A/HRC/44/48 Although it is not possible to identify precisely the reasons for the increase in diagnosed mental health conditions in children, and the resulting increase in the use of psychotropic medication and poly-pharmacy, widened diagnostic boundaries,33 increased use of technology34 and increased social isolation have been suggested. Inexplicably, this upward trend is happening at the same time as, and despite the fact that, an enormous body of evidence continues to emerge on the impact of adverse childhood experiences on mental health and well-being. 46. The tendency to medicalize children’s distress can lead to an approach whereby multiple medications are prescribed for various symptoms, where some symptoms are iatrogenic effects of the medications, despite the lack of evidence for poly-pharmacy in children.35 Children have a right to thrive, to develop in a holistic way to their full potential and enjoy good physical and mental health in a sustainable world. It is crucial that investments are made to provide the nutritional, educational and societal resources for healthy development, and that the effects of adverse childhood experiences are addressed. 47. The Special Rapporteur welcomes the attempts of organizations in the field of child and adolescent mental health to oppose excessive medicalization and to develop mental health-care services for children and adolescents that prevent coercive measures and excessive use of psychotropic medications. 36 It is important to train mental health professionals and educate broader society to understand that psychotropic medications are not effective first-choice treatment options in child and adolescent mental health care and that excessive use of psychotropic medications is not compliant with the right to health. A broad variety of other interventions, such as watchful waiting and other psychosocial interventions, must be available, accessible, acceptable and of sufficient quality. 48. Many care facilities for the aged routinely pathologize symptoms associated with ageing and use sedative and antipsychotic drugs on older persons as chemical restraints. There is a growing body of literature that suggests that the use of chemical restraints in older persons, particularly in care homes, is increasing. 37 Subjecting older persons with dementia to chemical restraints is inconsistent with a human rights approach and points to a clear need to increase resources to provide appropriate staffing and offer person-centred support. Most importantly, however, is the need to promote the conditions and social resources that foster healthy ageing and to develop policies and allocate resources that allow older persons to remain integrated in their communities. 49. Human rights-based approaches can help expose gaps in current policies and identify antiquated ideas that can undermine the conditions that are conducive to living a life with dignity. Without an interdisciplinary approach and genuine stakeholder involvement in the development of mental health policies, criminal justice reforms and clinical practice guidelines and education, it will be impossible to address the growing problem of medicalization and coercion that often follows. Responding effectively to this problem will require approaches that take into account how institutional thinking and practice and guild interests may impede the ability to genuinely make room for models of care that fall outside a medical model.38 33 34 35 36 37 38 12 See Allen Frances and Laura Batstra, “Why so many epidemics of childhood mental disorder?”, Journal of Developmental & Behavioral Pediatrics, vol. 34, No. 4 (May 2013). See Jean M. Twenge, “The sad state of happiness in the United States and the role of digital media” in World Happiness Report 2019, John F. Helliwell, Richard Layard and Jeffrey D. Sachs, eds. (New York, Sustainable Development Solutions Network, 2019). See Jon Jureidini, Anne Tonkin and Elsa Jureidini, “Combination pharmacotherapy for psychiatric disorders in children and adolescents: prevalence, efficacy, risks and research needs”, Pediatric Drugs, vol. 15, No. 5 (October 2013). See Joseph M. Rey, Tolulope T. Bela-Awusah and Jing Liu, “Depression in children and adolescents” in Textbook of Child and Adolescent Mental Health, Joseph M. Rey, ed. (Geneva, International Association for Child and Adolescent Psychiatry and Allied Professions, 2015). See Human Rights Watch. “‘Fading away’: how aged care facilities in Australia chemically restrain older people with dementia” (2019). See Roberto Mezzina and others, “The practice of freedom: human rights and the global mental health agenda” in Advances in Psychiatry, Afzal Javed and Kostas N. Fountoulakis, eds. (Cham, Switzerland, World Psychiatric Association/Springer Publishing, 2019).