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Title | Date added | Template | Body | Legal status | Document type | Year | Document code | Original document | Paragraph text | Thematics | Topic(s) | Person(s) affected | Year |
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The right to mental health 2017, para. 21 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 22 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 12 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | One decade later, progress is slow. Effective, acceptable and scalable treatment alternatives remain on the periphery of health-care systems, deinstitutionalization has stalled, mental health investment continues to be predominantly focused on a biomedical model and mental health legislative reform has proliferated, undermining legal capacity and equal protection under the law for people with cognitive, intellectual and psychosocial disabilities. In some countries, the abandonment of asylums has created an insidious pipeline to homelessness, hospital and prison. When international assistance is available, it often supports the renovation of large residential institutions and psychiatric hospitals, undermining progress. |
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The right to mental health 2017, para. 23 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | The professional group in psychiatry is a powerful actor in mental health governance and advocacy. National mental health strategies tend to reflect biomedical agendas and obscure the views and meaningful participation of civil society, users and former users of mental health services and experts from various non-medical disciplines. In that context, the 2005 WHO Resource Book on Mental Health, Human Rights and Legislation, developed using human rights guidelines at the time, was highly influential in the development of mental health laws that allowed “exceptions”. Those legal “exceptions” normalized coercion in everyday practice, widening the space for human rights violations to occur and it is therefore a welcome development to see the laws being revisited and the Resource Book formally withdrawn, as a result of the framework brought about by the Convention on the Rights of Persons with Disabilities. |
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The right to mental health 2017, para. 25 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | Conventional wisdom based on a reductionist biomedical interpretation of complex mental health-related issues dominates mental health policies and services, even when not supported by research. Persons with psychosocial disabilities continue to be falsely viewed as dangerous, despite clear evidence that they are commonly victims rather than perpetrators of violence. Likewise, their capacity to make decisions is questioned, with many being labelled incompetent and denied the right to make decisions for themselves. That stereotype is now regularly shattered, as people show that they can live independently when empowered through appropriate legal protection and support. |
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The right to mental health 2017, para. 74 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | The Special Rapporteur highlights the devastating impact that institutionalization has on young children, particularly on their mental health and holistic development. Mental health-related services for children receive inadequate investment and lack quality standards of care and staffing, thus creating an environment where abuse is common for children with disabilities or with difficulties in social and emotional development, especially for those in institutional care. There are many examples of innovative child mental health services and practices throughout the world and there is convincing research on their effectiveness in promoting mental health and preventing deterioration in mental health conditions. However, those good practices often serve merely as pilot projects, owing to a lack of political will to replicate and mainstream them in general childcare services. |
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The right to mental health 2017, para. 77 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 38 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 65 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | Coercion in psychiatry perpetuates power imbalances in care relationships, causes mistrust, exacerbates stigma and discrimination and has made many turn away, fearful of seeking help within mainstream mental health services. Considering that the right to health is now understood within the framework of the Convention on the Rights of Persons with Disabilities, immediate action is required to radically reduce medical coercion and facilitate the move towards an end to all forced psychiatric treatment and confinement. In that connection, States must not permit substitute decision-makers to provide consent on behalf of persons with disabilities on decisions that concern their physical or mental integrity; instead, support should be provided at all times for them to make decisions, including in emergency and crisis situations. |
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The right to mental health 2017, para. 83 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | Peer support, when not compromised, is an integral part of recovery-based services. It provides hope and empowers people to learn from each other, including through peer support networks, recovery colleges, club houses and peer-led crisis houses. Open Dialogue, a successful mental health system, has entirely replaced emergency, medicalized treatment in Lapland. Other non-coercive models include mental health crisis units, respite houses, community development models for social inclusion, personal ombudsmen, empowerment psychiatry and family support conferencing. The Soteria House project is a long-standing recovery-based model, which has been recreated in many countries. The increasing availability of alternatives and education and training on the use of non-consensual measures are critical indicators for measuring overall progress towards compliance with the right to health. |
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The right to mental health 2017, para. 88 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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Corruption and the right to health 2017, para. 19 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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Corruption and the right to health 2017, para. 20 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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Corruption and the right to health 2017, para. 15 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | The lesser form of corruption, namely, petty corruption, is quite common in the health sector and includes informal payments from patient to health-care provider, absenteeism of health personnel and preferential treatment. These forms of corruption are also sometimes called “survival corruption”, as they are exacerbated by a lack of resources in health-care settings, poor working conditions, low pay, and hierarchical structures, which drive people to engage in such acts. There is evidence that this “microform” of corruption has a particularly negative effect on the poor in society, as they are often unable to pay the bribes necessary for a certain service. |
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Corruption and the right to health 2017, para. 22 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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Corruption and the right to health 2017, para. 48 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | Where there is opacity surrounding decisions at the political, macro or micro levels, corruption can flourish, go undetected and occur with impunity. Transparency unveils corruption and is inextricably linked to the right to access information, participation and accountability. Access to information and transparency laws provide a framework for addressing corrupt practices, while the regulations and monitoring arrangements are also vital. Transparency can often be enhanced by the participation of rights holders and civil society organizations in decision-making processes that may be prone to corrupt practices. |
