A/HRC/44/48 26. The right to mental health is best enabled through the convergence of human rights and health determinants, where research and action on the structural, political and social determinants of distress, including poverty, inequality, discrimination and violence, are considered vital. 20 There is thus a need for more nuanced research in the field and a resource shift from the dominance of a biomedical paradigm towards the social sciences, emphasizing interdisciplinarity, intersectionality and the role of contextual factors. The biomedical approach to mental health conditions still has an important role to play, but it must be understood as one of many complex pieces in the rights-based transformation ahead. III. Over-medicalization and threats to human rights Context: from “bad” to “mad”. Medical power and social control A. 27. Many people from traditionally marginalized groups in society, such as people living in poverty, people who use drugs and persons with psychosocial disabilities, have been entangled by a holy trinity of labels: (a) Bad people/criminals, (b) Sick or mad people or patients, or (c) A combination of the two. Those labels have left such communities vulnerable to excessive punishment, treatment and/or therapeutic “justice” for conditions or behaviours deemed socially unacceptable. The result is an exclusionary, discriminatory and often racist pipeline from schools, streets and underserved communities into prisons, hospitals and private treatment facilities, or into communities under treatment orders, where human rights violations may be systemic, widespread and often intergenerational. The global mental health discourse remains reliant on this “mad or bad” approach and on laws, practices and the attitudes of stakeholders excessively dependent on the idea that mental health care is mostly about preventing behaviours that might be dangerous or require interventions based on medical (therapeutic) necessity. Those advocating rights-based approaches infused by modern public health principles and scientific evidence challenge the “mad or bad” dichotomy as outdated, discriminatory and ineffective. 28. The many global efforts towards decarceration and decriminalization are welcome, but attention should be paid to the attendant politics and policy shifts towards the phenomenon of over-medicalization, which raises significant human rights concerns. Whether confined or coerced on public safety or medical grounds, the shared experience of exclusion exposes a common narrative of deep disadvantage, discrimination, violence and hopelessness. 29. This pernicious form of medicalization presents challenges to the promotion and protection of the right to health. Medicalization occurs when a diversity of behaviours, feelings, conditions or health problems are “defined in medical terms, described using medical language, understood through the adoption of a medical framework, or treated through medical intervention”. 21 The process of medicalization is often associated with social control as it serves to enforce boundaries around normal or acceptable behaviours and experiences. Medicalization can mask the ability to locate one’s self and experiences within a social context, fuelling misrecognition of legitimate sources of distress (health determinants, collective trauma) and producing alienation. In practice, when experiences and problems are seen as medical rather than social, political or existential, responses are centred around individual-level interventions that aim to return an individual to a level of functioning within a social system rather than addressing the legacies of suffering and the change required to counter that suffering at the social level. Moreover, medicalization risks legitimizing coercive practices that violate human rights and may further entrench discrimination against groups already in a marginalized situation throughout their lifetimes and across generations. 20 21 8 See Dainius Puras and Piers Gooding, “Mental health and human rights in the 21st century”, World Psychiatry, vol. 18, No. 1 (February 2019). See Peter Conrad and Joseph W. Schneider, Deviance and Medicalization: from Badness to Sickness (Philadelphia, Pennsylvania, Temple University Press, 2010).