UN report points to power imbalances

Ella Rhodes reports…

'For decades, mental health services have been governed by a reductionist biomedical paradigm that has contributed to the exclusion, neglect, coercion and abuse of people with intellectual, cognitive and psychosocial disabilities, persons with autism and those who deviate from prevailing cultural, social and political norms… We have been sold a myth that the best solutions for addressing mental health challenges are medications and other biomedical interventions… Reductive biomedical approaches to treatment that do not adequately address contexts and relationships can no longer be considered compliant with the right to health.'

These strong words are not, as one may assume, from the pen of a radical socialist, but are taken from a recent United Nations report by Special Rapporteur Dainius Pūras, a psychiatrist from Lithuania. The report has been backed, in an open letter, by the British Psychological Society, Mental Health Europe, as well as organisations, psychiatrists and psychologists across the globe.

The United Nations Convention on the Rights of Persons with Disabilities was issued in 2006, and its implementation is monitored by a body of independent experts appointed by the Human Rights Council known as Special Rapporteurs. The UN Special Rapporteur's report is the first report of its kind to address what the right to mental health means in the light of this treaty.

Its author condemns the neglect of what he calls 'the preconditions of poor mental health', including violence, disempowerment, social exclusion, and harmful conditions at work and school. He wrote: 'There exists an almost universal commitment to pay for hospitals, beds and medications instead of building a society in which everyone can thrive…'

Pūras's report also contains a stern warning about the global mental health movement and the assumption that Western models of mental health and its treatment should be imposed on other nations. '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 scaling-up of care must not involve the scaling-up of inappropriate care.'

The report also has clear messages about what is needed instead. Drawing on a range of examples and resources, including the British Psychological Society's report Understanding Psychosis, it emphasises the need for a 'paradigm shift' towards offering culturally appropriate psychosocial interventions as the first-line, working in partnership with service users and carers, respecting diversity, and taking steps to eliminate coercive treatment and forced confinement.

Among the report's recommendations is a focus on embedding rights-based mental health innovation within public policy. 'The crisis in mental health should be managed not as a crisis of individual conditions, but as a crisis of social obstacles which hinders individual rights. Mental health policies should address the "power imbalance" rather than "chemical imbalance".'

Professor Peter Kinderman (University of Liverpool), said: 'I am proud that the British Psychological Society has already endorsed and supported Dr Pūras's report, but we need to go further. Reports like this are of little use if they are received and then left on the shelf. We need to continue to put pressure on governments, worldwide, to implement its recommendations. This is nothing less than a civil rights struggle, and we need to be engaged and active in support. It is up to all of us on the ground, professionals, service users, carers and others, to campaign for the principles of this report to be translated into action. We are grateful for the ambitious, clear and courageous lead set.'