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The right to mental health 2017, para. 21
- Paragraph text
- The promotion and protection of human rights in mental health is reliant upon a redistribution of power in the clinical, research and public policy settings. Decision-making power in mental health is concentrated in the hands of biomedical gatekeepers, in particular biological psychiatry backed by the pharmaceutical industry. That undermines modern principles of holistic care, governance for mental health, innovative and independent interdisciplinary research and the formulation of rights-based priorities in mental health policy. International organizations, specifically WHO and the World Bank, are also influential stakeholders, whose role and relations interplay and overlap with the role of the psychiatric profession and the pharmaceutical industry.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 22
- Paragraph text
- At the clinical level, power imbalances reinforce paternalism and even patriarchal approaches, which dominate the relationship between psychiatric professionals and users of mental health services. That asymmetry disempowers users and undermines their right to make decisions about their health, creating an environment where human rights violations can and do occur. Laws allowing the psychiatric profession to treat and confine by force legitimize that power and its misuse. That misuse of power asymmetries thrives, in part, because legal statutes often compel the profession and obligate the State to take coercive action.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 19
- Paragraph text
- Beyond the health sector, corrupt practices that have a direct impact on the right to health have occurred in other private sector companies, including private water companies, tobacco manufacturers, food and beverage manufacturers, car manufacturers and the natural resources extraction industry. Such practices include, for example, bribery of public officials and the manipulation of scientific research practices. In his previous reports, the Special Rapporteur has highlighted how power asymmetries have given rise to the widespread prioritizing of specialized medicine over primary care and public health interventions, including poverty reduction, labour conditions and early childhood services (see A/HRC/35/21, paras. 21-26). Such asymmetries generate preferences for physical health care over mental health care; biomedical interventions over non-biomedical interventions; the prioritization of certain disciplines that promote expensive biomedical technologies over social sciences in public health research agendas; and limited space for civil society participation in health policymaking.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 49
- Paragraph text
- There are particular challenges to transparency in the health sector. Asymmetric information between providers, payers and users leads to provider or user moral hazard. Information is divided between a multitude of different actors, including regulators, payers, providers, users and suppliers, which reduces transparency. There are many varying ways to improve transparency depending on the context. For example, transparency in procurement is enhanced through public access to procurement bidding results, monitoring of the prices paid and analysis of bids. Transparency in recruitment can be supported through the publication of criteria. Transparency through the promotion of information that sets out the services and treatments to which individuals are entitled and how these services are reimbursed can help minimize inequalities in access to care through corrupt practices. The publication of transparent waiting lists can negate the practice of bribery to access more rapid treatment.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 14
- Paragraph text
- With the adoption of the 2030 Agenda for Sustainable Development and recent efforts by influential global actors such as WHO, the Movement for Global Mental Health and the World Bank, mental health is emerging at the international level as a human development imperative. The 2030 Agenda and most of its sustainable development goals implicate mental health: Goal 3 seeks to ensure healthy lives and promote well-being at all ages and target 3.4 includes the promotion of mental health and well-being in reducing mortality from non-communicable diseases. How national efforts harness the momentum of the 2030 Agenda to address mental health has important implications for the effective realization of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 64
- Paragraph text
- Justification for using coercion is generally based on “medical necessity” and “dangerousness”. These subjective principles are not supported by research and their application is open to broad interpretation, raising questions of arbitrariness that has come under increasing legal scrutiny. “Dangerousness” is often based on inappropriate prejudice, rather than evidence. There also exist compelling arguments that forced treatment, including with psychotropic medications, is not effective, despite its widespread use. Decisions to use coercion are exclusive to psychiatrists, who work in systems that lack the clinical tools to try non-coercive options. The reality in many countries is that alternatives do not exist and reliance on the use of coercion is the result of a systemic failure to protect the rights of individuals.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 66e
- Paragraph text
