WHO and UN Advocate for Mental Health Reform, Face Opposition

The World Health Organization (WHO) and the Office of the High Commissioner on Human Rights (OHCHR) have launched new guidance aimed at overhauling the mental health landscape, moving it away from practices long-criticized for violating human rights and towards a system rooted in dignity, autonomy, and community support.

Ahead of World Mental Health Day, the freshly minted guidance, titled “Mental health, human rights and legislation: guidance and practice,” aims to catalyze global momentum in challenging traditional norms in psychiatry. Its focus? To end the widespread human rights abuses that have become almost synonymous with mental health care in many parts of the world and to increase access to compassionate, quality care.

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, emphasized:

Volker Türk, UN High Commissioner for Human Rights, shared his vision:

Yet, as international entities rally behind the cause, the report is not without controversy. Not only does the initiative face opposition from prominent groups in the survivor community, but the current debate has also resurfaced deep-rooted tensions between global health organizations, the psychiatric community, and users and survivors of psychiatry.

WHO-UN Guidance

Despite the ratification of the United Nations Convention on the Rights of Persons with Disabilities in 2006, there remains a grim reality: involuntary treatments, inhumane living conditions, and myriad forms of abuse persist in mental health settings globally.

The latest WHO-UN guidance follows a 2021 WHO report on Community Mental Health services that promoted community-integrated, rights-based, and person-centered care, emphasizing the importance of social determinants, holistic recovery, and the reduction of coercion in treatment. This publication represented a pivotal moment in the global mental health discourse, echoing the calls for a more humane, inclusive, and compassionate system of care.

According to Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, the new guidance aims to empower individuals with mental health conditions and psychosocial disabilities to thrive within their communities, reaffirming their right to dignified, rights-based care.

As it stands, the lion’s share of mental health funding is funneled into psychiatric hospitals, especially in high-income countries. Yet evidence increasingly suggests that community-based care is more cost-effective, humane, and effective. The new guidance is poised to usher in a paradigm shift — from institutionalized care to community-integrated systems that offer holistic support, from housing assistance to peer networks.

Key to this reimagined landscape is ending coercive practices that have long shadowed mental health care. Not only do such practices infringe upon the right of individuals to make autonomous decisions about their health, but they also inflict physical and psychological harm, often exacerbating existing conditions.

But the call to action doesn’t stop at the health sector. The guidance extends its reach, urging all legislators and policymakers to reevaluate laws that intersect with mental health — be it policies addressing poverty, discrimination, or inequality.

Recognizing the diversity of cultures, legal systems, and social contexts, the guidance provides a flexible framework. Countries are encouraged to adapt it to their unique circumstances without sacrificing the core tenet of upholding human rights.

According to the guidance, a cornerstone of this transformation is to involve those with lived experiences, ensuring that their voices are not only heard but are instrumental in shaping the future of mental health care.

Opposition Emerges from User and Survivor Groups

The Center for the Human Rights of Users and Survivors of Psychiatry Validity Foundation and the World Network of Users and Survivors of Psychiatry, together with other human rights defenders, have publicly opposed the draft guidance that the OHCHR and WHO presented for public consultation. Their opposition arose in response to previous drafts, and they have not yet issued a statement on the final version of the guidance.

Their critique underscores a pressing concern: despite the high-profile individuals attending the launch event on October 9, there’s a glaring absence of global or regional organizations representing users or survivors of psychiatry and people with psychosocial disabilities, as well as the Committee on the Rights of Persons with Disabilities.

In its draft form, they highlight that the guidance seemed to prioritize changes to existing mental health laws over the needed systematic reforms to protect the rights of those with psychosocial disabilities. The critics argue that the guidance appears to advocate for regulating the rights of these individuals within mental health laws, which they see as discriminatory and misaligned with the principles of the Convention on the Rights of Persons with Disabilities (CRPD). Previous versions of the guidance, they note, have even endorsed practices violating the CRPD.

