The global mental health status quo should move away from the outdated ‘mad or bad’ approach which seeks to prevent behaviours deemed as ‘dangerous’ or provide treatment considered ‘medically necessary’ without consent, he said.Pūras said that the dominance of the biomedical model has resulted in an overuse of medicalisation and institutionalisation, according to a message received here from Geneva.
He warned against the exaggerated benefits of psychotropic medications and highlighted that their effectiveness is not comparable to other medicines that are essential for certain physical conditions, such as for example, antibiotics for bacterial infections.
“I appreciate the progress made to understand the role of psychotropic medications, but also recognise that there are no biological markers for mental health conditions,” he said. Hence the specific mechanisms by which psychotropic drugs might be effective, are simply unknown,” the Special Rapporteur said.
Pūras said that the status quo in mental health care has ignored the social, political or existential context that contributes to the high prevalence of feelings of sadness, anxiety, fear and other manifestations of mental distress.
“There is no simplified mechanistic solution to mental distress,” he said. “For the majority of mental health conditions, psychosocial and other social interventions are the essential option for treatment.”
He highlighted that systemic obstacles, such as power asymmetries in mental health care, the dominance of the biomedical model and the biased use of knowledge, need to be addressed by changes in laws, policies and practicesThe UN expert reiterated his call for mental health care action and investment to be redirected to rights-based supports, to non-coercive alternatives that address the psychosocial determinants of health, and to the development and strengthening of practices that are non-violent, peer-led, trauma-informed, community-led, healing and culturally sensitive.
“I’m calling once again for the ultimate elimination of segregated psychiatric institutions that reflect the historic legacy of social exclusion, disempowerment, stigma and discrimination.”
To achieve this, realisation of the principles and values of the Convention of the Rights of Persons with Disabilities should guide mental health policies and services, and discriminatory laws and practices should be abandoned.
“COVID-19 has exacerbated the failures of the status quo in mental health care. The pandemic provides the global community with a unique opportunity to demonstrate political will to move away from medicalisation and institutionalisation in mental health-care,” the Special Rapporteur said.