- [The Special Rapporteur takes note of the concerns of various stakeholders, particularly within the medical communities, regarding the absolute ban on all forms of non-consensual measures. He acknowledges that their radical reduction and eventual elimination is a challenging process that will take time. However, there is shared agreement about the unacceptably high prevalence of human rights violations within mental health settings and that change is necessary. Instead of using legal or ethical arguments to justify the status quo, concerted efforts are needed to abandon it. Failure to take immediate measures towards such a change is no longer acceptable and the Special Rapporteur proposes five deliberate, targeted, and concrete actions as follows:] Scale up research investment and quantitative and qualitative data collection to monitor progress towards these goals.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 13
- Paragraph text
- Alongside general corruption, health sector corruption is widespread and has serious consequences for the enjoyment of the right to health on the basis of equality and non-discrimination. The most common forms of corruption in the health sector are selling government posts, absenteeism, bribes, procurement corruption, theft or misuse of property, fraud, and embezzlement of user fee revenue, as well as informal payments to health-care providers. A range of stakeholders may be implicated in these and other corrupt practices in the health sector affecting the enjoyment of the right to health. These include but are not limited to health ministers, parliaments, accrediting and licensing bodies, public and private insurers, hospitals, health professionals and health professional associations, community health workers, pharmacists, pharmaceutical companies and biotechnology companies, medical researchers and medical research groups and patients and patient support groups. As will be argued below, they all bear responsibilities with regard to the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 46
- Paragraph text
- Key elements of meaningful participation with the aim of preventing and controlling corruption are the active disclosure of important health-related information and the participation of relevant stakeholders in health decision-making, including in health sector plans, in the annual budget process and in review processes for health laws, policies and programmes. In the context of budgets, participation involves the engagement of a variety of stakeholders in determining the allocation of funding, as well as monitoring expenditure. Methods for realizing participation include forums and conferences, local health committees and teams, citizens’ juries, public meetings, but also institutional participation, for example in hospital boards. Key stakeholders include, but are not limited to, national health assemblies, community-based and grass-roots organizations, professional associations and other non-governmental bodies and civil society organizations.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 25
- Paragraph text
- Corruption undermines the State’s obligation to realize the right to health “to the maximum of its available resources”. Notably, embezzlement diverts financial resources from their intended purpose. Corruption also reduces the ability of governments to generate maximum resources, including through international cooperation, in the first place by making countries less attractive to donors and investment, and may support tax evasion. Measures to prevent and protect against corruption offences are therefore an essential component of this obligation.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 70
- Paragraph text
- A 2006 study found that the majority of DSM-IV (fourth edition of the Manual) panel members had financial ties to drug companies and that 100 per cent of the Mood Disorders work group and the Schizophrenia and Psychotic Disorders work group had commercial ties to the companies that manufacture antidepressants and antipsychotics. Despite a disclosure policy implemented by the American Psychiatric Association one year later, the majority of individuals serving on the DSM-5 (fifth edition of the Manual) still had such ties and, as with the DSM-IV, the most conflicted panels were those for which pharmacological treatment was the first-line intervention.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 41
- Paragraph text
- States have an obligation to protect against harm by third parties, including the private sector, and should work to ensure that private actors support the realization of the right to mental health, while fully understanding their role and duties in that respect.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 24
- Paragraph text
- The status quo in current psychiatry, based on power asymmetries, leads to the mistrust of many users and threatens and undermines the reputation of the psychiatric profession. Open and ongoing discussions within the psychiatric profession about its future, including its role in relation to other stakeholders, is critical. The Special Rapporteur welcomes and encourages such discussions within the psychiatric profession and with other stakeholders, and he is convinced that the search for consensus and progress is to the advantage of everyone, including psychiatry. The active involvement of the psychiatric profession and its leaders in the shift towards rights-compliant mental health policies and services is a crucial element for success in positive global mental health changes.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 28
- Paragraph text
