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The world must change the way mental health challenges are addressed, UN expert says

06 July 2020

GENEVA (6 July 2020) – A UN human rights expert has urged States, the civil society, psychiatric organisations, and the World Health Organisation to change the way we understand and respond to mental health challenges.

“I welcome the international recognition of mental health, but much more is still needed,” the UN Special Rapporteur on the right to physical and mental health, Dainius Pūras, said during the presentation of a new report to the Human Rights Council.

“The global mental health status quo should move away from the outdated ‘mad or bad’ approach which seeks to prevent behaviours deemed as ‘dangerous’ or provide treatment considered ‘medically necessary’ without consent,” he said.

Pūras said that the dominance of the biomedical model has resulted in an overuse of medicalisation and institutionalisation. He warned against the exaggerated benefits of psychotropic medications and highlighted that their effectiveness is not comparable to other medicines that are essential for certain physical conditions, such as for example, antibiotics for bacterial infections.

“I appreciate the progress made to understand the role of psychotropic medications, but also recognise that there are no biological markers for mental health conditions,” he said. Hence the specific mechanisms by which psychotropic drugs might be effective, are simply unknown,” the Special Rapporteur said.

Pūras said that the status quo in mental health care has ignored the social, political or existential context that contributes to the high prevalence of feelings of sadness, anxiety, fear and other manifestations of mental distress.

“There is no simplified mechanistic solution to mental distress,” he said. “For the majority of mental health conditions, psychosocial and other social interventions are the essential option for treatment.”

He highlighted that systemic obstacles, such as power asymmetries in mental health care, the dominance of the biomedical model and the biased use of knowledge, need to be addressed by changes in laws, policies and practices

The UN expert reiterated his call for mental health care action and investment to be redirected to rights-based supports, to non-coercive alternatives that address the psychosocial determinants of health, and to the development and strengthening of practices that are non-violent, peer-led, trauma-informed, community-led, healing and culturally sensitive.

“I’m calling once again for the ultimate elimination of segregated psychiatric institutions that reflect the historic legacy of social exclusion, disempowerment, stigma and discrimination.”

To achieve this, realisation of the principles and values of the Convention of the Rights of Persons with Disabilities should guide mental health policies and services, and discriminatory laws and practices should be abandoned.

“COVID-19 has exacerbated the failures of the status quo in mental health care. The pandemic provides the global community with a unique opportunity to demonstrate political will to move away from medicalisation and institutionalisation in mental health-care,” the Special Rapporteur 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. 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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