Mental health and human rights: never waste a serious crisis

In an interview with the New York Times soon after the US election [1] Barack Obama's Chief of Staff, Rahm Emanuel, said: "Never let a serious crisis go to waste" asserting that crises are "opportunities to do big things." In an interview with the Wall Street Journal [2] he elaborated on the meaning of these statements as he set out a series of essential principles for the Obama administration's program of reform. Emanuel identified previous missed opportunities to deal with major problems, including health, energy, education, fiscal and tax policy, and regulatory reform. "Things we had postponed for too long that were long term are now immediate and must be dealt with ... The problems are big enough that they lend themselves to ideas from both parties for the solution."During the weekend of 23/24 May 2009 the Jakarta newspapers were focusing on an unfolding crisis in mental health. The headlines in front page and page 2 news stories read: Mental illness patients die of diarrhea and malnutrition [3]Doctors to inspect overcrowded shelters where mentally ill patients are dying [4]Mentally ill enter shelters 'for life' [5]. The flurry of media interest was precipitated by a report from the Jakarta Social Agency that in the city's four 'shelters' for people with chronic mental illness residents are dying of from malnutrition, over-crowding and diarrhoea. "There was not much of an outcry about it; for six months three people every four days died from diarrhea and malnutrition at shelters for mentally ill people in the capital. No fuss was made until the city administration received a report from an agency about the staggering numbers. Recent data from the Jakarta social agency revealed that 181 people died between October 2008 and May 22, 2009, at four shelters in Daan Mogot and Cengkareng, both in West Jakarta, and Cipayung and Ceger, in East Jakarta." [3] A further 57 people who had been transferred from the shelters to the responsible mental hospital had died in the s