A/HRC/34/32 2. Stigma and discrimination 15. There are many negative beliefs around mental health conditions, such as that they are evidence of personal weakness or that they have their origins in witchcraft or spiritual or supernatural phenomena. 24 Together with deeply engrained, adverse stereotypes around persons living with or perceived as having mental health conditions, including the belief that they are incapable of exercising agency over decisions that affect them or of contributing positively to society, these misconceptions have been largely responsible for creating and perpetuating stigma and discrimination. 16. This stereotyping, prejudice and stigmatization is present in every sphere of life, including social, educational, work and health-care settings, and profoundly affects the regard in which the individual is held, as well as their own self-esteem. The lack of systematic training and awareness-raising for mental health personnel on human rights as they apply to mental health allows stigma to continue in health settings, which compromises care. In relation to access to health care, medical insurance schemes often incorporate terms that indirectly discriminate against persons with mental health conditions. Pre-existing conditions or assessments, for instance, may disqualify them from obtaining full health coverage, based on a diagnosis of a mental health condition. 3. Lack of free and informed consent 17. As noted by the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, informed consent is not mere acceptance of a medical intervention, but a voluntary and sufficiently informed decision, protecting the right of the patient to be involved in medical decision-making and assigning associated duties and obligations to health-care providers.25 In order for consent to be valid, it should be given voluntarily and on the basis of complete information on the nature, consequences, benefits and risks of the treatment, on any harm associated with it and on the availability of alternatives.26 Involuntary treatment refers to the administration of medical or therapeutic procedures without the consent of the individual. Treatment administered, for example, on the basis of misrepresentation would constitute involuntary treatment, as would treatment given under threat, without full information or on dubious medical grounds. 27 Guaranteeing informed consent is a fundamental feature of respecting an individual’s autonomy, self-determination and human dignity. 28 B. Systemic challenges applicable to mental health 18. The right to health entitles rights holders to a health system that supports the attainment of the highest level of health. The concerns identified below have particular relevance in the context of this standard and for the availability, acceptability, accessibility and quality of mental health services. 24 25 26 27 28 WHO and World Organization of Family Doctors, Integrating Mental Health into Primary Care: a Global Perspective, p. 168. See A/64/272, para. 9. Ibid., para. 15. European Agency for Fundamental Rights, “Involuntary placement and involuntary treatment of persons with mental health problems” (2012), pp. 44-47. See A/64/272, para. 18. 7