The Research

Mental health, human rights and legislation: guidance and practice

.This publication was written jointly by WHO and OHCHR.
DOI: https://iris.who.int/bitstream/handle/10665/373126/9789240080737-eng.pdf

Key takeaway points from the report (from Dr Jessica Taylor):

1. 1. WHO and UN are calling for significant shift away from the biomedical model of mental health which encourages psychiatric diagnoses, medications, forced restraints, institutionalisation, imprisonment and other oppressive medical practices – towards a trauma-informed, social, human rights, person-centred approach to mental health.
   2. WHO and UN highlight the current ways the biomedical model of mental health harms, oppresses, controls, isolates, stigmatises and discriminates against those who have been told they have psychiatric disorders, and who have not been validated in their traumas, distress, poverty, environments, oppression, or experiences.
   3. WHO and UN recognise that women and girls, people who are gay, lesbian, bisexual and transgender are more likely to be labelled as mentally ill, and more likely to face forced sterilisations, coerced abortions, coerced contraception, and conversion therapies.
   4. WHO and UN recognise that there are widespread human rights violations and harm being caused by current biomedical model approaches to mental health, which includes our psychiatric hospitals, services, treatments, and approaches
   5. WHO and UN recognise that people who have been diagnosed with psychiatric disorders have been positioned as dangerous, unreliable and unstable, meaning that they are stigmatised and discriminated against in multiple systems of power (including health, criminal justice, family justice, education, employment, finances and their rights)

What changes are the WHO and UN expecting to see?

1. 1. The end of discrimination based on psychiatric diagnosis, including discrimination used to prevent access to health insurance, accommodation, and support.
   2. The recognition and respect for legal capacity and personhood of people using any kind of mental health services.
   3. The essential use of informed consent in all psychiatric services, treatments and approaches which includes accurate and truthful explanations of treatment evidence bases, side effects, withdrawal impacts, possible complications and non-medical alternatives.
   4. The elimination of coercive or manipulative practices in psychiatry and mental health, including the end of all forced psychiatric treatments, or treatments that are coerced or manipulative (e.g. You can only access support if you take this medication/You can only have access to your children if you accept this diagnosis and take this medication).
   5. The prohibition of involuntary sectioning and hospitalisation and forced treatment.
   6. The elimination of forced seclusion and restraints.
   7. The development of trauma-informed, rights-based community support for everyone in need of support in their trauma or distress,
   8. The development of peer-led and peer-run support services for people in distress and trauma,
   9. The implementation of programmes to help the deinstitutionalisation of people who have been institutionalised for long periods.
   10. Accountability in all psychiatric services and provisions, which includes the establishment of independent monitoring bodies,
   11. Establishing a system for implementing redress, reparations and remedies where people have been harmed by psychiatry and the biomedical model of mental health

Why is this new guidance so important? According to the document, the following reasons have been presented by the UN and WHO as to why this guidance to move away from the biomedical model is so important:

1. 1. Stigma, discrimination and several other human rights violations occur regularly in mental health and psychiatric provisions to this day.
   2. There is an overreliance on biomedical approaches to treatment options, which favour medications, and more dangerous procedures such as ECT.
   3. Many people with psychiatric diagnoses, particularly those who are minoritized and marginalised, are not treated equally in law.
   4. Access to justice for people with psychiatric diagnoses on file has commonly been restricted, affecting their right to a fair trial, denying them the possibility to contest detention, forced treatment and abuses in mental health services.
   5. Psychiatric diagnoses have been used to restrict a person’s right to file a police complaint or stand trial, to be taken seriously, to be protected from abuse, to be believed, to be seen as a credible victim or witness, to give evidence, to have access or custody of their children etc.
   6. People with psychiatric diagnoses on file will often be treated as if they do not have mental capacity and cannot make their own decisions about their lives or their care – including whether or not they wish to receive any care for perceived ‘mental health issues’.
   7. International human rights laws require non-discrimination and respect for human rights in all settings, including psychiatry.
   8. All humans should have the right to reject medical treatment in psychiatry and mental health, and should not be able to be forced or coerced into accepting medications or other treatments.
   9. There is little focus on the social determinants of ‘mental health’, as the biomedical model has been so influential. Instead there needs to be focus on the true roots of human suffering and distress including oppression, harm, violence, abuse, poverty, cultural norms, discrimination, isolation, disadvantage, exploitation, bullying, chronic illness, lack of access to services and breaches of human rights.
   10. There has been little acknowledgement of the racism, colonialism, homophobia, ageism, sexism, misogyny, ableism, classism or the many other factors that psychiatry has leant upon and supported over decades. Further, there is much evidence that those from poverty, those with refugee status, those who seek asylum, and those from indigenous communities and cultures are more likely to be positioned as mentally ill, dangerous, and non-credible.
   11. Psychiatry and the biomedical model of mental health is dominated by Western reductionist medical beliefs that people are mentally disordered and dangerous, which came from colonial rule, and the rise of the lunatic asylums via the church and the government.