I am honoured to welcome you to this essential discussion of a topic which is far too often swept to the margins of society.
The right to the highest attainable standard of health is fundamental to human dignity, and there is no health without mental health. Clearly, the provision of good mental health services and support are essential: they cannot be viewed as a luxury, any more than clinics which fix broken limbs or treat malaria. And just as clearly, mental health services cannot legitimately be given a lower priority than services that focus on physical health.
A very high proportion of us may be affected by mental conditions over the course of our lifetimes: as many as one in four people, according to some estimates. Mental health services of quality should be accessible to all, regardless of social class or any other distinguishing status; and use of these services should not generate stigma or shame.
But in reality, very few users of mental health services, people with mental health conditions or psychosocial disabilities will benefit from the accessible, quality services and support which are their right.
Instead, many will face discrimination. Profoundly harmful stereotypes about people living with – or perceived to have – mental health conditions will condition the health services they receive, with long-term impact on their participation and inclusion in society.
Psychiatric institutions, like all closed settings, generate exclusion and segregation, and being forced into one amounts to arbitrary deprivation of liberty. They are also, often, the locus of abusive and coercive practices, as well as violence potentially amounting to torture.
Institutionalisation and segregation has been an inadequate response at all levels – for adults with disabilities as well as children. The threat of becoming institutionalised also impedes users from accessing services in the early stages of anxiety or stress. An emphasis on institutionalisation has meant that rather than resolving gaps and weaknesses within family and community networks, bonds have been broken and children and adults have been denied their right to a family and to participation and inclusion in the community.
To be banished from humanity – seen as unworthy of belonging and confined in seclusion– is deeply damaging to the human soul. Forced treatment – including forced medication and forced electro convulsive treatment, as well as forced institutionalisation and segregation – should no longer be practiced. Instead, States should ensure that people with mental health conditions and those with psychosocial disabilities can access treatment and support services, including peer support, in their communities. Segregation is harmful – not only for the individual, but also for the community as a whole.
Manifestly, the human rights of persons with psychosocial disabilities and those with mental health conditions are not being widely upheld around the world. This needs to change. The Convention on the Rights of Persons with Disabilities offers a legal framework for a more comprehensive approach that upholds the rights of people with psychosocial disabilities including the full enjoyment and exercise of legal capacity and free and informed consent; the right to live and be included in the community; de-institutionalisation; and the right to liberty and security without discrimination. We must all advance to strengthen and support this framework: as we will see in this meeting, change is possible and is happening now.
Deciding for oneself; living in the community; working and socializing without discrimination – these are four essential areas where progress can deliver enormous impact in the well-being of millions of people.
Over the next two days this consultation will explore ways to reaffirm the dignity and equality of users of mental health services, people with psychosocial disabilities and those with mental health conditions. Among us are many notable practitioners struggling to ensure human rights-based systems of care and support, as well as several people who have themselves experienced the current practises. I thank you for your work to cast light on the inadequate systems in place, and your efforts to restore the voices of those whose dignity is undermined.
We share the hope that we can contribute to the reform of policies which deepen the discrimination, abuse and arbitrary institutionalization they frequently face, as well as other practices that fail to respect their autonomy, choices and rights.