World Health Day – Friday 7 April
GENEVA (5 April 2017) – Treatment for people suffering from depression must shift from heavy reliance on drugs and medicalised interventions to addressing power imbalances and inequalities that often underlie the condition, a United Nations human rights expert says.
open statement published ahead of World Health Day on 7 April, the UN Special Rapporteur on the right to health, Dainius Pūras, says societies must reconsider dominant biomedical approaches to depression in line with the Agenda 2030 Sustainable Development Goals to secure the right to health for all.
“A balanced approach to mental health is needed, including population-based services as well as care and support for individuals, so that we can forge better interventions in the community and strengthen protection for rights holders seeking or using healthcare services,” says Mr. Pūras.
The UN health expert’s comments come amid growing evidence suggesting a link between depression and early childhood adversities, inequalities, insecurity and violence, some of it gender-based, and their disproportionate effect on vulnerable people, such as those affected by poverty and social exclusion.
Mr. Pūras stresses: “Treating depression and other forms of psychosocial distress with drugs, and medicalizing these conditions, has become the dominant approach. However, the use of psychotropic medications as the first line of treatment, especially for mild and moderate cases of depression, is quite simply unsupported by the evidence. The overreliance on biomedical interventions causes more harm than good, undermines the right to health, and must be abandoned.”
The expert says: “The risk factors of depression and suicidal behaviour must be reduced, while policies that protect against them and enhance individual and community resilience should be encouraged.”
Mr. Pūras calls for community-based psychosocial interventions for anyone facing emotional or social distress. “Psychiatric interventions are not needed in many cases and the appropriate care and support can be provided by general care workers, such as family doctors, community nurses and home visitors.
“In most cases of mild and moderate depression, “watchful waiting”, human interaction and just talking and listening may be all that is required. These interventions must be considered as frontline treatments,” he stresses.
“While biomedical interventions still remains an important treatment option for severe depression and other mental health conditions, we should not accept their use to address issues which are closely related to social and emotional problems, such as unequal power relationships, the consequences of violence, and other adversities that determine our social and emotional environment,” adds Mr. Pūras.
“I call on States to shift their mental health investments from focusing on ‘chemical imbalances’ to tackling ‘power imbalances’ and inequalities,” the expert says.
“We all need to talk about depression and policy makers need to talk about what has gone wrong with addressing the mental health both of individuals and societies, and about the changes we need. It may be a difficult conversation but it is important that we have it now.”
Millions of people from all walks of life across the world are affected by depression and other mental health conditions, but not everyone is able to access appropriate care or support,” he stresses.
The expert wishes the issue of mental health to be on the agenda when relevant public policies are being developed, in addition to general health services, including education, poverty-reduction, and violence-prevention.
Mr. Pūras says: “There is consensus that everyone should be able to access appropriate care and support for mental health as needed, but medical authorities, policy-makers, and all of us must come together to decide how best this can be done.”
NOTE TO EDITORS: World Health Day, which is supported by the United Nations, is held annually on 7 April to mark the anniversary of the founding of the World Health Organization. This year the theme is “depression”.
Mr. Dainius Pūras (Lithuania), Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of
physical and mental health, is a medical doctor with notable expertise on mental health, child health, and public health policies. He is a Professor and the Head of the Centre for Child psychiatry and social pediatrics at Vilnius University, and teaches at the Faculty of Medicine, Institute of International relations and political science and Faculty of Philosophy of Vilnius University, Lithuania.
The Special Rapporteurs are part of what is known as the
Special Procedures of the Human Rights Council. Special Procedures, the largest body of independent experts in the UN Human Rights system, is the general name of the Council’s independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world. Special Procedures’ experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity.
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