Mental Health Reform and Human Rights in Chile

Mental Health Reform and Human Rights in Chile 1990 -2018: achievements and challenges Dr. Alberto Minoletti

Number of persons cared for mental disorders per 100, 000 population in outpatient facilities: 2004 -2014 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Primary health care Community mental health teams 2004 2014

Number of beds per 100, 000 population in different mental health facilities: 1990 -2014 25 20 15 10 5 0 Acute beds in general hospitals Acute beds in mental hospitals 1990 Chronic beds in Places in supported mental hospitals homes 2014

Main Achievements in Human Rights with Mental Health Reform • Increased availability, accessibility and quality of community mental health services • Life with higher dignity, autonomy and social inclusion for many persons with psychosocial disabilities • Health workers more aware of human rights • Less use of coercion, abuse and violence with persons using mental health services

Main legislative and regulatory measures in human rights for mental health services Legislation - Guarantees of care for 4 mental disorders (parity with physical health) - Oversight agency to protect the rights of persons using mental health services - Informed consent for treatment and research - Restrictions to involuntary hospitalization Regulation - Prohibition of psychosurgery in persons with psychosocial disability - Review mechanisms for sterilization (only with informed consent) - Rules for crisis management and physical restraint

Gaps in human rights of persons with mental health conditions and psychosocial disabilities in Chile • 418 persons still hospitalized in mental hospitals, exposed to degrading treatments and abuse • Some persons in supported home have reported coercion, punishments and lack of liberty • WHO Quality. Rights showed low achievement in activities to support social inclusion in outpatient facilities • Significant gaps in access and quality of care persist in all health areas • The stigma about mental illness is still high in the health system and in the Chilean population