6 June 2017

Africa: Nothing Short of a 'Sea Change' Will End Years of Gross Neglect in Mental Health Care - UN Expert

Photo: Prinsloo/UNICEF
A young man, 17 is part of a national reintegration strategy in Burundi. At this re-education centre the children are provided help including access to social workers and psychologists.

Citing decades of neglect in mental health care, a United Nations human rights expert today denounced "biomedical gatekeepers" who perpetuate stigma and urged States and psychiatrists to act with courage to reform a "crisis-hit system built on outdated attitudes."

"We need little short of a revolution in mental health care to end decades of neglect, abuse and violence," Dainius Pūras, the UN Special Rapporteur on the right to health said after presenting his latest report to the UN Human Rights Council in Geneva.

The UN expert reported that right violations affect often the socially challenged groups including persons with intellectual, cognitive and psychosocial disabilities. He also stressed that people of all ages, when they have mental health needs, too often suffer from either an absence of care and support or from services that are ineffective and harmful.

Mr. Pūras suggested moving away from traditional practices and thinking, and enabling a long overdue shift to a rights-based approach.

"Where mental health systems exist, they are segregated from other healthcare and based on outdated practices that violate human rights," he noted, underscoring that mental health policies and services are in crisis - not a crisis of chemical imbalances, but of power imbalances - and called for bold political commitments, urgent policy responses and immediate remedial action.

Turning to the underlying causes of these imbalances delaying the transition to rights-based care, he said that the dominance of the biomedical model, with its overdependence on medication, and the "biased" use of evidence, contaminates knowledge about mental health.

"There is now unequivocal evidence of the failures of a system that relies too heavily on the biomedical model of mental health services, including the front-line and excessive use of psychotropic medicines, and yet these models persist," Mr. Pūras explains.

"This pattern occurs in countries across the national income spectrum", he added. The UN expert points out that it "represents a failure to integrate evidence and the voices of those most affected into policy, and a failure to respect, protect and fulfil the right to health."

In his report, Mr. Pūras warns that power and decision-making in mental health are concentrated in the hands of "biomedical gatekeepers", particularly those representing biological psychiatry.

"These gatekeepers, supported by the pharmaceutical industry, maintain this power by adhering to two outdated concepts: that people experiencing mental distress and diagnosed with "mental disorders" are dangerous, and that biomedical interventions are medically necessary in many cases."

In order to ensure compliance with the UN Convention on the Rights of Persons with Disabilities, Mr. Pūras calls for a paradigm shift as these concepts keep alive stigma and discrimination.

Special Rapporteurs and independent experts are appointed by the Geneva-based UN Human Rights Council to examine and report back on a specific human rights theme or a country situation. The positions are honorary and the experts are not UN staff, nor are they paid for their work.

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