The right to mental health

The historical divide, both in policies and practices, between mental and physical health has unfortunately resulted in political, professional and geographical isolation, marginalization and stigmatization of mental health care.  The modern public mental health approach, which emerged in the global scene in the end of the twentieth century with a critical mass of new evidence on the importance of mental health and the effectiveness of integrated approaches, still faces enormous challenges.

There are two key messages of the modern public mental-health approach that should be highlighted. Firstly, there is no health without mental health. Secondly, good mental health means much more than the absence of a mental impairment.

The modern understanding of mental health includes good emotional and social well-being, healthy non-violent relations between individuals and groups, with mutual trust of, tolerance of and respect for the dignity of every person. In that regard, promoting good mental health should be a cross-cutting priority relevant to the sustainable development agenda, as it is of concern to many of its elements, including the protection of dignity and people in order to ensure healthy lives and strong inclusive economies; promote safe and peaceful societies and strong institutions; and catalyse global solidarity for sustainable development (A/HRC/29/33 and E/CN.4/2005/51). 

See also the Special Rapporteur’s report on right to health in early childhood A/70/213 where the need to address effective psychosocial interventions not as a luxury is developed; and specific chapters on 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. The right to mental health has been also addressed by the Special Rapporteur in each of his country visits, including to Malaysia (2015); Paraguay (2015); Algeria (2016) and Croatia (2016).

In his report on mental health A/HRC/35/21, the Special Rapporteur on the right to health 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 further elaborates on the current status quo, 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. The Special Rapporteur addresses the “global burden of obstacles" that has maintained the status quo, namely: i) the dominance of the biomedical paradigm; ii) power asymmetries which impact all levels of the decision-making in mental health policies and services, and iii) the biased use of evidence in mental health.

The Special Rapporteur underlines that the status quo in current psychiatry is based on power asymmetries that lead to the mistrust of many users, to their disempowerment and stigmatization. He calls for a shift in the paradigm to one that is recovery and community-based, promotes social inclusion and offers a range of rights-based treatments and psychosocial support at all. The right to health requires that mental health care be brought closer to primary care and general medicine, integrating mental health with physical health, professionally, politically and geographically.

In this context, the Special Rapporteur also calls for leadership to confront the global burden of obstacles and embed rights-based mental health innovation in public policy. That includes State champions in international policy efforts, the leadership of professional psychiatry in assessing constructively its approach to the necessity for change, managers of mental health services leading change by example and municipal officials championing grassroots innovation. These champions must work in partnership with their constituents, including persons with intellectual, cognitive and psychosocial disabilities.

The Special Rapporteur’s report on mental health triggered various responses from different stakeholders as follows (in chronological order):

The right to mental health at the Human Rights Council

The right to mental health has been increasingly discussed at the Human Rights Council. In March 2016, Portugal, Brazil together with 73 States issued a Joint Statement to highlight the centrality of mental health for the full realization of the right to health and highlighted the utmost 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. These include stigma and discrimination, violations of economic, social and other rights and the denial of autonomy and legal capacity. The report recommended a number of policy shifts, such as the recognition of the individual’s autonomy, agency and dignity, the improvement in the quality of mental health service delivery, ending of involuntary treatment and institutionalization and the creation of a legal and policy environment conducive to the realization of the human rights of persons with mental health conditions and 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 by 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 urged States to develop services that do not lead to over-medicalization and inappropriate and that do not fail to respect the autonomy, will and preferences of all persons. It strongly encouraged States to support persons with mental health conditions or psychosocial disabilities to empower themselves in order to know and demand their rights.