accessible.

4.5 During the whole justice process persons with disabilities are not provided with reasonable accommodation, for instance sign language, Braille and other support they may need when it comes to those with mental and intellectual disabilities.

4.6 The human resource in the administration of justice is not trained to handle persons with disabilities for the purpose of providing reasonable accommodation and full participation.

5.0 RECOMMENDATIONS

5.1 The government should ensure that all the laws are in harmony with the Persons with Disabilities Act of 2012 when it comes to the right to exercise legal capacity; access to justice; participation in public and political life; accessibility and contracts.

5.2 The draft Constitution should be quickly released to the public and the process of enacting it expedited because persons with disabilities made progressive submissions which includes their rights to personal development and independence of person and the right to education. The Constitution should be in line with the principles of the CRPD.

5.3 Zambia should ratify the optional protocol to the CRPD. The Persons with Disabilities Act provides for this.

5.4 The Judicial Service Commission should ensure that all court buildings are adjusted and modified for the purpose of making them physical accessible to persons with disabilities. This includes placing signage to guide those who are hearing impaired.

5.5 The whole justice system should provide reasonable accommodation when it comes to persons with disabilities. This includes providing sign language, Braille and support measures for those who may need them especially those with mental and intellectual disabilities.

5.6 Human resource in the administration of justice should undergo training on issues pertaining to the CRPD and the Persons with Disabilities Aact in order to enable them handle issues of persons with disabilities appropriagtely. This should include the revision of all the curricula used for traing such human resource including the police, prison workers, lawyers and magistrates.

5.7 Persons with disabilities should always be consulted in all matters that concern them. This is to uhold the slogan “Nothing about us without us”.

 

 

We pray that our issues will be attended to with the urgency they require.

 

Signed,

 

 

Wamundila Waliuya,

Executive President.

 

Submitted today, the 29 of July, 2014.

Visit our blog on: www.disabilityrightswatch.blogspot.com 

Parents of chldren with disabilities and their children have teamed uo to take advocacy for their children;s rights to another level

Human Rights Watch Report calls for disability specific HIV services

The Human Rights Watch says the Zambian government and international donors should develop disability specific HIV services and ensure accessibility and non-discrimination within mainstream HIV services.
HRW launched its report, "We Are Al...so Dying of AIDS" Barriers to HIV services and Treatment for Persons with Disabilities in Zambia on Tuesday July 15 in the capital, Lusaka.
The report recognises that the Zambian government has made significant progress in scaling up its response to HIV generally, but few programs are accessible to people with disabilities and social stigma prevents their access to HIV services on an equal basis with others.
"Across the contimum of care - from education to testing to treatment - people with disabilities in Zambia face hurdle after hurdle." said Rashmi Chopra, Sandler fellow at Human Rights Watch and author of the report.
As a regional leader in developing and expanding comprehensive HIV services, Zambia should remove barriers and become a model for inclusion of people with disabilities.
The full report can be accessed on http://hrw.org/node/126103

WAWA takes time to explain Education for All

By Wamundila Waliuya

Education must be for all! I really like this statement but I do not understand it. If I understand it, then, it should mean that there should be no form of discrimination in the education system. Is it possible today? I think so.

Let us try to look at it from this point of view. The education system everywhere should carry teacher training programme for all; a curriculum for all; teaching methodology for all; physical infrastructure for all; a school and community for all; teachers for all; school support staff for all; communication modes and language for all; education planning and budget allocation for all. This sounds crazy! But I am trying to talk about a system that gives access, effective participation and progression for all learners.

I again sound vague when referring to ‘all’. Who are these all? It may mean all citizens interested in learning. All citizens interested to learn should find the education system ready to absorb and accommodate them appropriately. The teachers must be ready for them. The school infrastructure must be ready for them. The curriculum, both core and extra-curriculum must be ready for them. The community too must be ready for them. Everything reconciling with education and learning must be ready. No one interested to learn must be made to adjust to the education system. They should only fit into the already accommodating system.

I think I am still vague when referring to ‘all’ and ‘them’. Let us look further at this example. The school system must be able to be ready for them interested in using staircases and those who are not interested in stairs cases but are interested in lifts, escalators or ramps. The schooling system should also accommodate those who use print, large print and Braille or those who use all the modes of communication. The schooling system should be able to accommodate those who use speech and can hear; those who use speech but use sign language also; those who use sign language only etc. The schooling system should accommodate those who prefer to have extra time to learn and prefer to learn certain subjects that suitable for them. The schooling system should be able to set different examining methods for those who prefer to be examined differently. For instance, one learner would say, “I do not need to learn mathematics because I feel I can not assimilate it at the same speed as my colleagues can. My intellectual capacity can accommodate mathematics. So I would like to learn particular practical skills and be examined in that”. The education system should accommodate this learner who needs to learn too. Not all learners need mathematics, science, geography, history and book keeping. Some learners would only need communication skills, home economics and activities of daily living and be examined in these. Nothing is wrong with this. But we tend to force all subjects or courses on everyone. Why?

Let us look at another scenario. A teacher training curriculum planning technical team is sitting and one says, “Guys, let us make a curriculum for teacher training which will include the following: compulsory English language, sign language, tactile language, Braille and at list one local language. Of course bearing in mid other courses like psychology, sociology and teaching methodology”. The planner then says, “You are correct, the teaching methods should equip the teachers with skills to accommodate those who need more time to learn; those who need individualized attention; those who prefer sign language; those who prefer computers with screen reading software; those who prefer large print; those who use Braille”. The other joins in to say, “Let us not forget those learners who need more intensive support like orphans with stress, girls with stress and those with intellectual difficulties”. Another jokingly but seriously says, “Let us not forget the elderly who still want to go back to primary school.” This seems to be a serious technical team. What do you think? A newly graduating teacher should be proud to shout, “I am a teacher for all learners”.

What an expensive education system! It is not expensive. It is inclusive. My question now is: where does the so called “special education” fall. Let’s talk.