The groups urge a rejection of this guidance, emphasizing that its approach is at odds with the goals of the CRPD, and they call for a more vigilant oversight of its implementation.

Historical Tensions

Not only does the initiative face opposition from prominent groups in the survivor community, but the current debate has also resurfaced deep-rooted tensions between global entities, the psychiatric community, and users and survivors of psychiatry.

The complex relationship between the United Nations, the WHO, the field of psychiatry, and users and survivors is not new. Historically, a palpable “tug of war” has been evident, with proponents of the Convention on the Rights of Persons with Disabilities (CRPD) and rights-based approaches advocating on one side and established psychiatric and pharmaceutical interests defending their ground on the other. This contentious relationship has been well-documented in public statements and academic publications.

In past reports to the United Nations (UN), child psychiatrist Dainius Pūras advocated for a significant transformation in how society understands and addresses mental health issues. Deemed “groundbreaking” by the UN Office of the High Commissioner on Human Rights, these reports emphasized issues like the overwhelming dominance of the biomedical paradigm in mental health care and power disparities in decision-making. Despite being supported by many, the reports received backlash from several medical and psychiatric organizations.

In a particularly illuminating example, the Australian & New Zealand Journal of Psychiatry presented a point/counterpoint between researchers advocating for a rights-based focus in mental health, such as Gill and Cosgrove and Jureidini, and those who labeled such views as “anti-psychiatry,” a stance represented by authors like Dharmawardene and Menkes. Further fuel was added to the fire when World Psychiatry published multiple articles suggesting amendments to the CRPD, particularly advocating the continuation of forced treatment.

In response, six major organizations championing the rights of those with psychosocial disabilities penned an open letter. The open letter, notably signed by the European Network of (Ex-)Users and Survivors of Psychiatry (ENUSP) and the World Network of Users and Survivors of Psychiatry (WNUSP), among others, emphasized the transformation needed, stating:

However, by 2020, even critical entities like the World Psychiatric Association began aligning with UN recommendations, signaling a slow shift towards more person-centered and rights-based mental health approaches.

Later, survivor-researchers Jasna Russo and Stephanie Wooley stressed that the CRPD’s aim wasn’t to tweak the psychiatric field but to entirely rethink the policies and attitudes that underpin it. They highlighted how existing power imbalances often sideline the voices of survivors. A striking example is the UK’s 2007 Mental Health Act, which often framed patients as unreliable and risky.

As global entities like the WHO and OHCHR endeavor to reshape the future of mental health, the path forward remains contentious. It’s evident that the call for transformative change resonates universally, but the means to achieve this vision diverges significantly among stakeholders.

The debate underscores a critical facet of mental health reform: the need for inclusivity. To genuinely craft a system that upholds human rights and dignifies every individual, the voices of those directly affected—survivors and those with lived experiences—must be at the forefront of decision-making.

A cohesive, universally accepted approach to mental health reform may seem distant against the backdrop of these debates. However, the global momentum, steered by these discussions, is undeniably moving towards a more inclusive, compassionate, and rights-based future for mental health care.

As the world marks World Mental Health Day 2023, the stage is set for a global conversation — one that will determine how societies uphold the rights and dignity of those living with psychosocial disabilities.

 

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World Health Organization (WHO) & Office of the High Commissioner on Human Rights (OHCHR). (2023, October 9). WHO-OHCHR launch new guidance to improve laws addressing human rights abuses in mental health care. https://www.who.int/news/item/09-10-2023-who-ohchr-launch-new-guidance-to-improve-laws-addressing-human-rights-abuses-in-mental-health-care

The Center for the Human Rights of Users and Survivors of Psychiatry Validity Foundation, & The World Network of Users and Survivors of Psychiatry. (2023, October 9). Statement opposing OHCHR-WHO guidance on mental health, human rights, and legislation. http://www.chrusp.org/