Overcoming resistance to the rights-based care model
The model of mental health care is changing; services increasingly include, and have for years, person-centered care, based on rights and the recovery model . Advances in advance decision planning, the incorporation of mutual support technicians or the deployment of the QualityRights program demonstrate this. There are numerous examples of institutions and services that in recent years have made a clear commitment to incorporating a rights perspective and the fight against stigma in their care models.
But experiences of discrimination in the healthcare field continue to exist, and people continue to experience stigma as they go through services. Changes such as those represented by modifying the mental health care model do not happen overnight, and the path is not without obstacles and resistance.
Resistance to change is a common reaction in any field of work. The fear of doing things differently is inherent in human nature and is often also manifested in transformations of care models. In the case of the rights-based care model in mental health, this change implies a profound rethinking of care practices and the relationships between professionals and people served in services.
The recovery model, a paradigm shift in the approach to mental health
Professionals in the spotlight
In the process of change, mental health professionals often feel they are ultimately responsible for the rights violations and discrimination that may occur in healthcare. However, the reality is that they are part of a much broader social mechanism , in which numerous actors and structures intervene, including the legal framework, institutions and social dynamics.
The main challenge for professionals is to find a balance between compliance with protocols, regulations, laws and the application of a care focused on the rights of the person. This scenario can generate tensions and a sense of frustration in those who, despite wanting to apply a rights perspective, see themselves limited by a system that is still in transition.
In the rights-based care model in mental health, change implies a profound rethinking of care practices and the relationships between professionals and people being cared for.
Furthermore, the shift towards a rights-based model involves a transformation of the relationships between professionals and the person being cared for. While the traditional model was based on an asymmetrical power relationship, in which the professional made decisions for the person, the new model proposes collaborative work in which the voice of the person being cared for must be the center of attention. This change is not easy, as it requires training and a restructuring of the professional role.
In this sense, it is essential that institutions provide spaces for reflection and training so that professionals can understand and incorporate the principles of rights-based care. Likewise, it is necessary to promote learning networks between professionals to share experiences and strategies that allow for the effective implementation of this model.
Training and awareness-raising of mental health professionals from the recovery model
Adopting a human rights-based model of care requires a transformation of the mental health system , including changes in infrastructure, methodologies and available supports. Currently, services work under a considerable care load, with high staff turnover and little time available. Without the necessary resources, professionals may perceive this model as difficult to implement or even an unviable option.
Some professionals may feel frustrated when, despite wanting to apply a rights perspective, they find themselves limited by a system that is still in transition.
A model focused on the rights of the person requires adequate resources and spaces to offer personalized and community support, as well as professionals trained in rights-based care that is free from discrimination.
Social and structural stigma
Structural and social stigma directly contribute to the perpetuation of rights violations and experiences of discrimination. This stigma often places professionals in a role of social control , where they are expected to differentiate between what is considered "normal" and what is not.
People with mental health problems are often associated with stereotypes of aggression and unpredictability . This perception encourages control and monitoring of their lives, which creates a barrier to their autonomy. Professionals, under this view, may be forced to make decisions from a paternalistic perspective, differentiating between "madness and reason", thus perpetuating an asymmetrical power relationship. In addition, some professionals have also internalized stigmatizing beliefs throughout their training or work history, which influences the way they approach care.
Training and critical reflection are essential to identify and dismantle these biases, promoting truly stigma-free and rights-based care. Therefore, it is essential to continue working to eradicate stigma at all levels of mental health care.
Fighting stigma in mental health in the healthcare sector
Professional responsibility
The principle of responsibility is fundamental to the work of mental health professionals, as they have the mission of ensuring the well-being of the people they care for. However, this principle can conflict with the rights-based care model, which prioritizes each person's decision-making capacity , including the right to take risks and make mistakes.
This paradigm shift requires a new way of understanding professional responsibility. It is not just about protecting, but about accompanying people in making informed decisions, with a balance between support and autonomy. This implies a profound change in work methodologies, leaving behind a paternalistic vision and promoting shared co-responsibility between professionals, the people they care for and society in general.
However, legal liability remains a key factor in the decision-making of mental health professionals. In situations where a person may be at risk , professionals are subject to legal frameworks that may limit their ability to act exclusively according to a rights-based model of care. This highlights the need for clear legal changes and regulations that are aligned with a rights-based model of care.
It is not just about protecting, but about accompanying people in making informed decisions, with a balance between support and autonomy, leaving behind a paternalistic vision and promoting shared co-responsibility.
Responsibility should not fall exclusively on professionals , but should be shared with a system that promotes the rights and well-being of all people involved in mental health care. For this model to be truly effective, professionals must be able to move from individual responsibility to shared co-responsibility with the people they care for and with society in general.
Overcoming obstacles: good practices
It is essential to make rights violations and discrimination visible in order to quantify the problem and understand the urgency of change. Pointing out these situations should not be perceived as an attack on professionals, but as an opportunity to transform reality. A reality that is urgently needed to be transformed, since behind all these barriers and resistance there are people experiencing discrimination with negative consequences in all aspects of their lives.
Sharing successful experiences of rights-based care, highlighting positive examples and generating spaces for collective reflection facilitates the transition to another model.
To overcome these and other obstacles we encounter in implementing the rights-based care model, we must be able to imagine that the scenario is possible and that there are alternatives . Sharing successful experiences of rights-based care, highlighting positive examples and generating spaces for collective reflection facilitates the transition to another model.
Good practices in supporting decision-making
At Obertament, in its mission to address stigma and discrimination in the healthcare field, we have worked hand in hand with the services to develop a collection of good practices for combating stigma in community mental health . The experience of entities and services has shown that the systematization of good practices is key to ensuring respectful and stigma-free care. It is not just a matter of good intentions or the personal sensitivity of professionals, but of integrating specific and systematized actions that guarantee care aligned with human rights and that can be replicated by other services.
Rights-based mental health care is not a utopia, but a path that is already being taken in many spaces. With the commitment of people with lived experience, professionals, institutions and society, it is possible to transform mental health care and guarantee respect for the rights of all people.
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