Abstract
Globally, persons with mental illness are an extremely vulnerable group in terms of human rights violations, despite national and international treaties and legislation aimed at safeguarding their human rights and dignity in particular. In South Africa, the Life Esidimeni tragedy and the resultant death of approximately 140 persons with mental disabilities, have thrust mental health into the spotlight and exposed the dire state of mental health locally. The gap between policy and practice raises questions about how mental health services may contribute to the dignity of persons with mental illness. For this study, a qualitative, semi-structured interview methodology was used to explore the perceptions and experiences of dignity among 12 persons with mental illness. These individuals were all residents of a single, community-based mental health facility in Johannesburg. Key themes that emerged about perceptions of dignity were self-worth, respect and dignity as a human right, and the importance of feeling independent. Informed by a social exclusion framework of analysis, the findings indicated that dignity was related to individual (how participants felt about themselves), relational (relationships with family and friends) and structural dimensions (feeling independent and being able to make decisions about their own lives), with a smaller focus on the distributional dimension (access to services and opportunities). In terms of the impact of mental health and human rights interventions on dignity, findings at times indicated a mismatch between respondents’ perceptions of what dignity should be, and their lived experiences of hospitalisation, community-based mental health care and mental health professionals. Experiences of dignity were both positive and negative. Positive experiences revolved around the formation of relationships, feeling validated by service providers and receiving good care and access to services at community and institutional level. Negative experiences revolved around a lack of decision making, independence and not being listened to by professionals. Regarding policy recommendations, it is important that every aspect of mental health legislation and policy, including hospital and community-based care as well as interactions with mental health professionals, is implemented in inclusive ways that promote the right to dignity of persons with mental illness. This also includes removing barriers which hinder access to health, education, employment and political participation.
M.Phil. (Social Policy and Development)