A new report of the UN High Commissioner for Human Rights debated in the UNs Human Rights Council this week stresses the urgent need for systemic reform of mental health systems. The report demand focusing on models that shift away from a narrow emphasis on biomedical approaches towards a more holistic and inclusive understanding of mental health. It further stresses a need for transition to community-based mental health care and support.
UN Human Rights Council debate
Ms. Peggy Hicks, Director at the UN Office of the High Commissioner for Human Rights presented the High Commissioner’s Comprehensive Report on Mental Health and Human Rights to the UN Human Rights Council last Friday which then was followed by a debate ending this week. The report had been requested by the Human Rights Council with a Resolution adopted in April 2023.
The new report contains an analysis of the main obstacles and challenges in applying a human rights-based approach to mental health. This includes addressing stigma, ensuring access to equitable care, and empowering persons with psychosocial disabilities, users of mental health systems, and survivors of involuntary hospitalization in policy-making.
“This shift requires changes in legislation and policies to align with human rights standards, destigmatizing mental health services, eliminating coercive practices, investing in community-based services and cross-sectoral collaboration, ensuring informed consent for all mental health interventions, and addressing systemic inequalities,” Ms. Peggy Hicks told the Human Rights Council.
As part of the debate in the Human Rights Council, Tina Minkowitz of the Center for the Human Rights of Users and Survivors of Psychiatry reminded the UN member states of their binding obligations under the Convention on the Rights of Persons with Disabilities to implement deinstitutionalization plans and strategies as called for in the 2022 Guidelines on Deinstitutionalization.
“Significantly, this includes elimination of all involuntary hospitalization and treatment in mental health settings, including in situations of individual crisis and the creation of supports for people dealing with extreme distress and unusual perceptions that do not require a mental health diagnosis and that respect the person’s self-knowledge as well as their will and preferences,” Tina Minkowitz pointed out.
The practice of legally authorizing and carrying out involuntary hospitalization in psychiatry is contrary to articles 12, 13, 14 and 19 of the UN Convention on the Rights of Persons with Disabilities (CRPD) the UN Committee on the Rights of Persons with Disabilities has clearly established.
The report points out that the right to health is recognized in several international human rights instruments, and States parties to the International Covenant on Economic, Social and Cultural Rights have the obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights, including the right to health. The same obligations apply as much to mental health as to physical health, the report points out.
Discrimination and stigmatization
The report notes that discrimination and stigmatization of persons with psychosocial disabilities and users of mental health services remain alarmingly pervasive around the globe. Those challenges manifest in multiple forms, through systematic undue restrictions on their human rights due to barriers that hinder their equal access to the basic services and facilities that they require.
The report also notes that persons with lived experience of mental health conditions or psychosocial disabilities often face stigma among health professionals.
Coercive practices
Laws and health practices continue to allow involuntary treatment and institutionalization, affecting, in particular, persons with psychosocial disabilities. Persons with psychosocial disabilities and users of mental health services remain in institutions, confined and subjected to involuntary treatment, often in inhumane conditions, including being chained, the report pointed out.
The report further noted that there is insufficient independent oversight and accountability to address the reoccurring violations in the context of compulsory admissions and use of outdated facilities.
Challenges in legislation and policy implementation
The vast majority of States in Europe have ratified relevant human rights treaties recognizing the right to the highest attainable standard of physical and mental health, including the Convention on the Right of Persons with Disabilities.
The new report in view of this notes that efforts are needed to ensure that international obligations are incorporated into national laws and that competent institutions have the necessary capacity to effectively uphold and enforce these rights.
In many contexts, the rights of persons with psychosocial disabilities are violated, restricting their autonomy, participation and ability to provide free and informed consent, the report points out. Those restrictions are widely recognized as systemic issues that require alignment with international human rights standards, including the Convention on the Rights of Persons with Disabilities.
Specifically the reports explains that many countries have laws that allow forced treatment or institutionalization, under specific circumstances, such as when a person is deemed to be a risk to themselves or others, for example through criteria such as ”last resort”, “medical necessity” or “incapacity”.
The report notes that those legal exceptions “are of concern as they result in restrictions on the rights set forth in the Convention on the Rights of Persons with Disabilities, unduly limiting the autonomy of persons with lived experience, their participation in decision-making processes and their ability to provide consent.” Denial of legal capacity, as outlined in the Convention, is one of the main gaps in domestic legislation, critically affecting the enjoyment and exercise of a wide range of human rights, including access to justice, effective remedy and reparation.
As a specific example the report notes that Articles 6, 7 and 8 of the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine (Oviedo Convention) of the Council of Europe establish exceptions to the principle of free and informed consent outlined in article 5 of the same treaty, based on multiple grounds.
And that since 2014, the Council of Europe has been drafting an additional protocol to the Oviedo Convention entitled “the protection of human rights and dignity of persons with mental disorder with regard to involuntary placement and involuntary treatment”. United Nations human rights mechanisms, civil society organizations and other stakeholders have called for the withdrawal of the current draft protocol, which, in their view, maintains an approach to mental health policy and practice that is based on coercion and is incompatible with contemporary human rights-principles and standards and the rights enshrined in the Convention on the Rights of Persons with Disabilities, particularly in relation to institutionalization.
Systemic reform of mental health systems
The UN High Commissioner underscores the urgent need to adopt a human rights-based approach to mental health as a fundamental element of the right to the highest attainable standard of health under international human rights law. That involves a transition away from a narrow emphasis on biomedical approaches towards a more holistic and inclusive understanding of mental health and, therefore, a transition to community-based mental healthcare and support is essential.
Further legislative reform efforts need to be accompanied by efforts to address stigma and discrimination, expand access to human rights-based mental healthcare and support.
In considering legal, policy and institutional reforms governments should consider as a matter of priority a shift of the paradigm “from punitive approaches to health- and human rights-centred measures.” That includes implementing a restorative approach that focuses on providing community-based mental healthcare rather than punishment.
As well as ensure that free and informed consent is the basis of all mental health-related interventions, recognizing that the ability of individuals to make decisions about their own healthcare and treatment choices is an essential element of the right to health.
“Consequently,” the UN High Commissioner recommends states to, “end coercive practices in mental health, including involuntary commitment, forced treatment, seclusion and restraints in order to respect the rights of persons using mental health services. Ensure that all mental healthcare systems respect the autonomy and informed consent of persons with psychosocial disabilities and users of mental health services, in accordance with international human rights law.”
———-
First published in this link of The European Times.
