Maintaining dignity and reducing stigma for persons who need mental healthcare by Henriëtta Herronia Venter 170 86142 Submitted in partial fulfilment of the requirements for the degree Magister Legum (Medical Law and Ethics) in the Faculty of Law, University of Pretoria December 2018 Supervisor: Professor Annelize Nienaber 1 Table of contents Chapter 1 .............................................................................................................................................. 4 Introduction ............................................................................................................................................ 4 1.1 Background ................................................................................................................................... 4 1.2 Research problem ................................................................................................................... 5 1.3 Assumptions ............................................................................................................................ 6 1.4 Research questions ................................................................................................................. 6 1.5 Motivation ............................................................................................................................... 6 1.6 Literature review ..................................................................................................................... 6 1.6.1 Research question 1: ....................................................................................................... 6 1.6.2 Research question 2: ....................................................................................................... 8 1.6.3 Research question 3: ..................................................................................................... 10 1.7 Methodology ......................................................................................................................... 13 1.8 Chapter outline ..................................................................................................................... 13 Chapter 2 ............................................................................................................................................ 16 Clarification of concepts ....................................................................................................................... 16 1. Introduction .............................................................................................................................. 17 2. Concepts.................................................................................................................................... 17 2.1 Dignity ........................................................................................................................... 17 2.2 Stigma ........................................................................................................................... 18 2.3 Mental illness/mental disorder ..................................................................................... 19 2.4 Humane and ethical treatment of mental healthcare users ........................................ 21 2.5 Morality ......................................................................................................................... 25 2.6 Religion .......................................................................................................................... 26 2.7 Values ............................................................................................................................ 26 2.8 Mental healthcare ......................................................................................................... 27 2.9 Law ................................................................................................................................ 28 2.10 The Constitution, 1996 .................................................................................................. 29 Chapter 3 ............................................................................................................................................ 31 Psychological perspectives on human dignity ...................................................................................... 31 1. Introduction .................................................................................................................................. 32 2. Literature review of psychological content .................................................................................. 33 2.1 Mental health .............................................................................................................................. 33 2.2 The prevalence of mental disorders ........................................................................................... 35 2.3 Persons living with mental health issues and dignity ................................................................. 38 2 2.4 Persons living with mental health issues and stigma ................................................................. 40 2.5 Changing attitudes towards mental health ................................................................................ 43 2.6 Persons with mental health issues, and the role and conduct of the mental healthcare worker .......................................................................................................................................................... 44 3. Conclusion ..................................................................................................................................... 45 Chapter 4 ............................................................................................................................................ 47 Medico-legal perspectives on dignity as a moral and constitutional value .......................................... 47 1. Introduction .................................................................................................................................. 47 2. Moral and ethical behaviour ......................................................................................................... 48 3. Medical ethics and law.................................................................................................................. 49 4. Inherent dignity held by every person and supported by the Constitution, 1996 ....................... 53 5. The notion of tolerance ................................................................................................................ 54 6. Conclusion ..................................................................................................................................... 55 Chapter 5 ............................................................................................................................................ 56 The effect of the Constitution, 1996 ..................................................................................................... 56 1. Introduction .................................................................................................................................. 56 2. Constitutional values .................................................................................................................... 56 3. Fostering a rights culture .............................................................................................................. 58 4. The impact of law to maintain dignity and reduce stigma for persons needing mental healthcare 58 5. Challenges ..................................................................................................................................... 62 6. Summary ....................................................................................................................................... 63 Chapter 6 ............................................................................................................................................ 64 Conclusion and recommendations ....................................................................................................... 64 1. Introduction .................................................................................................................................. 64 2. Knowledge gathered, and insights gained through this research ................................................ 65 3. Recommendations ........................................................................................................................ 69 4. Afterword ...................................................................................................................................... 75 Bibliography ...................................................................................................................................... 77 3 Chapter 1 Introduction 1.1 Background In spite of the universal appeal of dignity, it is a topic that is seldom discussed.1 Although people may not have words to describe the concept of dignity, all have an internal experience of it as they know what it feels like to be treated as inferior, discriminated against, ignored, misunderstood, criticised and excluded, therefore, treated in an undignified manner.2 The feeling of humiliation that accompanies being treated poorly, in subtle and less subtle ways, prevents people from taking the actions needed to recover from violations of their dignity, such