A human rights-based global agenda for mental health and human rights

Summary

In this report the Special Rapporteur elaborates on the elements that are needed to set a rights-based global agenda for advancing the right to mental health.

The Special Rapporteur welcomes increasing recognition that there is no health without mental health but highlights the continuous global failure of the status quo to address human rights violations in mental healthcare systems that reinforce a vicious cycle of discrimination, disempowerment, coercion, social exclusion and injustice. To end this cycle, treatment and distress must be seen more broadly and move beyond the biomedical understanding of mental health.

The expert argues that mental conditions are not like other physical conditions (e.g. bacterial meningitis) for which there are essential medicines such as antibiotics. The pathophysiology of mental conditions and the specific mechanisms by which psychotropic drugs may be effective are unknown. He stresses that, although much progress has been made in terms of understanding the pharmacokinetics and pharmacodynamics of antidepressants and antipsychotic medications, their effectiveness is not comparable to amoxicillin for a bacterial infection.

Recommendations

The Special Rapporteur appreciates the different worldwide initiatives to advance all elements of global mental health. Those elements include promotion, prevention, treatment, rehabilitation and recovery. He calls for conversations at global, regional and national levels to discuss how to better understand and treat mental health conditions. Actions must be rights-based, holistic and rooted in the lived experience of those left furthest behind by harmful systems and practices.

The Special Rapporteur makes a number of recommendations for States, for organizations representing the psychiatric profession and for the World Health Organization. In particular, he recommends the WHO review its current essential medicines list and remove the mental health medications for which there is no evidence of adequate risk/benefit. He calls for concerted efforts among WHO and other Global Mental Health actors to develop a new, holistic list of essential psycho-social and population-based interventions, which are informed by evidence and supported and developed by rights-based principles.

See letter (7 August 2020) from the World Psychiatric Association (WPA) and the World Medical Association (WMA) in response to the report.

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