Report on the role of the determinants of health in advancing the right to mental health

12 April 2019
Special Rapporteur on the right to health
At the Human Rights Council’s 41st session (24 June-12 July 2019)


In the present report the Special Rapporteur elaborates on the critical role of the social and underlying determinants of health in advancing the realization of the right to mental health.

He argues that good mental health and well-being cannot be defined by the absence of a mental health condition, but must be defined instead by the social, psychosocial, political, economic and physical environment that enables individuals and populations to live a life of dignity, with full enjoyment of their rights and in the equitable pursuit of their potential.

Factors such as access to healthcare, food, housing, education and work, as well as other social and psychosocial elements affect mental health. In particular, the quality of social relationships matters. Connections between individuals, families and communities over the course of life, across generations, between government and people, between different nations, and between mankind and nature are critical for mental health. These relationships are shaped by structures in homes, schools, workplaces, healthcare settings and society at large, and are therefore linked to issues such as abusive relationships, violence and social disparities, among others.

Key recommendations

The Special Rapporteur highlights the need for and States’ obligations to create and sustain enabling environments that incorporate a rights-based approach to mental health. These environments should value social connection and respect through non-violent and healthy relationships, and promote a life of dignity and well-being for all persons throughout their lifetimes.

States should enable healthy and positive relationships based on trust, respect and tolerance. They should create opportunities for solidarity, mutual support and trust. This means promoting community inclusion, environments free from violence, and participation in cultural diversity. It also means eradicating xenophobia, decriminalising poverty and behaviours such as drug use and sexual diversity. This also involves refocusing mental health care away from residential institutions and towards non-coercive alternatives that address holistic well-being—placing individuals, their definition of their experiences and their decisions at the centre.

The expert also highlights the need to support families to improve the quality of relationships between parents and children. He reiterates his call to eliminate institutional care for children, and elaborates on the need to address bullying and prevent depression and suicide. He calls for modern public health approaches that value and foster non-violent relationships and avoid excessive medicalisation.

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