WHO: The Quality Rights e-training for a paradigm shift in mental health

Michelle Bachelet, UN High Commissioner for Human Rights delivered a statement for the launch of an unheard “Quality Rights” e-training that will help, among other things, put an end to systemic abuses in psychiatry and mental health.

Michelle Bachelet:

Greetings to all. Thank you to the World Health Organization for inviting UN Human Rights to take part in the launch and rollout of this vital e-training. It is an honour to participate.

Today’s launch of the Quality Rights e-training is timely, and its focus on mental health, recovery and community inclusion could not be more crucial.

As we are all aware, the COVID-19 pandemic has demonstrated the devastating social impacts of global health crises. The years of neglect and underinvestment in mental health has been heavily exposed, as has the longstanding stigma of mental health conditions and discrimination against people with psychosocial disabilities.

Their human rights are continuously under threat.

We urgently need a paradigm shift. My Office’s recent report on mental health and human rights highlighted that people with mental health conditions and with psychosocial disabilities face all kinds of discrimination. They are often denied legal capacity on the basis of their disability, forcibly admitted to institutional settings, and coerced into treatment.

This is happening because of outdated laws, policies and practices.

Restoring the dignity and rights of people with mental health conditions and with psychosocial disabilities needs to be our priority. We need to discontinue the use of discriminatory laws and practices and advance towards approaches with equality and non-discrimination at their core. Such approaches must conform with international human rights standards as set out in the Convention on the Rights of Persons with Disabilities.

The Quality Rights e-training will play an essential role in transforming attitudes and practices in mental health. It will provide vital support to countries in their implementation of a rights-based and recovery-oriented approach to mental health services.

I am particularly pleased that the e-training is being integrated and delivered in the context of the Special Initiative for Mental Health. Dr Tedros, I commend you for your vision in creating and accelerating the implementation of this initiative and WHO’s commitment to keep mental health high on the human rights, sustainable development and humanitarian agendas.

My Office is committed to continue our collaboration and to support this excellent initiative. I will be inviting all staff to undertake the training, and – through our web and social media channels as well as at high-level events – to actively disseminate it to relevant audiences throughout the world.

As we recover from the pandemic, we have a crucial opportunity to find the path towards better, more inclusive, sustainable societies. Tools such as this can help us take the steps on that path.

Thank you.

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The WHO seeks to end human rights violations in psychiatry

The mental health care services in Europe and globally in the main continues to be provided in psychiatric wards and hospitals. As The European Times is documenting human rights abuses and coercive practices in these facilities are common. The World Health Organization (WHO) in new guidance material released this week evidence that providing community-based mental health care that is both respectful of human rights and focused on recovery is proving successful and cost-effective.

Mental health care recommended in the new guidance by WHO should be located in the community and should not only encompass mental health care but also support for day-to-day living, such as facilitating access to accommodation and links with education and employment services.

WHO’s new “Guidance on community mental health services: promoting person-centred and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach, as recommended by the WHO Comprehensive Mental Health Action Plan 2020-2030 endorsed by the World Health Assembly in May 2021.

Fast transition to redesigned mental health services required

“This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions, to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support,” said Dr Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance.

Since the adoption of the United Nations’ Convention on the Rights of Persons with Disabilities (CRPD) in 2006, an increasing number of countries have sought to reform their laws, policies and services related to mental health care. All European countries have signed and ratified this Convention. However, to date, few countries have established the frameworks necessary to meet the far-reaching changes required by international human rights standards.

Reports from around the world highlight that severe human rights abuses and coercive practices are still far too common in countries of all income levels. Examples include forced admission and forced treatment; manual, physical and chemical restraint; unsanitary living conditions; and physical and verbal abuse.

The majority of government mental health budgets still goes to psychiatric hospitals

According to WHO’s latest estimates, governments spend less than 2% of their health budgets on mental health. Furthermore, the majority of reported expenditure on mental health is allocated to psychiatric hospitals, except in high-income countries where the figure is around 43%.

The new guidance, which is intended primarily for people with responsibility for organizing and managing mental health care, presents details of what is required in areas such as mental health law, policy and strategy, service delivery, financing, workforce development and civil society participation in order for mental health services to be compliant with the CRPD.

It includes examples from countries including Brazil, India, Kenya, Myanmar, New Zealand, Norway and the United Kingdom of community-based mental health services that have demonstrated good practices in respect of non-coercive practices, community inclusion, and respect of people’s legal capacity (i.e. the right to make decisions about their treatment and life).

Services include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches and support provided by peer groups. Information about financing and results of evaluations of the services presented are included. Cost comparisons provided indicate that the community-based services showcased produce good outcomes, are preferred by service users and can be provided at comparable cost to mainstream mental health services.

“Transformation of mental health service provision must, however, be accompanied by significant changes in the social sector,” said Gerard Quinn, UN Special Rapporteur on the Rights of Persons with Disabilities. “Until that happens, the discrimination that prevents people with mental health conditions from leading full and productive lives will continue.”

Council of Europe wants to enforce harmful coercive psychiatric treaments – UN experts oppose

Independent UN human rights experts called on Friday for a European body of intergovernmental experts to stop legislation supporting coercive mental health measures.

Five UN experts issued a statement calling upon the Council of Europe’s Committee on Bioethics to withdraw a draft  Additional Protocol to the Oviedo Convention – a treaty protecting the human rights of people with regard to biology and medicine – that would codify a  mental health policy based on coercion and bring “stigmatization and fear to people with psychosocial disabilities”. “Overwhelming evidence from the European Disability Forum, Mental Health Europe and other organizations and growing consensus within the United Nations including at the World Health Organization (WHO), show that forced admission to medical institutions and coercive treatments in institutions will bring harmful effects such as pain, trauma, humiliation [and] shame”, the experts said. This is incompatible with contemporary human rights principles and standards.

Quell the draft

If adopted during a vote in early June, the draft Additional Protocol would continue to allow all the 47 State parties of the Council of Europe to use coercive measures against people with mental health conditions, including their forcible committment to psychiatric institutions.

The coercive approach to mental health is “doing harm to people with disabilities” and “we should not go backwards to authorize this outdated approach”, the experts said, adding that individutals with psychosocial disabilities “have the right to live in the community and to refuse medical treatment”.

“We call upon all State delegations to object to the draft Additional Protocol in the upcoming meeting and we urge the Council of Europe to end legitimizing forced institutionalization and the use of coercion against persons with disabilities, including older persons with disabilities”, they underscored.

Be part of the future

The controversial draft treaty has also aroused opposition within Europe and from the international community.

Voices within the Council of Europe, such as the Council of Europe’s Parliamentary Assembly and the Council of Europe’s Commissioner for Human Rights have all been vocal against the draft Protocol.

“When there are efforts worldwide to reform mental health policy, it comes to our surprise that the Council of Europe, a major regional human rights organization, is planning to adopt a treaty that would be a setback to reverse all positive developments in Europe and spread a chilling effect elsewhere in the world”, the experts said.

They stressed that the Council of Europe now has “a unique opportunity to shift away from old-fashioned coercive approaches” to mental health, towards concrete steps to promote supportive mental health services and realize human rights for all “without discrimination on the grounds of disability”.

“We urge the Council of Europe to be part of the future and not part of the past in mental health”, concluded the experts.

Click here for the names of the experts who endorsed in this statement.

Special Rapporteurs and independent experts are appointed by the Geneva-based UN Human Rights Council to examine and report back on a specific human rights theme or a country situation. They are not UN staff nor paid for their work.