Declaration of Kobe on the Human Rights of People with Mental Illness

We, the members of the WASP, WPA, WAPR, WFMH and JSSP, at the joint meeting in Kobe, Japan in October 2004 are mindful of the large numbers of persons with mental illness and disabilities that die prematurely in developed and developing countries, and

Expressing our understanding that fundamental to human rights and affirmed in the Declaration of Principles at the founding of the United Nations, is the right to live and to health, and

Dismayed by reported life expectancies in a multitude of developing countries of less than 50 years and with reports of persons with mental illness who become separated from their families dying prematurely at even younger ages, and

Concerned that in America death rates have almost tripled among persons with mental disorders, coincident with increasing homelessness and untreated mental illness, and

Recognizing that worldwide some 3 million persons with mental illness die prematurely each year from a range of preventable risk factors, and noting that,

Deficits in the quality of medical care seem to explain a substantial portion of the excess mortality experienced by patients with mental disorders after myocardial infarction; and further noting that

Medications and psychosocial rehabilitation have been shown to be effective in promoting community and family retention,

However, note with concern that in many developing countries, medications for mental illness are costly and not accessible for many families, and

Noting with approval that the WHO and advocacy groups have succeeded in alerting the public to the massive premature death toll among persons with HIV-AIDS, and

Recognizing that the efforts of such advocacy has resulted in greater access to medications for HIV-AIDS in developed and developing countries, and

Recognizing that the WHO has, in the Alma Ata Declaration and in recent years urged strengthening of treatment and psychosocial rehabilitation in primary care; and noting with concern that

Primary Mental Health Care and particularly that provided by nurses is not available in developing countries largely as a result of the nurses trained there being recruited to developed countries without compensation to the countries of origin,

We Therefore:

Declare the need to work with the WHO and other international organizations, NGO’s and Ministries of Health to alert the public and to advocate to make psychotropic medications more accessible and affordable to those in need of them, and

Urge the WHO and NGO’s to stimulate research in developing countries which can elucidate strategies which can promote community retention and reduce premature mortality among persons with mental illness, and further

Urge consideration of this resolution and action by other associations and advocacy organizations

1. World Health Organization, Life expectancy tables, 2003
2. Currier, Glen Psychiatric Bed Reductions and Mortality for Persons with Mental Disorders, Psychiatric Services, July 2000, 51 p 851 Death rates rose from 5.7 per 100,000 in 1979 to 15.5 per 100,000 in 1995
3. Druss et al., Archives General Psychiatry, June 2001.

October 27 2004

WASP Bucharest Declaration on Social Well-being and Mental Health Evidence Informed Policies

We, the participants of the 23rd World Congress of Psychiatry, Bucharest, Romania October 25-28, 2019 affirm that social determinants of mental health and access to care needs urgent attention of policy makers, planners, administrators, mental health professionals and governments of the world. At this Congress global citizens, service users, families, careers, mental health advocates and professionals with an interest in mental health have come together to express our belief that there is no good mental health in absence of good social, economic and physical environments.

We support the Astana Declaration, confirming the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind. Good mental health care together with good social integration, for service users and their families, are two pillars that contribute to put into practice this fundamental right.

We consider that the conditions in which people are born, grow, develop, live, work and become older are shaped by the distribution of power, political will and resources at global, national and local levels. These conditions may contribute to mental disorders onset and course: the social inequalities are associated with increased risk of many common health disorders – including mental health disorders – and even of premature death.

We also recognize that these mentioned conditions may become a valuable protective resource to improve the population global health, and to reduce the risk of mental disorders, if managed properly. For that, actions need to be universal, across the whole of society, and proportionate to the needs, in order to level the social gradient in health outcomes.

We believe that by acting on the social conditions in which people live it is possible to contribute to promote the person’s dignity, a better subjective mental health and well-being, to build the capacity of communities to manage adversity, and to reduce the burden and consequences of mental health problems. We also believe that disadvantages because of mental health problems damage the social cohesion of communities and societies by decreasing interpersonal trust, social participation and civic engagement.

We declare that social interventions are crucial for the prevention of mental disorders, and they should be considered in any plan of treatment for these disorders. Social problems and mental health problems are interrelated, and they cannot be solved without collaboration between all institutions, providers and disciplines of human knowledge, influence and action.

We recognize Social Psychiatry as a branch of Psychiatry concerned with the effects of the social environment on the mental health of individuals as well as the effects of persons with mental disorders on the social environment. Social Psychiatry is specifically focused on the interpersonal and cultural context of mental disorders and mental well-being.

We support the Alma-Ata and Astana declarations, and professionals working in Social Psychiatry have the right and the duty to participate individually and collectively in the planning and implementation of the mental health care. These professionals have a moral responsibility to speak for patients and their needs, highlight the impact of social inequalities and resulting inequalities as a result of mental illness, and advocate for those who are most vulnerable and may not have a voice or may not be heard.

WHEREAS, 14% of the global burden of disease is attributed to mental disorders;
WHEREAS, mental disorders account worldwide for 21 % of the total number of years lived with disability;
WHEREAS most of the people affected by these disorders, – 75% in many low-income countries – do not have access to the treatment they need;
WHEREAS there is a gap between what is needed and what is currently available to reduce the burden of mental disorders worldwide and to promote mental health.

We call on governments at all levels to ensure:
• that social well-being principles are included in their mental health policies and programmes and that people with mental illness and their families are included in the design and implementation of these policies and programmes.
• the equitable and universal distribution of power and resources at global, national and local levels in order to satisfy the population mental health needs in all ages
• that there is parity of funding to support promotion of mental health and the prevention and management of mental illness.

We urge the United Nations, the WHO, the World Bank and other international organizations to continue their collaboration to ensure parity of funding for mental and physical health.

We call local, regional, national and international associations and organizations of social and mental health professionals, service users and providers, producers, families and careers to advocate for the promotion of social determinants of health and to denounce any attempt of the dignity in the care of persons with mental health disorders

We support and advocate for integrative collaboration between primary care, secondary care, social care, mental health services users and their families, careers & communities, society, governments, NGO’s and private sector as a tool to accelerate the delivery of best mental health coverage and to improve the population mental health and social well-being

We call on institutions involved in education and training of mental health and social care professionals to include in all graduation and post-graduation curricula the social dimension issues in mental health as well the development of skills to manage the social dimension and resources in the prevention, treatment and rehabilitation of persons with mental health problems.

We call the World Health Organization and the Nations to:
1. Foster the researches and innovation in mental health, to ensure affordable and appropriate prevention, treatment and rehabilitation interventions in an integrated manner, with multidisciplinary teams to increase life expectancy and quality of life
2. Use the results of the researches to develop an evidence brief for policy on mental health
3. Convene a deliberative policy dialogue
4. Develop a mental health evidence-informed policy, action plan to implement it and assess the related -performance of health systems to improve the mental health of populations
5. Engage in these processes from the early stages the key stakeholders: politicians, researchers, public health-decision makers, patients and communities in large.

Signed by:
Prof Roy Abraham Kallivayalil (WASP President)
Prof Rachid Bennegadi (WASP President Elect)
Prof Fernando Lolas (WASP Secretary General)
Prof Doina Cozman (Co-chair, National Org Committee)
Dr Alexandru Paziuc (Co-chair, National Org Committee) 26 October, 2019