A/HRC/44/48 assumption that individuals diagnosed with mental health conditions require medication as a first-choice treatment, undermining their own insight into their distress. 42. The Special Rapporteur has repeatedly made calls for a more expansive understanding of mental health, which aligns with the Constitution of WHO extending beyond individual factors and interventions. The essential medications list may imply that making such drugs available is equivalent to providing the appropriate standard of care for the treatment of mental health conditions, which is not the case. The list is insufficient for assessing compliance with the right to health. Relying predominantly on the essential medicines list is misleading and presents a challenge to the right to health. Any suggestion that psychotropic medications are the most important method of managing mental health conditions, including those of persons with disabilities, contravenes the provisions of the Convention on the Rights of Persons with Disabilities, which establishes a shift away from the medical model. Furthermore, placing psychotropic medications on the list of essential medicines sends a misleading message to stakeholders (States, users and providers of mental health services) and undermines the fact that for the majority of mental health conditions, psychosocial and other social interventions should be viewed as the “essential” option for treatment. 43. In the light of new evidence, the enhanced understanding of how to support good mental health and the significant obstacles that overreliance on medications for mental health present to the realization of the right to health, WHO should review the current essential medicines list of mental health medications (Nos. 24.1–24.4), with a view to removing the ones for which there is no evidence of an adequate risk/benefit profile. In its place, the Special Rapporteur calls on WHO and other Global Mental Health actors to work towards developing a new, holistic list of essential psychosocial and population-based interventions, informed by evidence and supported and developed by rights-based principles, which can more appropriately guide States towards full compliance with the right to health. Until the crisis of the status quo is recognized and a more holistic list is developed, there remains a continued risk of systemic violations of human rights in the delivery of mental health-care services. C. Across the life course: specific groups vulnerable to excessive medicalization 44. Throughout the life cycle, many individuals at the intersection of race, class and gender are at increased risk of the effects of excessive medicalization. Indeed, it is well documented that persons with intellectual, cognitive or psychosocial disabilities, particularly those who are poor and/or from groups in marginalized situations, are particularly vulnerable. In that way, medicalization can pathologize responses to social inequities and escalate social control and violations of rights in vulnerable populations. Scholarship on this issue details numerous examples where “the project of helping certain groups of people merged all too easily with the project of controlling them”.30 The Special Rapporteur highlights the experiences of several groups that are particularly vulnerable to excessive medicalization. 45. There is a general international trend towards increasing psychotropic prescription rates for children and adolescents (as well as for adults), although rates vary widely between countries.31 A growing number of studies have documented a trend in long-term poly-pharmacy in children and adolescents for antipsychotics and other psychotropic classes.32 Such drugs are increasingly used for behavioural and social control. Exposing children unnecessarily to psychotropic medications undermines the right to health. 30 31 32 See Jonathan Metzl. The Protest Psychosis: How Schizophrenia Became a Black Disease, (Boston, Massachusetts, Beacon Press. 2010). See Hans-Christoph Steinhausen, “Recent international trends in psychotropic medication prescriptions for children and adolescents”, European Child & Adolescent Psychiatry, vol. 24, No. 6 (June 2015). See Amanda R. Kreider and others, “Growth in the concurrent use of antipsychotics with other psychotropic medications in Medicaid-enrolled children”, Journal of the American Academy of Child & Adolescent Psychiatry, vol. 53, No. 9 (September 2014). 11