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The right to mental health 2017, para. 77
- Paragraph text
- Reductive biomedical approaches to treatment that do not adequately address contexts and relationships can no longer be considered compliant with the right to health. While a biomedical component remains important, its dominance has become counter-productive, disempowering rights holders and reinforcing stigma and exclusion. In many parts of the world, community care is not available, accessible, acceptable and/or of sufficient quality (often limited to psychotropic medications). The largest concentration of mental hospitals and beds separated from regular health care is in higher-income countries, a cautionary note for lower and middle-income countries to forge a different path and shift to rights-based mental health care.
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 38
- Paragraph text
- International treaties recognize the obligation of international cooperation for the right to health, a responsibility reinforced by the commitment to a global partnership for sustainable development in Sustainable Development Goal 17. Higher-income States have a particular duty to provide assistance for the right to health, including mental health, in lower-income countries. There is an immediate obligation to refrain from providing development cooperation supporting mental health-care systems that are discriminatory or where violence, torture and other human rights violations occur. Rights-based development cooperation should support balanced health promotion and psychosocial interventions and other treatment alternatives, delivered in the community to effectively safeguard individuals from discriminatory, arbitrary, excessive, inappropriate and/or ineffective clinical care.
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 88
- Paragraph text
- Today, there are unique opportunities for mental health. The international recognition of mental health as a global health imperative, including within the 2030 Sustainable Development Agenda, is welcome progress. The right to health framework offers guidance to States on how rights-based policies and investments must be directed to secure dignity and well-being for all. To reach parity between physical and mental health, mental health must be integrated in primary and general health care through the participation of all stakeholders in the development of public policies that address the underlying determinants. Effective psychosocial interventions in the community should be scaled up and the culture of coercion, isolation and excessive medicalization abandoned.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 20
- Paragraph text
- Although many everyday practices in health-related services may not be considered as corruption, legally speaking, their accumulation and their acceptance by various stakeholders have a detrimental cumulative effect on the performance of health-care systems and, indirectly, on individual and societal health. It is for that reason that the present report is focused not only on those forms of corruption that are legally defined as breaking the law and should be brought to justice, but also on those practices which undermine principles of medical ethics, social justice, as well as effective and transparent health-care provision. When such practices are not properly addressed, they pave the way to non-transparent decisions at all levels of policymaking, policy implementation and services provision and thus lead to corrupt environments and foster institutional 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)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 22
- Paragraph text
- In the context of universal health coverage, as one of the important global commitments under the 2030 Agenda, it is critical to strengthen health-care systems so that all segments of population trust primary care and primarily use this level of services for most health conditions. This would be an effective anti-corruption measure to help decrease the prevailing tendency whereby users of health services prefer to bypass primary care and use specialized health-care services. The Special Rapporteur welcomes recent initiatives developed and replicated in some countries through which medical doctors educate the general population against wasteful or unnecessary use of medical tests, treatments and procedures in health care. Such initiatives, inter alia, “choosing wisely”, “realistic medicines” or “preventing over-diagnosis”, should be supported by States as effective measures to develop rational health-care services and thus prevent unnecessary and costly use of specialized 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)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 35
- Paragraph text
- Corruption also infringes medical ethics, which are an essential component of acceptable health care. Lastly, in terms of quality, corruption can affect the quality of medicines, for example, when regulators are bribed to carry out less rigorous checks, or when hospital administrators purchase medicines of unknown quality. Quality can also be compromised where bribes are extorted or accepted in decisions on hiring staff, or accrediting, licensing or certifying facilities, in deciding which medicines to include on essential medicines lists, or to market unregulated medicines, which can increase mortality and morbidity among those affected, as well as hampering disease control efforts. Nepotism, cronyism and other forms of favouritism can also compromise the quality of health and health-related services.
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 20
- Paragraph text
- The psychosocial model has emerged as an evidence-based response to the biomedical paradigm.It looks beyond (without excluding) biological factors, understanding psychological and social experiences as risk factors contributing to poor mental health and as positive contributors to well-being. That can include short-term and low-cost interventions that can be integrated into regular care. When used appropriately, such interventions can empower the disadvantaged, improve parenting and other competencies, target individuals in their context, improve the quality of relationships and promote self-esteem and dignity. For any mental health system to be compliant with the right to health, the biomedical and psychosocial models and interventions must be appropriately balanced, avoiding the arbitrary assumption that biomedical interventions are more effective.
