A/HRC/41/34 right to mental health complements this idea with the requirement that no one be denied access to a healthy psychosocial environment to sustain their well-being, and that everyone be entitled to a life with respect, social connection, equal opportunities and dignity. 6. Work on determinants is also influencing the evolving issue of mental health. The WHO comprehensive mental health action plan 2013–2020 includes the promotion of mental health through action on social determinants as one of its five key objectives. However, this objective has not been translated into practical action. Policy, funding, research priorities and debate on how to strengthen the response to global mental health challenges are still dominated by targeting individuals and their mental health conditions, such as calls to scale up services that provide treatment. This approach has a tendency to reinforce a biomedical narrative that disregards alternative treatments, understates the role of psychotherapy and other psychosocial interventions, and, more importantly, does not address the determinants contributing to poor mental health. 7. The burden of managing and coping with the systemic damage caused by ignoring the determinants of health has fallen on individuals. These individuals then turn to a mental health-care sector that often lacks adequate resources and appropriate approaches to cope with collective failures. States have an obligation to ensure that individuals can exercise their right to decline treatment and to help those seeking to gain access to rights-based treatment, care and support (including social support, user-led provision or other alternative services). States also have an obligation to create supportive and enabling environments that foster mental health and well-being. 8. Human rights have the aim of protecting the well-being of people and are therefore determinants of mental health. Some 70 years after the adoption of the Universal Declaration of Human Rights, there is evidence that rights-based indicators of poor mental health are improving. These indicators include an overall reduction in suicide, 3 global advances in the reduction of extreme poverty, 4 a reduction in interpersonal violence, 5 greater gender equality,6 a trend towards the abolition of child corporal punishment 7 and an overall reduction in totalitarian regimes. 8 This trend suggests that human rights-based policies and practices of societies around the world have had a positive effect. However, these successes are under threat from a growing movement of powerful global stakeholders who oppose universal human rights principles and argue that the post-war world order, which established those principles, has failed. This misrepresentation must be challenged as it undermines States’ obligations to protect and promote human rights, including the right to health. 9. The focus of the present report is on how these intersecting political discussions, economic and social rights imperatives, and the struggle to overcome structural obstacles, can be fortified by the right to the enjoyment of the highest attainable standard of health. In particular, the Special Rapporteur emphasizes how realization of the right to mental health can guide more holistic, equitable, responsible and community-centred action on the promotion of mental health. 10. Terminology in the sphere of mental health is a contested terrain. There is a need to accept different terms according to how people define their own experiences of mental health. “Mental health” itself can signal a biomedical tradition for explaining and understanding lived experiences, psychic or emotional distress, trauma, voice hearing or disability. The Special Rapporteur acknowledges this contested area and the importance of the health sector and the medical model when used appropriately. He challenges 3 4 5 6 7 8 See Bertolote, J.M. and De Leo, D., “Global suicide mortality rates – a light at the end of the tunnel?” in Crisis: the Journal of Crisis Intervention and Suicide Prevention, vol. 33, No. 5 (2012), pp. 249– 253. See https://ourworldindata.org/poverty-at-higher-poverty-lines. See World Bank Group, World Development Report 2017: Governance and the Law (2017), p. 133. See World Bank Group, “Women, business and the law 2019: a decade of reform” (2019). See Frank J. Elgar and others, “Corporal punishment bans and physical fighting in adolescents: an ecological study of 88 countries” in BMJ Open (2018). See Freedom House, “Freedom in the world 2018: freedom in crisis”. 3