EDITORIAL
DOI: 10.11606/issn.1806-6976.v13i4p174-175

Mental Health and Vulnerability: challenges and potentialities in the use of the human rights reference

Carla Aparecida Arena Ventura

Associate Editor of the SMAD, Revista Eletrônica Saúde Mental Álcool e Drogas, Full Professor of the University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil. E-mail: caaventu@eerp.usp.br

"Vulnerability" is the sense of "fragility"⁽¹⁾. This interdisciplinary term applies to different thematic areas, such as Law, Bioethics, Environmental Health, Epidemiology and Mental Health. The weakening of people´s capacity to act and defend themselves, becoming more vulnerable, emerge positions and initiatives aimed at guaranteeing rights, grounded in the human rights, the principles of equality and non-discrimination and based on the recognition of the condition of humanity of every human person⁽¹⁾.

The concept of social vulnerability arises in the individual-collective relationship and highlights to changing social conditions, built on relationships of power⁽¹⁾. In this context, vulnerability can be directly related to the deterioration of social and civil rights, resulting in the weakening of individuals’ citizenship^(1-2). In collective health, the concept of vulnerability overcomes prejudice based on the identification of groups of risk and individual culpability and it is linked to the guarantee of citizenship of politically fragile populations from a human rights perspective^(1-4).

Vulnerability articulates with the individual, social and programmatic components, allowing multidimensional analyses and interweaving to the material, psychological, cultural, moral, legal and political conditions that can direct knowledge and practices in health^(1-3). The individual component refers to the person’s information about the problem and its capacity to operate them in the construction of protective practices integrated to the daily life; the social component is related to obtaining information and the power to influence socially and politically to achieve free expression, security, and protection; and the programmatic component is linked to the quality and effective functioning of control programs and services^(1-3).

Some population groups are more vulnerable than others. Also, vulnerable groups share common challenges related to their social and economic position, social support and living conditions, including: stigma and discrimination; experiences of violence and abuse; restriction of the exercise of civil and political rights; exclusion from participation in society; reduced access to health and education services; and exclusion of opportunities to generate income and work⁽⁵⁾. These factors interact with each other, leading to a decrease in resources and an increase in the marginalization and vulnerability of those affected⁽⁵⁾.

In mental health, it is important to recognize the individual, social and programmatic vulnerability of people with mental disorders and drug users, who face restrictions on the exercise of their civil and political rights, and their ability to participate in the public sphere^(5-6). They also face difficulties in accessing health services and face disproportionate barriers to access to education and job opportunities. Adding to these factors, people with mental disorders and drug users die prematurely, when compared with the general population^(5-6).

On the other hand, vulnerability can also lead to deterioration of mental health. Stigma and discrimination generate low self-esteem, decreased self-confidence, reduced motivation, and less hope for the future^(5-6). It also results in isolation, considered an important risk factor for the emergence of mental disorders and drug use. Mental health is also affected when civil, political, social, economic and cultural rights are denied^(5-6).

Therefore, there is a great impact of mental disorders and drug use in families and communities, besides stigma, discrimination, and social exclusion. Dealing with the mental health problems of vulnerable population groups can promote greater participation of people in economic, social and civic activities. In this sense, the human rights reference determines the protection and promotion of human rights and results in countries’ obligation to internally ensure the rights of people with mental disorders⁽⁵⁾. Actions and practices based on the principles established by the treaties and other international instruments for the protection of the human rights of people with mental disorders can substantially improve the living conditions of this vulnerable population group, awareness and autonomy and enabling the shared construction of positive life experiences, if integrated into national intersectoral policies, plans and strategies⁽⁵⁾.

Considering that there is no possibility of autonomy without admitting the condition of vulnerability of people^(1,7), the articles of this work of the Electronic Journal Mental Health, Alcohol and Drugs (SMAD) invite us to reflect directly or indirectly on the relationship between health/mental illness and the individual, social and programmatic vulnerability of people with mental disorders and users of alcohol and other drugs. Thus, this number is composed of two literature reviews and five original articles that focus on different factors associated with mental disorders and drug use, relating them, explicitly or implicitly, to situations of vulnerability.

Vulnerability cannot be confused with disability and vulnerable groups should not be considered as passive victims of their own destiny. In this perspective, it is fundamental that studies in the area of mental health seek alternative ways to deal with the vulnerability of people with mental disorders and users of alcohol and other drugs. Actions to prevent and promote mental health are also described among the articles in this work.

Finally, vulnerability contains the possibility of autonomy, which is expressed, in practice, in the possibilities of "saying and acting"⁽¹⁾, rights traditionally denied to people with mental disorders and drug users. The use of the human rights reference as the basis for dialogue and mobilization of people with mental disorders and drug users, together with other social actors, can be a mechanism for these people to deal with their own vulnerability by appropriating their own reality and creating the conditions to consciously act and transform. Good reading to all!

References

1. Sevalho G. The concept of vulnerability and health education based on the teory laid out by Paulo Freire. Interface. (Botucatu). 2018; 22(64):177-88. http://dx.doi.org/10.1590/1807-57622016.0822.         [ Links ]

2. Ayres JRCM, França I Júnior, Calazans GJ, Saletti HC Filho. O conceito de vulnerabilidade e as práticas de saúde: novas perspectivas e desafios. In: Czeresnia D, Freitas CM, organizadores. Promoção da saúde: conceitos, desafios, tendências. Rio de Janeiro: Fiocruz; 2003. p. 117-38.         [ Links ]

3. Ayres JRCM, Calazans GJ, Saletti HC Filho, França I Júnior. Risco, vulnerabilidade e práticas de prevenção e promoção da saúde. In: Campos GWS, Bonfim JRA, Minayo MCS, Akerman M, Drumond Júnior M, Carvalho YM, organizadores. Tratado de Saúde Coletiva. Rio de Janeiro: Fiocruz; 2006. p. 375-417.         [ Links ]

4. Ayres JRCM, Paiva V, França I Júnior, Gravato N, Lacerda R, Negra MD, et al. Vulnerability, human rights, and comprehensive health care needs of young people living with hiv/aids. Am J Public Health. 2006;96:1001-6. Doi: 10.2105/AJPH.2004.060905        [ Links ]

5. World Health Organization. Mental Health and Development: targeting people with mental health conditions as a vulnerable group. Geneva: WHO; 2010.         [ Links ]

6. World Health Organization. Social Determinants of Mental Health. Geneva: WHO; 2014.         [ Links ]

7. Amorim R Neto, Rosito MMB. Freire, Dussel e Kohlberg: da vulnerabilidade à autonomia. Rev Contrapontos. [Internet]. 2007 [Acesso 17 mar 2018];7(3):615-27. Disponível em: https://siaiap32.univali.br/seer/index.php/rc/article/view/927/782        [ Links ]