- 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
- 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. 36
- Paragraph text
- The right to mental health includes both immediate obligations and requirements to take deliberate, concrete, targeted action to progressively realize other obligations. States must use appropriate indicators and benchmarks to monitor progress, including in respect of reducing and eliminating medical coercion. Indicators should be disaggregated by, among others, sex, age, race and ethnicity, disability and socioeconomic status. States must devote the maximum available resources to the right to health, yet globally, spending on mental health stands at less than 10 per cent of spending on physical 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 44
- Paragraph text
- Meaningful participation of people in decisions that affect their health and socioeconomic well-being is a key component of the right to health and crucial when it comes to combating corruption in health care and in society at large. States’ obligations under article 12 of the International Covenant on Economic, Social and Cultural Rights require that the right to participate in decision-making processes affecting their health and development must be an integral component of any relevant policy, programme or strategy. Sustainable Development Goal target 16.7 stipulates the duty to ensure responsive, inclusive, participatory and representative decision-making 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
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
The right to mental health 2017, para. 43
- Paragraph text
- Health settings must empower users as rights holders to exercise autonomy and participate meaningfully and actively in all matters concerning them, to make their own choices about their health, including sexual and reproductive health, and their treatment, with appropriate support where needed.
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 30
- Paragraph text
- The Constitution of WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Like all aspects of health, a range of biological, social and psychological factors affect mental health. It is from this understanding that duty bearers can more accurately understand their corresponding obligations to respect, protect and fulfil the right to mental health for all. Most of the current discussions around mental health and human rights have focused on informed consent in the context of psychiatric treatment. While that discourse is deeply meaningful, it has emerged as a result of systemic failures to protect the right to mental health and to provide non-coercive treatment alternatives.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 11
- Paragraph text
- Both corruption occurring in society at large (general corruption), as well as corruption specifically occurring in the health or other health-related sectors, have a negative impact on the enjoyment of the right to health. These forms are intertwined. Corruption in society at large may affect the regulatory environment and the efficiency of State institutions. It hinders economic growth and sustainable development as well as equitable distribution of resources. It undermines public confidence in the State and may obstruct attainment of the commitments made through Sustainable Development Goal 16 to create effective and accountable institutions.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 40
- Paragraph text
- Discrimination encompasses any distinction, exclusion or restriction that has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise by all persons, on an equal footing, of all rights and freedoms. Non-discrimination and equality are human rights obligations which are fundamental to realizing the right to health. Not only must health and other goods and services be available to all on the basis of non-discrimination, but broader promotion and protection of equality and non-discrimination are vital in guaranteeing the equitable enjoyment 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 6
- Paragraph text
- Despite clear evidence that there can be no health without mental health, nowhere in the world does mental health enjoy parity with physical health in national policies and budgets or in medical education and practice. Globally, it is estimated that less than 7 per cent of health budgets is allocated to address mental health. In lower-income countries, less than $2 per person is spent annually on it. Most investment is focused on long-term institutional care and psychiatric hospitals, resulting in a near total policy failure to promote mental health holistically for all. The arbitrary division of physical and mental health and the subsequent isolation and abandonment of mental health has contributed to an untenable situation of unmet needs and human rights violations (see A/HRC/34/32, paras. 11-21), including of the right to the highest attainable standard of mental and physical 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
- 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. 3
- Paragraph text
- In many countries health is among the most corrupt sectors. Health sector corruption, including for example the bribing of health officials and unofficial payments to health-care providers, obstructs the ability of States to fulfil their right to health obligation and to guarantee available, accessible, acceptable and good quality health services, goods and facilities. Yet corruption affecting health also occurs in other sectors and industries, for example, the water sector, and the food and beverages, tobacco and other industries. Moreover, corruption has significant implications for equality and non-discrimination since it has a particularly marked impact on the health of populations in situations of vulnerability and social exclusion, in particular those living in poverty and children.
