1. Foreword


I commend the government of Zambia for facilitating access to MDAC and MHUNZA to conduct the first ever human rights investigation into mental health services in the country. Independent human rights monitoring and documentation are a vital source of information for governments and civil society as they seek to advance the rights of people with mental health issues. The willingness of the government of Zambia should serve as an example to other countries in the region and globally.

Shuaib ChalkenShuaib Chalken

The report itself documents a number of serious human rights violations including unlawful detention in psychiatric hospitals, unregulated use of seclusion and restraints in both conventional and traditional healing settings, and physical abuse and exploitation within communities. These reflect what I have observed in other developing contexts, often occurring as a result of low awareness of human rights standards, limited financial and human resources and insufficient human rights advocacy. The report serves as a clear call for more awareness and greater action by governments which have ratified the UN Convention on the Rights of Persons with Disabilities (CRPD), which Zambia did in 2010.

A key finding in this report is that people with mental health issues experience abuse and exploitation in settings where they seek services (psychiatric facilities and traditional healing settings), and also in their communities. Abuse in the home is widespread, reflecting the wider social discrimination faced by people with mental health issues. The persistent disregard for rights of people with mental health issues often stems from deeply-ingrained stigma, a global phenomenon. Stigma breeds exclusion, discrimination and criminal neglect.

Action to stop ill-treatment and other forms of abuse should be swift. I am hopeful that the government of Zambia will take such action. The current process of legislative reform, including the passage of the Mental Health Bill and the drafting of a new Constitution, provide opportunities to outlaw violations in all settings and mandate the provision of human rights-compliant services in the community. The government should regulate traditional healers so that the unqualified “healers” can never be allowed to exploit or abuse people. In common with the situation in many other countries, people with mental health issues in Zambia are still frequently deprived of their liberty and placed in psychiatric institutions. To change this situation, I urge the government of Zambia to implement Article 19 of the CRPD. This requires governments to take steps to ensure that people with mental health issues live safely in their communities with choices equal to others. The Zambian government must close facilities that result in long-term incarceration, recognising that the rightful place of everyone in Zambia to access support so that they can live with whom they want. Facilities such as the Nsadzu Mental Health Rehabilitation Centre which segregate and isolate people should ensure that residents are supported to be fully included in their communities just like everyone else. The Zambian government has been willing to allow independent human rights monitoring of mental health services. A next step is for it to ratify the Optional Protocol to the UN Convention against Torture. The government should then establish an independent monitoring body mandated to conduct similar monitoring on a regular basis – and not just to psychiatric hospitals but to every facility where a person can be deprived of their liberty.

I thank MDAC and MHUNZA for producing this report. Collaboration between user-led organisations such as MHUNZA and professional human rights organisations such as MDAC enhances awareness of the human rights of people with disabilities both domestically and internationally.

I hope that the evidence of ill-treatment established by this report will provide momentum to decision-makers to undertake reforms, and will inspire others and people with disabilities themselves to come forward and advocate for change. We need leadership both within government and outside it to create more inclusive societies. The Zambian government should increase the mental healthcare budget. International donors should invest in services which respect human rights.

People with mental health issues have been waiting for too long to be included in societies. The evidence of human rights violations in this report spurs us to quickly reverse the situation. Change is possible and it must start now.

Shuaib Chalklen
United Nations Special Rapporteur on Disability

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