The right to mental health

The modern public mental health approach emerged on the global scene at the end of the twentieth century. It contained a critical mass of new evidence on the importance of mental health and the effectiveness of integrated approaches.
Two key messages of the modern public mental-health approach are:

• there is no health without mental health; and
• good mental health means much more than the absence of a mental impairment.

This approach still faces enormous challenges. The historical divide—both in policies and practices—between mental and physical health has unfortunately resulted in political, professional and geographical isolation; and marginalization and stigmatization of mental health care.

In 2017, the Special Rapporteur issued a ground-breaking report addressing the “global burden of obstacles” in mental health settings and in the field of psychiatry. The obstacles are:

1. the dominance of the biomedical paradigm;
2. power asymmetries which impact all levels of the decision-making in mental health policies and services, and
3. the biased use of evidence in mental health.

Accordingly, the status quo in current psychiatry is based on power asymmetries that lead to the mistrust of many users, to their disempowerment and stigmatization.

Reports

The Special Rapporteur’s work on mental health has been developed in numerous thematic reports.

In a 2020 report to the Human Rights Council (A/HRC/44/48), the Special Rapporteur addresses the need for a global agenda for mental health that is human rights-based. He makes a number of recommendations to States, organizations in the psychiatric profession and World Health Organization on how to do so.

In 2019, the annual report to the Human Rights Council (A/HRC/41/34) elaborates on the critical role of the social determinants of mental health. In particular, the Special Rapporteur focuses on the key role that the social, psychosocial, political, economic, and physical environment has in enabling a person to a life in dignity, in rights, and in the equitable pursuit of their potential.

The report to the General Assembly in 2018 (A/73/216) discusses the role of discriminatory attitudes and xenophobic political rhetoric in creating environments of fear and intolerance for people on the move and host communities. These environments damage the quality of human relationships, and bring mistrust, disrespect and intolerance into societal life.

In his ground-breaking 2017 report on mental health (A/HRC/35/21), the Special Rapporteur recalls that the modern understanding of mental health is shaped by paradigm shifts often marked by a combination of improvements and failures in evidence-based and ethical care. He elaborates on the current status quo, which is preoccupied with the excessive use of biomedical treatments and non-consensual measures. This creates an environment which is not conducive for realizing the right to mental health. He calls instead for a recovery- and community-based model which promotes social inclusion and offers a range of rights-based treatments and psychosocial support. Further, the right to health requires that mental health care be brought closer to primary care and general medicine.

In the report on the right to health in early childhood (A/70/213), the Special Rapporteur addresses the need for effective psychosocial interventions.

The Special Rapporteur also dedicates specific chapters to mental health in the reports about the right to health of adolescents (A/HRC/32/32) and about corruption and the right to health (A/72/137).

Special Rapporteur Dainius Puras has also addressed the right to mental health in each of his country reports.

The right to mental health at the Human Rights Council

The right to mental health is a subject of ever-increasing importance at the Human Rights Council. In March 2016, 73 States issued a joint statement to highlight the centrality of mental health for the full realization of the right to health. It highlighted the importance of adopting a human rights perspective to ensure the respect for the inherent dignity of all human beings and the full enjoyment of human rights without discrimination.

In July 2016, Human Rights Council Resolution A/HRC/RES/32/18 recognized the need to fully integrate a human rights perspective into mental health and community services to eliminate violence and discrimination while promoting inclusion and participation. This Resolution requested the High Commissioner to prepare a report presented in March 2017 (A/HRC/34/32) which identified some of the major challenges faced by users of mental health services, persons with mental health conditions and persons with psychosocial disabilities.

In September 2017, Human Rights Council Resolution A/HRC/RES/36/13 recognized the importance of integrating mental health services into primary and general health care. This requires providing effective mental health and other community-based services that protect, promote and respect the enjoyment of the rights to liberty and security of person, as well as to live independently and be included in the community, on an equal basis with others. The Resolution requested the High Commissioner to organize a consultation to identify strategies to promote human rights in mental health and report on it.

Human Rights Council Resolution A/HRC/RES/43/13 of July 2020 calls on States to promote a paradigm shift in mental health and to adopt, implement, update, strengthen or monitor, as appropriate, all existing laws, policies and practices. It requests the High Commissioner to organize in 2021 a consultation to discuss the best ways to harmonize national laws, policies and practices relating to mental health with the norms of the Convention on the Rights of Persons with Disabilities.

Responses from Stakeholders

The Special Rapporteur’s 2020 report on a human rights-based global agenda for mental health and human rights triggered a response from the World Psychiatric Association (WPA) and the World Medical Association (WMA). See letter (7 August 2020).

The Special Rapporteur’s 2017 report on mental health triggered various responses from different stakeholders as follows:

• The World Medical Association, WMA (26 Jun 2017)
• A wide variety of organisations including Mental Health Europe and the British Psychological Society, as well as individuals representing people with personal experience of mental health services, professionals and academics (8 August 2017)
• The Word Psychiatric Association, WPA (29 August 2017)
  
• The German Association for Child and Adolescent Psychiatry (12 Sept 2017)
• The European Psychiatric Association, EPA (26 Sept 2017
• The Society of Biological Psychiatry, SOBP (26 Sept 2017)
• The International College of Neuropsychopharmacology, CINP (27 Sept 2017)
• The European College of Neuropsychopharmacology, ECNP (6 Oct 2017)
• The European Brain Council, EBC (12 Oct 2017)
  

Related press releases

• “The world must change the way mental health challenges are addressed, UN expert says,” issued 6 July 2020
• “COVID-19 has exacerbated the historical neglect of dignified mental health care, especially for those in institutions: UN expert,” issued on 23 June 2020
• “Major changes to suicide prevention needed, with rights-based approach to make life ‘more liveable’ — UN expert,” on the World Mental Health Day on 10 October 2019
• “UN expert highlights importance of social relationships for mental health and well-being,” issued on 24 June 2019
• “World needs ‘revolution’ in mental health care – UN rights expert,” issued on 6 June 2017
• UN rights expert urges shift away from drugs in addressing depression – World Health Day – Friday 7 April 2017
• “South Africa: UN experts shocked by death of at least 37 people in flawed relocation process from psychiatric hospitals,” issued on 2 December 2016