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Corruption and the right to health 2017, para. 49 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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Corruption and the right to health 2017, para. 50 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | There is a significant demand from civil society for accountability of Governments and other institutions. Sustainable Development Goal 16 includes a commitment to create effective, transparent and accountable institutions at all levels. Accountability is at the heart of human rights and central to the fight against corruption. Human rights-based accountability for corruption helps reveal where corruption has taken place and resulted in human rights abuses. Effective accountability processes are also important for the reason that they can have a deterrent effect in relation to corruption. It is therefore troubling that research suggests that accountability for corruption is rare, indicating a need for governments to take concerted steps to strengthen accountability mechanisms and processes. |
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Corruption and the right to health 2017, para. 33 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | In terms of affordability, health-care providers can make health-care services more expensive by demanding payments (informal or under-the-table payments), which can put treatment out of reach and be a matter of life or death, contribute to morbidity or impoverish patients and their families. The payment of bribes by patients for privileged care is common in many countries and results in discriminatory access to care, with wealthier patients likely to access care more easily than those that are too poor to pay bribes. As a result of bribery in procurement processes, medicines may be more expensive. |
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Corruption and the right to health 2017, para. 35 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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Corruption and the right to health 2017, para. 88d | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | [The Special Rapporteur also urges other relevant stakeholders to:] Strengthen those elements in the medical education curriculum of future medical doctors that strengthen their knowledge and skills in order to prevent them from becoming involved in corrupt acts, unethical behaviour, reliance on excessive and unnecessary medical interventions, disease mongering, favouritism, informal payments and other practices that are either corrupt or increase the risk of corruption; |
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The right to mental health 2017, para. 4 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | Everyone, throughout their lifetime, requires an environment that supports their mental health and well-being; in that connection, we are all potential users of mental health services. Many will experience occasional and short-lived psychosocial difficulties or distress that require additional support. Some have cognitive, intellectual and psychosocial disabilities, or are persons with autism who, regardless of self-identification or diagnosis, face barriers in the exercise of their rights on the basis of a real or perceived impairment and are therefore disproportionately exposed to human rights violations in mental health settings. Many may have a diagnosis related to mental health or identify with the term, while others may choose to identify themselves in other ways, including as survivors. |
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The right to mental health 2017, para. 20 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 14 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 16 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | An effective tool used to elevate global mental health is the use of alarming statistics to indicate the scale and economic burden of “mental disorders”. While it is uncontroversial to note that millions of people around the world are grossly underserved, the current “burden of disease” approach firmly roots the global mental health crisis within a biomedical model, too narrow to be proactive and responsive in addressing mental health issues at the national and global level. The focus on treating individual conditions inevitably leads to policy arrangements, systems and services that create narrow, ineffective and potentially harmful outcomes. It paves the way for further medicalization of global mental health, distracting policymakers from addressing the main risk and protective factors affecting mental health for everyone. To address the grossly unmet need for rights-based mental health services for all, an assessment of the “global burden of obstacles” that has maintained the status quo in mental health is required. |
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The right to mental health 2017, para. 36 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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The right to mental health 2017, para. 78 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | The right to health requires that mental health care be brought closer to primary care and general medicine, integrating mental with physical health, professionally, politically and geographically. It not only integrates mental health services into mainstream health care so they can be accessible for everyone, it ensures that entire groups of people who are traditionally isolated from mainstream health care, including persons with disabilities, receive care and support on an equal basis with others. Inclusion also comes with socioeconomic advantages. Mental health concerns everyone and when needed, services should be accessible and available to all at the primary and specialized care levels. |
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The right to mental health 2017, para. 81 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | While the paradigm shift in mental health requires a move towards integrated and population-based services, mental distress will still occur and rights-based treatment responses are required. The interventions used to address serious cases are perhaps the biggest indictment of the biomedical tradition. Coercion, medicalization and exclusion, which are vestiges of traditional psychiatric care relationships, must be replaced with a modern understanding of recovery and evidence-based services that restore dignity and return rights holders to their families and communities. People can and do recover from even the most severe mental health conditions and go on to live full and rich lives. |
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The right to mental health 2017, para. 62 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | In particular, children and adults with intellectual disabilities and with autism too often suffer from institutionalized approaches and excessively medicalized practices. Institutionalizing and medicating children with autism, based on their impairment, is unacceptable. Autism represents a critical challenge to modern systems of care and support, as medical attempts to “cure” the condition have often turned out to be harmful, leading to further mental health deterioration of children and adults with the condition. Support for them should not only address their right to health, but their rights to education, employment and living in the community on an equal basis with others. |
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The right to mental health 2017, para. 64 | Aug 19, 2019 | Paragraph | Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | Non-negotiated soft law | Special Procedures' report | 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. |
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