The Right to Health and Making Informed Choices – Where’s the Choice with “Choose Well”?

“There are people out there who are not well and they don’t know where to go or how to go’”

Mental Health service user (Time to Listen: Time to Act, March 2014)

In May of this year, the Chief Medical Officer released his annual report on healthcare in Northern Ireland. Amidst the warnings on obesity and the dangers of smoking were serious messages around suicide prevention. Most revealing perhaps was the statement that “the majority of people who die by suicide do not seek help from obvious sources such as mental health services.”

Today, mental health service users and carers who are part of the Mental Health Rights Campaign took to the steps of Stormont to call on the new Minister to take a modest and reasonable first step to counteract this.

The Mental Health Rights Campaign is calling for a small but important change to be made in a public information campaign named “Choose Well” which aims to give people information on where to go for medical help, in advance of it being re-run this Autumn. They are calling for it to include mental health, which it currently does not.

With a meeting with the Health and Social Care Board arranged for next week, the Campaign is also stressing that not only does mental health need included in Choose Well, but also that people on the ground, those impacted by decisions made about mental health – need to be involved in any changes, to make sure its the right information that is included.

In the last six weeks almost 1000 people, including  grassroots mental health organisations such as PIPS and FASA as well as the majority of MLAs on the Health Committee from all political parties have signed up in support.

Choose Well’s “primary focus” according to the Health and Social Care Board is to “inform Northern Ireland residents of the range of care settings available to them and to provide some advice in respect of which setting may be most appropriate for them based on their conditions.” Between October 2013 and March 2014, a total of £167, 000 was spent on the campaign.[i]

Examining the human rights issues around the Mental Health Rights Campaign adds further weight to the groups’ modest request.

The Right to Health & ‘choice’

The British and Irish governments have both ratified the 1976 International Covenant of Economic, Social and Cultural Rights which through Article 12 places an obligation on the government and by extension the NI Department for Health and all relevant bodies concerned with the delivery of health care services; to progressively realise the right to the highest standard of physical and mental health.

In their work to further explain the obligations on government the UN Committee on Economic, Social and Cultural Rights (CESCR) has made it clear that the Article 12 right extends to a right to information to enable citizens to make the best choices. The Committee have stated:

“The obligations to fulfil the right to health require the State to undertake actions that create, maintain and restore the health of the population. Such obligations include…(iv) supporting people in making informed choices about their health.”[ii]

Critically, the obligations on government regarding the right to health also extend to the manner in which change is made- the affected group also have a right to be part of the decision making process. The Committee have stated;

“A further important aspect is the participation of the population in all health-related decision-making at the community, national and international levels.”

Research carried out by the Mental Health Rights Campaign, with mental health service users and carers across Northern Ireland who had recent experience of accessing help when in distress or crisis concluded that in contrast to the obligation on government, 9/10 people accessing mental healthcare don’t have enough information about where to go to get help.

9/10 people felt they were unable to make an informed choice about the best healthcare option for them when they were in mental health crisis or distress.

Choose Well

Implicit in the concept of “Choose Well” is that individuals have a choice. International human rights law obligations dictate that this choice should be an informed one.

Yet the evidence on the ground emphatically suggests that for those in mental health distress or crisis much more remains to be done. By omitting references to mental health in their flagship public information campaign around access to services the government arguably have demarcated our public conversation around accessing healthcare into distinct and it could be said, not necessarily equal categories of physical and mental health.  Despite human rights obligations which do not distinguish the government’s obligations in the right to the highest attainable standards of both mental and physical health, the Choose Well campaign only provides information about where to access treatment from government resourced settings to protect our physical health.

Conversely, the public health message to those in need of mental health care in public information campaigns which are exclusively about mental health such as “Mind Your Head” has largely articulated the personal role in looking after our mental wellbeing – we are encouraged to ‘mind our head’ and ask for help.

Additionally, narrow (and distinct from traditional healthcare settings) routes to services for those in mental health crisis are often to the fore of mental health information campaigns which advertise web addresses which list often overburdened community support services and the government’s 24hr crisis advice line service ‘Lifeline’. Despite an increase in demand for Lifeline services, it has recently been the subject of public concern with respondents to a consultation noting difficulties in “getting through on telephone; one respondent reported that more than 10 of their clients told them that they couldn’t get through when they phoned the service”.[iii] Additionally, though Lifeline can signpost or even provide limited counselling services itself there are concerns that in contrast to specific components of the international human rights obligations[iv],  the consultation summary indicates that;

“Some respondents complained about the of lack of face to face counselling provision in their rural localities while others respondents raised concern that Lifeline was replicating counselling in areas already adequately resourced.”

Clearly the public message about where and how to access appropriate mental health treatment needs work if it is to allow those in crisis or distress to make   effective choices about how to get help.

Modest change required

Those who have experienced mental health crisis and distress are all too aware of the confusing and frightening nature of those dark times. Ensuring that they are able to access information quickly and easily about where to go for care should be the government’s first step in ensuring that their health care needs are addressed and their international human rights protected.

Specifically the campaign calls on Minister Wells to;

1. Revise the HSC ‘Choose Well’ public information campaign, within a reasonable and defined timescale

2. Include appropriate information about where to go when in mental health distress

3. Involve mental health patients and carers in the development of this information in order to ensure that it meets their needs

The former UN Special Rapportuer on the right to the highest attainable standard of mental and physical health, Professor Paul Hunt, who is currently taking part in the Northern Ireland Human Rights Commission’s Emergency Healthcare Inquiry  has added his support to the campaign. In a Message of Support to groups involved in the campaign, Professor Hunt stated;

“For people in mental health crisis, it is crucial that they are able to get help quickly. Having clear information about where you can access care for a health condition is a vital part of a State’s obligation to ensure it is realising the human right to an adequate standard of health. I strongly commend the groups involved with the Mental Health Rights Campaign in their work to ensure information is made available as widely as possible for those with mental health issues.” 

When choice in all healthcare options is being restricted through budget cuts and a ‘Transforming Your Care’ agenda which has as a likely consequence the reduction of mental health inpatient beds, surely it is a reasonable ask to request modest revisions to a government information campaign designed to help people make the right choices for them.