Julie Hannah and Tasneem Sadiq
We are who we are because of other people – Ubuntu saying
Relationships matter. Relationships—the vital connections between individuals, families, communities, and with the natural environment, throughout the course of our lives—are a foundational precondition for our health and well-being. Access to a psycho-social and social environment that fosters respectful relationships is a human right, as outlined by the UN Special Rapporteur on the right to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras, in his latest report to the Human Rights Council.
Presented today in Geneva, this report is the first examination of the multiple ways in which human rights, including the right to health, intersect with the determinants of mental health and well-being. Almost two decades after General Comment 14 established and began to elaborate on the centrality of determinants in the full and effective realisation of the right to health, the Special Rapporteur’s latest report builds on this important public health and human rights discussion.
The report identifies three key elements:
- Human rights are a determinant of and pathway towards positive mental health and wellbeing.
- Mental health promotion must be given parity of resourcing as mental healthcare. Population-based health promotion is not a luxury, but a human right of equal importance with individual health treatment.
- Action on determinants, particularly social and psycho-social determinants, is vital to the promotion of mental wellbeing.
Global attention has been focused on the insufficient funding directed to mental wellbeing, which has led to calls for enough funding to close the treatment gap for everyone experiencing psycho-social difficulties. While acknowledging the importance of increasing funding for wellbeing, in this report the Special Rapporteur also urges action on structural factors that can produce mental distress. These include violence, discrimination, social exclusion, poverty, excessive criminalisation, xenophobia, harmful “traditional family values”, coercive and paternalistic healthcare systems, and retrogressive policies that constrain civil society from building spaces for participation and accountability for all.
The report stresses the importance of the interdependence of human rights, and is critical of policy approaches that are selective of human rights. For example, the report identifies various situations where rights are provided selectively and harm results: a labour force with access to counselling but denied labour rights; a child confined to an institution even though they have access to food and shelter; communities of people who uses drugs criminalised and/or coerced into treatment remain deprived of dignity; a single mother with the freedom to work but without access to healthcare, family or sick leave; an individual with psycho-social disabilities languishing in a coercive and violent healthcare facility; communities of individuals living in poverty subjected to the retrogressive, bureaucratic violence of austerity. A range of structural barriers, including inequalities and discrimination, produce negative mental health outcomes—especially for those experiencing multiple and intersecting forms of oppression. The report stresses the importance of holistic, rights-based responses to overcome these oppressions that lead to mental distress.
Positive social relationships that protect and improve population level mental health are outlined. Policy action that improves resilience and fosters trust, gives a holistic expression to the right to health outside the healthcare sector. All relationships in society are shaped by wider social, economic, political, and cultural forces that States have an obligation to ensure are consistent with right to health obligations under international law.
The report identifies health promoting, structural interventions at all stages of life, from early childhood, adolescence, adulthood and working life, to the later stages of life. These interventions not only support the fulfilment of the right to mental health, they can reduce the need for treatment-focused health action. More than a decade ago, the WHO Commission on the Social Determinants of Health soberly stated that ”social injustice is killing people on a grand scale.” The Special Rapporteur comprehensively links this injustice to the systematic and selective deprivation of various rights and identifies key social arenas for intervention including schools, families, workplaces, and the community.
This is the mandate’s first report to consider the human rights significance of human relationships with the natural world. Relationships with nature are a means of achieving wellbeing, resulting in better living conditions, positive health outcomes and lower levels of psychological stress—such relationships intersect the right to mental health with environmental and cultural rights, recognizing that a breakdown of natural resources damages both community life and individuals.
By stressing the need for States to fund mental health promotion activities, and not just mental health treatment, the Special Rapporteur makes a radical departure from the traditional calls for funding in mental health. This can only be achieved through political will, courageous leadership, participatory and localised processes, and a new commitment for equitable, population-based approaches to improve health outcomes for all.
Julie Hannah is director of the International Centre on Human Rights and Drug Policy at the University of Essex, UK, and an advisor to the United Nations Special Rapporteur on the right to the enjoyment of the highest attainable standard of physical and mental health.
Tasneem Sadiq is a Senior Research Officer to the UN Special Rapporteur on the right to bealth, based at the Human Rights Centre, University of Essex.