- Powerful actors influence the research domain, which shapes policy and the implementation of evidence. Scientific research in mental health and policy continues to suffer from a lack of diversified funding and remains focused on the neurobiological model. In particular, academic psychiatry has outsize influence, informing policymakers on resource allocation and guiding principles for mental health policies and services. Academic psychiatry has mostly confined its research agenda to the biological determinants of mental health. That bias also dominates the teaching in medical schools, restricting the knowledge transfer to the next generation of professionals and depriving them of an understanding of the range of factors that affect mental health and contribute to recovery.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 71
- Paragraph text
- The obligation to secure social determinants to promote mental health requires cross-sectoral action to ensure a robust commitment from all relevant ministries. For example, suicide prevention strategies are traditionally targeted towards high-risk groups and address clinical depression as a biomedical phenomenon, while cross-sectoral programmes that address the social and environmental determinants of suicide through population-based approaches show more promise. Bullying in schools is another phenomenon to be considered as a global and national public health priority. States should first and foremost address emotional and psychosocial environments, targeting relationships rather than individuals.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 16
- Paragraph text
- Three main characteristics make the health sector particularly vulnerable to corruption: (a) power asymmetries or an imbalance of information, inter alia, between health-care provider and patient and between government, the private sector and rights holders; (b) uncertainty inherent in selecting, monitoring, measuring and delivering health-care services; and (c) the complexity of health systems: the large number of parties involved makes it more difficult to generate and analyse information in a transparent manner. A fourth problem, sometimes termed “provider moral hazard”, is that health professionals, public officials or private actors may choose to act in their own interests rather than in the interests of the rights holders towards whom they bear duties. Moreover, where health systems lack transparency, participation and accountability, a fertile breeding ground is created for corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 39
- Paragraph text
- The harmful effects of the tobacco industry and unhealthy foods industry has been covered up by manufacturers and industry lobbyists, including through sponsoring research to downplay links to health problems. Misinformation, pressure and bribery from private sector actors, including the food and beverage and breast-milk substitute industries and the tobacco and the polluting industries, can interfere with the obligation of governments to adopt an appropriate legislative, regulatory and policy framework to promote and protect public health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87a
- Paragraph text
- [The Special Rapporteur urges States to:] Implement the United Nations Convention against Corruption and to explicitly criminalize the corrupt acts identified in that treaty and which are also prevalent in the health sector;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87b
- Paragraph text
- [The Special Rapporteur urges States to:] Ensure the integration of the right to health as a standard in anti-corruption laws and policies aimed at regulating the health sector;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 62
- Paragraph text
- While governments have the primary duty to regulate and oversee the pharmaceutical sector, the pharmaceutical industry has a responsibility to engage with governments on the issue of corruption. It has an independent responsibility to prevent corruption throughout its value chain, inter alia, through institutional checks and balances, protection and security of medicines and the adoption of monitoring and accountability procedures such as audits and whistle-blowing mechanisms for all staff in the company.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 17
- Paragraph text
- Three major obstacles which reinforce each other are identified in the following sections.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 2
- Paragraph text
- While corruption manifests at many levels within societies and States, the present report focuses on the links between corruption and the enjoyment of the right to the highest attainable standard of health. Corruption in government, institutions and society at large is a significant obstacle to the enjoyment of the right to health of individuals and groups. In countries with a higher level of perceived national corruption, there is a much higher prevalence of poor health. Corruption in Government and society can reduce the ability of the government to raise resources for health and other social sectors through putting off investors or donors or as a result of tax evasion.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 51
- Paragraph text
- Accountability comprises three elements: monitoring (“what is happening, where and to whom (results) and how much is spent, where, on what and whom (resources)”), review (“analysing whether pledges, promises and commitments have been kept by countries, donors and non-state actors”) and remedies and action. The rule of law, transparency and access to information, including on decision-making processes, budgets and financial transfers in both the public and private sectors, provide vital conditions which help to strengthen accountability.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 53
- Paragraph text
