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Statement by Mr Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health at the 41st session of the Human Rights Council

Agenda Item 3: Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development

Geneva, 24 June 2019

Mr President,
Distinguished Delegates,
Ladies and Gentlemen,

It is my pleasure to be here today to present my thematic report on the role of the determinants of health in advancing the right to mental health (A/HRC/41/34). This report continues to develop one of the priorities I had identified at the beginning of my tenure, namely the right to mental health. It focuses on relationships and social connection, as opposed to individual and causal models which tend to over-rely on biomedical explanations of emotional distress and that deflect political attention away from rights-based policies and actions.

On this occasion, I also present the reports on my country visits to Kyrgyzstan and Canada, carried out from 22 to 31 May and from 6 to 16 November 2018, respectively.

Ladies and Gentlemen,

The realization of the right to mental health requires States to respect, protect, and fulfil the social and underlying determinants that promote mental health. My report begins by stressing the interrelation of rights and elaborates on why and how giving effect to the full range of human rights must be understood as a core determinant that promotes mental health.

The determinants that promote mental health are the material preconditions for individual health such as access to food, housing, education and work, but more importantly they also refer to the social and psychosocial elements that promote the well-being of individuals and society, building and promoting healthy and positive relationships. This means that the quality of social relationships matters and that connections between individuals, families and communities over the course of life, across generations, between government and people, between different nations, and between mankind and nature are critical for mental health.

These relationships are shaped by the socio-economic, political and cultural structures at homes, schools, workplaces, healthcare settings, and the society at large and are linked to issues such as abusive relationships, violence, and social disparities. The later affect in particular groups in vulnerable situations including ethnic and religious minorities, indigenous peoples, LGBTI persons and persons with disabilities.

Therefore, actions that promote community inclusion, environments free from violence, and participation in cultural diversity are actions that promote mental health because they enable healthy relationships based on trust, respect and tolerance. The same as those measures aimed at the eradication of xenophobia, the decriminalization of poverty and of behaviours such as drug use and sexual diversity, as well as the creation of opportunities for solidarity, mutual support and trust.

Mr. President,

The right-to-health framework highlights the obligations of States towards promoting the determinants of mental health and provides valuable elements to help shape policies and measures towards this end. These include areas that should be prioritized financially according to obligations of immediate effect and core obligations, such as the non-discriminatory provision of services and the development of national public mental health strategies across public policy sectors. In addition, the right-to-health framework indicates that the determinants of mental health must always be available, accessible, acceptable, and of good quality and that actions that promote them should be shaped in a participatory manner with accountability mechanisms to ensure that the promotion of mental health will not get diluted in the broader policies of other sectors.

In my report, I elaborate on a number of recommendations such as the imperative of eliminating discrimination within and beyond mental health-care settings. It is important that societal well-being be placed at the centre of development and assistance decisions and that States review their social, labour and economic policies in order to promote non-violent and respectful relationships. Among my recommendations I highlight child protection and the need to support families through effective infrastructure that improve the quality of relationships between parents and children. Institutional care for children should be eliminated, bullying should be addressed and depression and suicide prevented through modern public health approaches that value and foster non-violent relationships avoiding excessive medicalization.

I also highlight that regrettably, many parts of mental health-care systems, such as residential institutions and psychiatric hospitals, too often themselves breed cultures of violence, stigmatization and helplessness. Efforts should be refocused towards non-coercive alternatives that address holistic well-being, and place individuals and their definition of their experiences, and their decisions, at the centre.

Finally, I would like to invite States to exchange on good practices and challenges to develop measures that address the right to mental health, including its determinants. In other words, what measures has your Government taken to develop social, labour or economic policies to prevent violence or promote non-violence relationships, including between authorities and civil society? In particular, has your Government developed or promoted measures to:  a) Support healthy holistic development in childhood and adolescence? b) Address bullying? c)     Prevent depression and suicide? d) Prevent xenophobic action and rhetoric against persons in vulnerable situations, such as people on the move? e) Develop performance indicators on the reduction of coercion, institutionalization and excessive medicalization, and on the sustainable funding of rights-based alternatives to a biomedical framework and the use of coercion? If so, I would welcome to hear your experiences.

Ladies and Gentlemen,

Let me now turn to the two country visits conducted in 2018: Kyrgyzstan and Canada. I would like to express my sincere appreciation to the Governments of these countries for extending me an invitation and for their full cooperation.

I would like to start the presentation of my visit to Kyrgyzstan by congratulating the country for ratifying the Convention of the Rights of Persons with Disabilities, and action I recommended at the end of my visit.

During my visit, I realised that a strong political will is also present for the realization of the right to health, not only as a result of the inherited State-driven free medical care from the Soviet times, but also due to the different reforms implemented since the independence. The main challenge in this context lies with effective implementation and sustainability. Kyrgyzstan should address persisting corrupt and ineffective practices and take ownership of the programmes that have been developed with international cooperation, notably in a context where this cooperation is ending owing to the reclassification of Kyrgyzstan as a middle-income country. A long-term health care strategy that is supported with national investment is needed in order for the good efforts already undergoing to continue.

One of these good projects I witnessed refers to tuberculosis care in detention centres. I visited various health facilities at pre-trial detention centres and at various prisons and was encouraged not only by the solid scheme developed for the treatment of tuberculosis, but also by the solid efforts to provide care for drug users.

Among additional remaining challenges that Kyrgyzstan should continue to address, I elaborate on different sexual and reproductive health rights, on some persisting discriminatory practices in health-care services and on the need to progressively deinstitutionalize mental health and social welfare services through a long-term strategy in which investments are directed, as a priority, to family-focused and community-based services, with a human rights-based approach.

Mr President,

I would like to turn now to my visit to Canada. This highly developed country has a strong public health system firmly rooted in the principles of equity and fairness and the notion that access to healthcare should be based on need and not on the ability to pay. In my report, I commend Canada for, inter alia, the sustainable development of a broad range of mental health services; for its efforts to advance reconciliation with Indigenous peoples including measures to better address their right to health and well-being; for its comprehensive public health approach towards drug policy, and for the development of many provincial projects that recognize the interrelation of the right to health with other rights.

A pending challenge, however, refers to including a human rights-based approach to public health so that access to healthcare is justiciable through Canada’s Constitutional right to life.  Additional remaining challenges include: services that are not covered by the public health insurance, such as medicines; disparities across provinces and territories in accessing healthcare due to specific policies and practices, such as access to abortion; poor access to healthcare by persons in vulnerable situation, including Indigenous peoples and migrants, and the lack of parity between physical and mental health.

Many aspects of these challenges are in the process of being addressed by the current Government and I offer some recommendations in my report that will hopefully help Canada in these efforts. Internationally, the important role model that Canada represents implies the responsibility to ensure that all international support is in line with human rights.

Ladies and Gentlemen,

I have presented these thematic and country visit reports in a spirit of a constructive dialogue and engagement with you. I look forward to the dialogue today. Thank you.