- 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
- Poverty
- Person(s) affected
- All
- Children
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 45
- Paragraph text
- Participation in health decision-making leads to improved health outcomes and is essential for ensuring the distribution of policies and programmes to broader segments of the population, thus making governance more accountable. Participation goes beyond merely being educated, informed or consulted. It implies a human right to actively engage individuals and groups in the development, implementation and review of policies, standards, indicators, benchmarks or legislation, particularly aimed at including the voices and needs of more vulnerable or otherwise underrepresented and especially affected populations.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 58
- Paragraph text
- The medical profession has a responsibility to abstain from unethical and unprofessional behaviour under its professional codes, which often emphasize a commitment to integrity and non-corrupt behaviour. Among other acts, the medical profession is to refrain from favouritism and other forms of preferential treatment for well-connected individuals; accepting bribes; using hospital equipment for private business; and referring public hospital patients to their private practices. They should remain independent from outside organizations that have vested interests in their clinical activities. They should avoid conflicts of interest that compromise their decisions regarding the care of patients.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 26
- Paragraph text
- Moreover, since the right to health includes not only a right to health care but also to the determinants of health, it offers a road map and tools for addressing corrupt action in the health sector as well as corruption affecting the social, environmental and other determinants of health. Measures to address the right to health should be holistic and integrated, go beyond the provision of health services and be underpinned by cross-departmental commitment (see A/HRC/32/32, para. 37). It requires the improvement not only of outcomes but also of processes, for example with governance and health systems required to operate on the basis of principles including transparency, participation, accountability and non-discrimination, all of which have a particular importance for addressing 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)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 28
- Paragraph text
- When it comes to addressing corruption and a lack of transparency, the right to health is closely related to and dependent upon other human rights and fundamental freedoms that are critical to the fight against corruption, including the right to life; freedom of expression including the right to seek, receive and impart information; freedom of association; and the right to a fair trial. For example, freedom of expression offers a basis for protecting whistle-blowers, which is of key importance in combating corruption, while the right to information is vital to access information including on financial transactions and decision-making processes that may reveal corruption. The promotion and protection of these rights will also therefore be vital tools to address corruption affecting 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
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 31
- Paragraph text
- Corruption can also arise when States fail in their obligation to ensure that there is an adequate number of health professionals receiving domestically competitive salaries as petty corruption is often used by health professionals or other local officials to make up for inadequate, or unpaid salaries, although it should also be noted that bribes and illicit charges also occur where health professionals earn adequate salaries. As well as competitive salaries, reward for correct performance can also help to tackle corruption. Absenteeism of health service staff also negatively affects availability.
- 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
- 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. 77
- Paragraph text
- Institutional corruption in the mental health system has several consequences. One of them is the medicalization of human diversity and misery, which expands the number of patients labelled with mental illness. According to WHO, more than 300 million people of all ages globally suffer from depression, and depression is the leading cause of disability worldwide. However, some researchers have raised serious questions about the reliability of these disease burden estimates. One study concluded that poor-quality data limit the interpretation and validity of global burden of depression estimates. They warn that uncritical application of these estimates to international health-care policymaking could divert scarce resources from other public health-care priorities. While industry certainly profits from a biological approach that emphasizes these disease burden estimates, the attainment of the right to health globally becomes ever more elusive.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 36
- Paragraph text
- The right to health requires that States take action, including policy, legislative and budgetary action, to prevent corruption from impeding the available, accessible, acceptable and good-quality health care.
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 37
- Paragraph text
- Some obligations are not subject to progressive realization and must be implemented immediately, including certain freedoms and core obligations. Core obligations include the elaboration of a national public health strategy and non-discriminatory access to services. In terms of the right to mental health, that translates into the development of a national mental health strategy with a road map leading away from coercive treatment and towards equal access to rights-based mental health services, including the equitable distribution of services in the community.
- 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
The right to mental health 2017, para. 56
- Paragraph text
- Many countries are faced with a scarcity of human resources for mental health care and must undertake efforts to develop a workforce, including specialist and non-specialist health professionals, general practitioners and community health workers, as well as other professionals, such as teachers, social workers and other peer support and community workers with appropriate skills (including human rights education).
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 63
- Paragraph text
- Informed consent is a core element of the right to health, both as a freedom and an integral safeguard to its enjoyment (see A/64/272). The right to provide consent to treatment and hospitalization includes the right to refuse treatment (see E/CN.4/2006/120, para. 82). The proliferation of paternalistic mental health legislation and lack of alternatives has made medical coercion commonplace.
- 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
- Year
- 2017
Paragraph
The right to mental health 2017, para. 70
- Paragraph text
- There exists an almost universal commitment to pay for hospitals, beds and medications instead of building a society in which everyone can thrive. Regrettably, prevention and promotion are forgotten components of mental health action. Harmful assumptions that goodwill and sacrifice alone will enable populations to achieve mental health and well-being have excused this inaction.
- 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
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87n
- Paragraph text
- [The Special Rapporteur urges States to:] Create awareness among health-care providers that preferential treatment of well-connected individuals is unethical and at odds with the main principles for 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
- Year
- 2017
Paragraph