- Judicial, quasi-judicial, political and administrative mechanisms at the local, national and international levels can all play an important review function. It is essential that rights holders are aware of their entitlements and that complaints procedures are simple and accessible. Independent complaints procedures are often valuable. Rights holders must be able to participate in review procedures carried out by quasi-judicial, political or administrative bodies. Moreover, whistle-blower protection in the public and private sectors for individuals in procurement bodies, health authorities, health service providers and suppliers of medicine and equipment supports review through encouraging the reporting of corruption. Domestic human rights bodies, such as national human rights institutions, as well as international mechanisms such as the United Nations treaty bodies and the universal periodic review, can provide an important contribution to enhancing accountability for the right to health, including in the context of corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 55
- Paragraph text
- Under the Universal Declaration of Human Rights, all organs of society have human rights responsibilities. It is now widely acknowledged that, while States parties are ultimately accountable for the right to health, all members of society, including health professionals and the private business sector have responsibilities regarding the realization of the right to health. As indicated in the Guiding Principles on Business and Human Rights: Implementing the United Nations “Protect, Respect and Remedy” Framework, private actors have the responsibility to “respect” human rights.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 76
- Paragraph text
- When guidelines are produced by medical specialty groups, especially those with strong and pervasive industry ties, these groups tend to recommend market-driven treatment options (e.g. pharmacotherapy) when less expensive and safer (e.g., lifestyle change or psychosocial support) approaches are available. For example, meta-analyses,, re-analyses of antidepressant clinical trial data, and narrative reviews have explicitly concluded that because of the risk benefit profile, antidepressants should not be used as a first-line intervention for mild depression, as this may result in overtreatment. Nonetheless, some guidelines produced by industry-funded psychiatry specialty organizations continue to use a predominately biological framework and recommend antidepressant medication as a first-line intervention for even mild depression.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 29
- Paragraph text
- Because of biomedical bias, there exists a worrying lag between emerging evidence and how it is used to inform policy development and practice. For decades now, an evidence base informed by experiential and scientific research has been accumulating in support of psychosocial, recovery-oriented services and support and non-coercive alternatives to existing services. Without promotion of and investment in such services and the stakeholders behind them, they will remain peripheral and will not be able to generate the changes they promise to bring.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 1
- Paragraph text
- Corruption can have a devastating effect on good governance, the rule of law, development and the equitable enjoyment of all human rights, including the right to health. Corruption has been the subject of international legal commitments as well as recent political commitments. The 2030 Agenda for Sustainable Development and the Sustainable Development Goals (targets 16.5 and 16.6) stipulate that corruption and bribery, in all their forms, should be substantially reduced by 2030 and that effective, accountable and transparent institutions should be developed at all levels.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 7
- Paragraph text
- A distinction is frequently made between “grand” and “petty” corruption. Grand or “high-level” corruption refers to acts committed at a high level of government that distort policies of the central government, for example a health minister “skimming” money off a loan from a foreign country. Petty or “administrative” corruption is smaller-scale everyday corruption by low- and mid-level public officials in their interaction with citizens, for example an informal payment from patient to doctor.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
The right to mental health 2017, para. 19
- Paragraph text
- However, the field of mental health continues to be over-medicalized and the reductionist biomedical model, with support from psychiatry and the pharmaceutical industry, dominates clinical practice, policy, research agendas, medical education and investment in mental health around the world. The majority of mental health investments in low-, middle- and high-income countries disproportionately fund services based on the biomedical model of psychiatry. There is also a bias towards first-line treatment with psychotropic medications, in spite of accumulating evidence that they are not as effective as previously thought, that they produce harmful side effects and, in the case of antidepressants, specifically for mild and moderate depression, the benefit experienced can be attributed to a placebo effect. Despite those risks, psychotropic medications are increasingly being used in high-, middle- and low-income countries across the world. We have been sold a myth that the best solutions for addressing mental health challenges are medications and other biomedical interventions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph