Legacy

Introduction

In 2014, Dr. Dainius Pūras became the first medical doctor to be appointed by the UN Human Rights Council as Special Rapporteur on the right to physical and mental health. Throughout his tenure, Dr. Pūras pushed for a paradigm shift in mental health care, writing several ground-breaking reports.

As a researcher and human rights advocate, Dr. Pūras has led and actively participated in projects at the national and international level in public mental health, policies and services for children and families at risk, rights of children with developmental disabilities, and violence prevention.

He is a professor at Vilnius University, Lithuania, and the director of the Human Rights Monitoring Institute, an NGO based in Vilnius.

A Brief Timeline: The right to mental health at the Human Rights Council

Legacy

"There is no health without mental health and there is no good mental health and well-being without embracing a human rights-based approach. There is an urgent need to invest more in mental health." (A/HRC/44/48)

I. Laying the groundwork for a paradigm shift

From the time he was appointed to the United Nations Human Rights Council in 2014, Dr. Pūras has pushed for a paradigm shift in mental health care, bringing mental health into focus as a human rights and development priority. While his work has occasionally been met with derision from some mainstream psychiatric institutions, he continues to draw attention to coercive practices and human rights violations and to call for greater investment in rights-based approaches to mental health care and suicide prevention.

During his mandate, Dr. Pūras developed several reports that emphasize the importance of the social determinants of health and criticize the dominance of the biomedical model and the medicalization of depression. In this section, we will briefly explore some of the most significant bodies of work (a complete list can be found below).

In 2017, the Special Rapporteur issued a ground-breaking report that called on States and all stakeholders to move towards “mental health systems that are based on and compliant with human rights.” It encouraged a paradigm shift in the mental health field from a biomedical model to a human rights model, highlighting the harms associated with ignoring the social determinants of health.

II. Sparking global dialogue

"There is an inherent and universal value to supporting dignity and well-being; furthermore, it is a human rights imperative". (A/HRC/44/48)

The report sparked a global debate on the significance of leveraging a rights-based approach to mental health policy. An open letter welcomed “the global approach to health and psychological wellbeing ensuring the participation of diversity of rights-holders and relevant stakeholders including users and survivors, civil society and communities and empowers them.”

The Special Rapporteur’s 2020 report called on States and stakeholders to promote a paradigm shift in mental health and to adopt, implement, update, strengthen or monitor, as appropriate, all existing laws, policies and practices. The report triggered a critical response from the World Psychiatric Association (WPA) and the World Medical Association (WMA), in which they state they are concerned by “the inclination in the current global debate that persistently places into opposition human rights and medical ethics.”

III. Looking ahead

Many stakeholders, however, have embraced this new approach. Though initially reluctant to accept the main message of the Special Rapporteur’s reports, the World Health Organization (WHO) has recently built on the momentum created by Dr. Puras. In June 2021, WHO released their “Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches.” It presents successful examples of best practices in mental health service provision respecting dignity, moving to zero coercion, and eliminating neglect and abuse, and holds insight into the rights-based future of mental health.

There are some indications that show a possible change in the position of global actors who initially challenged the Special Rapporteur’s 2020 report. Interestingly, the WPA was also involved in the preparation of WHO’s "Guidance," which might hint at an evolving approach to mental health by leadership of global psychiatry.

Outputs

Throughout his tenure, the Special Rapporteur developed a significant body of work related to the right to mental health. A full list is below.

15 April 2020: A/HRC/44/48 addresses the need for a global agenda for mental health that is human rights-based and makes recommendations to States, organizations in the psychiatric profession and World Health Organization on how to transition to a human rights-based model

12 April 2019: A/HRC/41/34 elaborates on the critical role of the social determinants of mental health, focusing on the role that social, psychosocial, political, economic, and physical environments have in enabling a person to enjoyment of the highest attainable standard of physical and mental health

10 April 2018: A/HRC/38/36 examines the relationship between the right to health and specific forms of deprivation of liberty and confinement in penal and medical regimes.

27 July 2018: A/73/216 discusses the role of discriminatory attitudes and xenophobic political rhetoric in creating environments of fear and intolerance for people on the move and host communities.

28 March 2017: A/HRC/35/21 calls for a shift from the current status quo, with excessive use of biomedical treatments and non-consensual measures, to a recovery- and community-based model which promotes social inclusion and offers a range of rights-based treatments and psychosocial support.

28 March 2017: A/70/213, a report on the right to health in early childhood, addresses the need for effective psychosocial interventions.

Special Rapporteur Dainius Pūras also dedicates specific chapters to mental health in the following reports:

4 April 2016: On the right to health of adolescents (A/HRC/32/32)

14 July 2017: On corruption and the right to health (A/72/137)

16 July 2019: On a human rights-based approach to health workforce education (A/74/174)

Special Rapporteur Dainius Pūras has also addressed the right to mental health in each of his country reports.

Dainius Pūras (2015). Principles to guide a regional agenda on the right to health. Global Social Policy.

Dainius Pūras (2016). Human rights and mental health care - Can we find a common ground? European Psychiatry.

Dainius Pūras (2016). Universal Health Coverage: A Return to Alma-Ata and Ottawa. Health and Human Rights Journal.

Dainius Pūras (2017). Human rights and the practice of medicine. Public Health Reviews.

Dainius Pūras & Julie Hannah (2017). War on Drugs Reasons for drug policy reform: prohibition enables systemic human rights abuses and undermines public health. BMJ.

Dainius Pūras (2018). A human rights approach to mental health and people with disabilities. Bulletin of the World Health Organization.

Dainius Pūras & Piers Gooding (2019). Mental health and human rights in the 21st century. World Psychiatry.

Dainius Pūras & Julie Hannah (2019). Prioritising rights-based mental health care in the 2030 agenda. Book chapter in The Routledge Handbook of International Development, Mental Health and Wellbeing. [Edited by Laura Davidson].

S. P. Sashidharan, Roberto Mezzina and Dainius Puras (2019). Reducing coercion in mental healthcare. Epidemiology and Psychiatric Sciences.

Dainius Pūras (2020). Challenges in Promoting the Interdependence of all Human Rights. Health and Human Rights Journal.

Dainius Pūras et al. (2020). The right to health must guide responses to COVID-19. The Lancet.

Faraaz Mahomed, Jacqueline Bhabha, Michael Ashley Stein, and Dainius Pūras (2020). Establishing Good Practice for Human Rights-Based Approaches to Mental Health Care and Psychosocial Support in Kenya Access COVID Vaccines. Health and Human Rights Journal.

Peter Stastny, Anne M. Lovell, Julie Hannah, Daniel Goulart, Alberto Vasquez, Seana O’callaghan, and Dainius Pūras (2020). Crisis Response as a Human Rights Flashpoint: Critical Elements of Community Support for Individuals Experiencing Significant Emotional Distress. Health and Human Rights Journal.

Benjamin A. Barsky, Julie Hannah & Dainius Pūras (2021). Redefining International Mental Health Care in the Wake of the COVID-19 Pandemic. Book chapter in Mental Health, Legal Capacity, and Human Rights. [Edited by Michael Ashley Stein, Faraaz Mahomed, Vikram Patel & Charlene Sunkel].

Special Section: Public and Mental Health, Human Rights, and Atrocity Prevention. Health and Human Rights Journal, June 2021.

Sebastian von Peter , Volkmar Aderhold , Lauren Cubellis, Tomi Bergström, Peter Stastny, Jaakko Seikkula & Dainius Pūras (2019). Open Dialogue as a Human Rights-Aligned Approach. Frontiers in Psychiatry.

Audrey Chapman, Carmel Williams, Julie Hannah & Dainius Pūras. Reimagining the Mental Health Paradigm for Our Collective Well-Being. Health and Human Rights Journal.

The Special Rapporteur’s 2020 report on a human rights-based global agenda for mental health and human rights triggered a response from the World Psychiatric Association (WPA) and the World Medical Association (WMA). See letter (7 August 2020).

The Special Rapporteur’s 2017 report on mental health triggered various responses from different stakeholders as follows:

Photos

UN Special Rapporteur on the right to health