The World Health Organization and the UN Unite on Mental Health

On October 9, I was one of nearly 2,000 people attending the online launch of a truly groundbreaking report.

’Mental health, human rights and legislation: Guidance and practice’ is co-published by the World Health Organization and the United Nations (on behalf of the Office of the United Nations High Commissioner for Human Rights). It prioritises the human rights of people who use mental health services, which is an entirely different approach to most current mental health laws, which are focused primarily on compulsion and containment.

The international reforms proposed are based on a clear understanding of what is wrong with our current, medicalised, approach to human distress:

Mental health and well-being are strongly associated with social, economic, and physical environments, as well as poverty, violence, and discrimination. However, most mental health systems focus on diagnosis, medication, and symptom reduction, neglecting the social determinants that affect people’s mental health.

The 184-page document boldly spells out, in considerable detail, why new legislation is needed, around the world, to transcend the medical model espoused by drug companies, most psychiatrists, and even some psychologists:.

Legislation on mental health must take a new direction away from the narrow traditional “biomedical paradigm” that has contributed to coercive and confined environments in mental health services. To achieve this and fully embrace human rights, the Guidance proposes new approaches, such as setting a clear mandate for mental health systems to adopt rights-based approaches; enabling person-centred and community-based services; raising awareness and challenging stigma; eradicating discrimination and coercion; promoting community inclusion and participation; and developing accountability measures.

I have posted here previously on the problems associated with psychiatric drugs (including overprescribing to children and withdrawal symptoms) and electroconvulsive therapy (ECT; including adverse effects and misleading information). The WHO-UN report is refreshingly explicit on these two issues:

Countries should adopt a higher standard for the free and informed consent to psychotropic drugs given their potential risks of harm in the short and long term. . . . Legislation can require medical staff to inform service users about their right to discontinue treatment and to receive support in this. Support should be provided to help people safely withdraw from treatment with drugs.

Significant controversy surrounds the use of ECT and its associated risks, and there have been calls for it to be banned altogether. Its use has dramatically declined in many countries, and in Luxembourg and Slovenia, for example, it is not made available. . . . International human rights standards clarify that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment. People being offered ECT should also be made aware of all its risks and potential short- and long-term harmful effects, such as memory loss and brain damage. ECT is not recommended for children, and this should be prohibited through legislation.

My colleagues and I were also delighted to see our research cited in support of these evidence-based statements on ECT.

Critiques of the medical model approach to mental health, like this latest report, are sometimes met with defensive and scathing rebuttals, especially by some psychiatrists on social media. Amongst the plethora of welcoming responses to this report, mostly from patients let down by our current mental health systems, a colleague, Professor Peter Kinderman, cheekily tweeted: "I wonder if, now, those using ad hominem attacks to denigrate people with whom they disagree will switch from insults such as 'anti-psychiatry' and 'pill-shaming' and 'Scientologists' and instead refer to 'supporters of the WHO position'?"

Much more importantly, patients and their families will, when trying to resist compulsory treatments and confinement, have two powerful international institutions squarely on their side, alongside the 338 studies and reports they cite to support their conclusions and recommendations.

The new legislation that is needed, all over the world, cannot come soon enough. Human rights apply to everyone.