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COVID-19 has exacerbated the historical neglect of dignified mental health care, especially for those in institutions: UN expert

23 June 2020

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GENEVA (23 June 2020) – The COVID-19 pandemic has exposed decades of neglect and underinvestment in mental health care, an independent UN expert said today, calling for the ultimate elimination of closed psychiatric institutions where the impact has been more severe.

"COVID-19 forces us to rethink now more than ever mental health care and to integrate human rights to move away from the paradigm of forcibly confining persons with disabilities in psychiatric institutions," said Dainius Pūras, the UN Special Rapporteur on the right to health.

The spread of the virus, distancing and isolation, economic and social downturns, unemployment, and increase in domestic and other types of violence have fuelled mental distress, anxiety and fear, Pūras said. "These are exacerbated by massive attacks of disinformation, fake news, and conspiracy theories around the virus' origin, statistics and future immunisation."

The combination of school closures and lockdown conditions have a particular impact on children's stress, anxiety and mental health issues, the expert said. "This is especially worrying given the overall lack of recognition and awareness of the nature and scale of mental health problems among adolescents in many countries."

The Special Rapporteur said COVID-19 mental health impact has been more severe for people in institutions. Closed settings have become hotspots for the virus. Persons with disabilities in psychiatric institutions, older persons in care homes and people in detention are more vulnerable to contagion for the confinement they live in for prolonged periods of time. They have also experienced the highest rates of infection and mortality from COVID-19 worldwide.

"When mental health care measures are taken, they tend to follow the status quo and reinforce historical gaps, relying in the biomedical model, excessive pathologisation and overuse of psychotropic medications," Pūras said.  "Mental health care for persons with intellectual, cognitive and psychosocial disabilities has further relied on coercion, leading to discrimination, social exclusion and isolation.

The Special Rapporteur said the main obstacle to realise the right to mental health during COVID-19 times and beyond is the huge power asymmetries in mental health care and the biased use of knowledge and evidence.

"Investments in status quo coercive measures and overused biomedical interventions must stop and be redirected to integrated mental health services in primary and general health care, to evidence-based psychosocial interventions and training of community health workers," Pūras said.

States, international organisations and other stakeholders must make concerted efforts to radically reduce the use of institutionalisation in mental health-care settings, with a view to eliminating institutional care and replacing it with quality care in the community.

Puras praised the most recent Resolution of the 43th session of the Human Rights Council on Mental Health and Human Rights and called on States to seriously and entirely implement its recommendations, including to fully integrate a human rights perspective into mental health and community services, to promote a paradigm shift in mental health, and to abandon all practices and treatments that fail to respect the rights, autonomy, will and preferences of all persons on an equal basis with others.

"States have an obligation to respect, protect and fulfil the right to mental health, to guarantee access to rights-based treatment, care and support, and to ensure that individuals can exercise their right to decline treatment," the expert said.


*The expert: The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras

Mr. Dainius Pūras(Lithuania) took up his functions as UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health took up his functions as on 1 August 2014. Mr. Pūras is the Director of Human rights monitoring institute in Vilnius Lithuania, a professor of child and adolescent psychiatry and public mental health at Vilnius University and teaches at the faculties of medicine and philosophy of the same university. He is a medical doctor with notable expertise on mental health and child health.

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 organisation and serve in their individual capacity.

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