A/HRC/39/36
providers, schools and communities to raise awareness about mental health and facilitate
support for children.
17.
During the interactive dialogue, representatives of Lithuania and of Autistic
Minority International, Support-Fundació Tutelar Girona, Mental Health Europe, Salud
Mental España and Human Rights Watch took the floor. Lithuania welcomed the
consultation and called for continued efforts to be made towards a human rights-based
approach in mental health. The comments and questions that followed touched on: (a) the
fact that the absolute prohibition, in the Convention on the Rights of Persons with
Disabilities, of institutionalization applied equally to autistic children and other people on
the basis of “health” reasons; (b) the need to ensure that all approaches were centred on the
views of people with psychosocial disabilities themselves; and (c) the fact that practices
that were compliant with the Convention could precede and trigger legal reform and should
be encouraged, including through the training of professionals. Echoing the comments of
the Special Rapporteur on the rights of persons with disabilities, representatives of several
organizations expressed opposition to, and called for the withdrawal of, the draft additional
protocol to the Oviedo Convention.
18.
In response, the panellists welcomed the support for the paradigm shift,
acknowledged persistent barriers, including traditional psychiatric practices, and called for
laws and attitudes to be changed, as well as for the eradication of detention of children on
the basis of their mental health or any health condition.
B.
Improving human rights in mental health through system-wide
strategies
19.
Dr. Michelle Funk, of WHO, elaborated on the WHO QualityRights initiative to
advance the human rights-based approach to mental health and the work undertaken by
WHO with countries to: build capacity on human rights and mental health; transform those
systems to promote quality and rights, including by supporting civil society; and support
policy and legal reform that was compliant with the Convention on the Rights of Persons
with Disabilities, particularly in relation to legal capacity, liberty, community inclusion and
the elimination of violence. She emphasized that the QualityRights tools had had a
significant impact in changing attitudes, practices and service delivery — for respect of the
right of the individual to make his or her own decisions, to provide people with information
and choice about treatment options, and to end forced treatment, seclusion and restraint.
She shared results that illustrated reductions in violence, an increased use of support instead
of force, and a reorientation of services towards a recovery approach. WHO was developing
a best practice guide on community services that operated without coercion, supported
recovery, and promoted autonomy and inclusion.
20.
Dr. Vincent Girard, of the Agence régionale de santé Provence-Alpes-Côte d’Azur,
described the “Housing First” programme, which had been operating in France for over 20
years, supporting the inclusion of persons with psychosocial disabilities. Although France
had the second-highest mental health budget in Europe, human rights violations persisted:
psychiatric coercion was on the rise (with a 15 per cent increase since the 2011 law reform,
the objective of which was to strengthen the rights of forcibly hospitalized patients), and
nearly 45,000 people with psychosocial disabilities were living in the streets, and 25,000 in
prisons. He explained that the “Housing First” model did not condition access to housing
on the acceptance of care or on restriction of the consumption of drugs or alcohol, that the
person concerned was supported by a team, which included peer workers and was
coordinated by a social worker, and that the psychiatrist was not the one in charge. He said
that the intervention was effective because it focused on all aspects of an individual’s
needs, not on reducing symptoms, and that the results of the programme showed savings in
terms both of resource expenditure and of respect for human rights, by decreasing and
preventing hospitalization. He agreed that scientific research and projects must be used to
inform and reform policy in regard to the misconceptions of dangerousness and of medical
necessity to “fix a disorder”, which were not supported by modern evidence.
7
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