[D66] GGZ-GATE: Latest UN Report Calls for Global Paradigm Shift in Mental Health Care

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madinamerica.com:

Latest UN Report Calls for Global Paradigm Shift in Mental Health Care

UN representative Dainius Pūras argues that it is time to shift to a 
human rights-based approach to mental health.

By
José G. Luiggi-Hernández
July 21, 2020


In his latest report to the United Nations (UN), child psychiatrist 
Dainius Pūras advocates for a transformation in the way we collectively 
understand and intervene on mental health issues.

Pūras, serving as the UN Special Rapporteur on the rights to physical 
and mental health, argues that the dominant biomedical view of ‘mental 
illness’ has led the psychiatric and psychological fields to focus on 
institutionalization and biological interventions (e.g., psychotropic 
medications) at the expense of human rights and social change.

While the scientific exploration of the biological bases of particular 
symptoms is important for informing a complex understanding of ‘mental 
disorders,’ Pūras suggests that we shift our attention to the social 
determinants of health and prioritize human rights—which have been 
neglected by the current psychiatric framework. He writes:
“Those obstacles, 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,” Pūras writes. 
“In particular, the dominance of medicalization in both existing and 
even in some ‘progressive’ policy reforms continues to mask broader 
social injustices that must be confronted and addressed by the global 
community… Scaling up rights-based support within and outside existing 
mental health systems holds much promise for the changes that are needed.”

The Special Rapporteur’s report on the right of everyone to the 
enjoyment of the highest attainable standard of physical and mental 
health was divided into four sections: (1) Global mental health, (2) 
over-medicalization and threats to human rights, (3) Rights-based 
approaches to alternatives, and (4) Global threats and future trends.

Global Mental Health. As the UN serves global interests, it shares the 
goals of the Movement for Global Mental Health (MGMH) of increasing 
access to services and improving mental health and wellbeing across the 
world. However, Pūras’ report advocates shifting the framework of the 
MGMH towards a contextualized approach to mental health (as suggested by 
practitioners in the Global South) that takes social, political, 
economic, and cultural differences between countries into account.

Pūras discusses how colonial psychiatric systems were established in 
some countries, but the ways in which psychiatry is practiced and 
institutionalized is particular to each nation and locality. Further, 
each country faces distinct social and political determinants that can 
harm mental health. According to the Special Rapporteur:
“Those harms can arise from systemic violations of economic and social 
rights, such as neoliberal policies and austerity measures. Harms to 
mental health can equally arise from systemic violations of civil and 
political rights that lead to structural discrimination and violence 
against different communities, as well as restricting the space of civil 
society.”

Pūras suggests that high-income or low-income countries alike, in the 
Global North or South, immediately take steps to transition away from a 
reductionistic biomedical approach to understanding and treating mental 
health issues. To adequately address psychological distress, countries’ 
mental health policies must engage with transformative human rights 
actions, take a diversity of experiences into account, and implement 
social integration, connection, and participation that lead to 
transformation and empowerment. This shift includes a change from 
standardized forms of practice to locally adapted and culturally attuned 
practices.
Overmedicalization and threats to human rights. Pūras also addresses how 
current systems that individualize psychological distress (situating 
responsibility for mental distress within individuals) have led to a 
“mad or bad” approach. The “mad or bad” approach criminalizes people who 
experience psychological distress or labels them as “sick, mad, or 
patients.”

Criminalizing psychological distress has led to mass incarceration, 
while medicalization has taken the focus off of social inequities and 
led to the widespread promotion of psychiatric drugs by pharmaceutical 
companies. Pūras argues that it is necessary to decriminalize mental 
health problems (such as addiction, for example) and institutionalize 
psychiatry, in order to protect and promote human rights. Moreover, 
overmedicalization also stands in the way of a rights-based approach to 
mental health since, according to the Special Rapporteur, it “…can mask 
the ability to locate one’s self and experiences within a social 
context, fueling misrecognition of legitimate sources of distress 
(health determinants, collective trauma) and producing alienation.”
“In practice, when experiences and problems are seen as medical rather 
than social, political or existential, responses are centered around 
individual-level interventions that aim to return an individual to a 
level of functioning within a social system rather than addressing the 
legacies of suffering and the change required to counter that suffering 
at the social level. Moreover, medicalization risks legitimizing 
coercive practices that violate human rights and may further entrench 
discrimination against groups already in a marginalized situation 
throughout their lifetimes and across generations.”

Social determinants and rights-based approaches to mental health 
challenge these individualizing notions and highlight how a reductive 
biomedical understanding of mental health is challenged by scientific 
evidence and leads to obsolete treatments that are often ineffective.
Rights-based approaches and alternatives. Alternatives to biomedical 
approaches to mental healthcare have existed alongside conventional 
treatments for decades. These have changed lives and communities without 
resorting to coercion or other forms of violence while addressing the 
needs of people and groups.

Rights-based alternatives can take different forms. Some have worked to 
better the quality of mental healthcare services, changing institutions 
through systems-level reforms, localized innovations, peer-respite 
centers, recovery communities, medication-free wards, and developing 
communities and groups. Worldwide, these options have shown a “deep 
commitment to human rights, dignity, and non-coercive practices, all of 
which remain an elusive challenge in traditional mental health systems 
too heavily reliant on a biomedical paradigm,” says Pūras.

Rights-based alternatives are characterized by key principles: dignity 
and autonomy, social inclusion, participation, equality and 
non-discrimination, diversity of care, and addressing underlying social 
and psychosocial determinants of health.
Global threats and future trends. The Rapporteur identifies several 
threats to global mental health and wellbeing: climate change, digital 
surveillance, and COVID-19.

Climate change has worsened global social inequalities and is also 
exacerbated by the systems that keep these inequalities in place. The 
effects of climate change also pose a threat to the right to health, as 
it affects clean air, drinking water, adequate housing, food, economic 
security, social relationships, and community life.

Heatwaves also disproportionately kill those who are institutionalized 
and who are in the margins. Confronted with ecological destruction, 
people experience emotional and existential distress that, at times, 
leads to hopelessness. Some research suggests that this may be 
especially true for younger generations who are likely to bear the brunt 
of these effects.

Corporate- and State-owned digital surveillance databases (street 
cameras and facial recognition, data from government, banks, stores, 
internet searches, and social media) are being used for social 
categorization, criminalization, and commercial purposes. These data are 
often used without an individual’s permission or consent and are prone 
to errors that can lead to misinformation, misidentification, and 
misrecognition. Psychologically, this technology makes people fear 
social participation, which has an impact on their mental health and 
wellbeing.

Referencing COVID-19, Pūras acknowledged that the effects of the 
pandemic and the public health measures are still to be determined. 
However, he mentioned that “important challenges and opportunities 
related to mental health are expected, and these should be taken into 
account now.”

For decades, psychiatric and psychological knowledge, practices, and 
services have utilized a reductive biomedical model that has 
individualized suffering and psychological distress while ignoring the 
social and psychosocial determinants of health. These approaches have 
not only failed to address mental distress worldwide, but they have 
turned our collective attention away for the social factors that 
contribute to suffering.

Pūras’ suggestion of shifting to a rights-based approach to mental 
healthcare aims to provide solutions to mental health crises and 
distress that do not involve coercion or other human rights violation 
while also attending to the sociopolitical and economic factors that 
lead to distress.

****

United Nations General Assembly (2020). Right of everyone to the 
enjoyment of the highest attainable standard of physical and mental 
health: Report of the Special Rapporteur on the right of everyone to the 
enjoyment of the highest attainable standard of physical and mental 
health. Retrieved from:           https://undocs.org/A/HRC/44/48