{"id":10159,"date":"2018-01-11T14:41:49","date_gmt":"2018-01-11T14:41:49","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/WMAContribution-SRMentalHealthReport-June2017.pdf"},"modified":"2018-01-11T14:41:49","modified_gmt":"2018-01-11T14:41:49","slug":"wmacontribution-srmentalhealthreport-june2017-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/wmacontribution-srmentalhealthreport-june2017-2\/","title":{"rendered":"WMAContribution-SRMentalHealthReport-June2017"},"author":12,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

\"\"<\/a><\/p>\n

THE WORLD MEDICAL ASSOCIATION, INC.
\nL\u2019ASSOCIATION MEDICALE MONDIALE, INC
\nASOCIACION MEDICA MUNDIAL, INC
\nCentre International de Bureaux
\nImmeuble A \u00ab\u00a0Keynes\u00a0\u00bb Website : www.wma.net Postal Address :
\n13, chemin du Levant Telephone : (33) 4 50 40 75 75 Bo\u00eete Postale 63
\n01210 FERNEY-VOLTAIRE Fax : (33) 4 50 40 59 37 01210 FERNEY-VOLTAIRE Cedex
\nFrance E-mail address : wma@wma.net France
\nReport of the Special Rapporteur on the right of everyone to the enjoyment of the highest
\nattainable standard of physical and mental health (A\/HRC\/35\/21)
\nThirty-fifth session of the Human Rights Council – 6-23 June 2017
\nComments from the World Medical Association
\n1. Introduction
\nThe World Medical Association (WMA) is the global federation of National Medical Associations
\nrepresenting the millions of physicians worldwide. Acting on behalf of patients and physicians, the
\nWMA endeavours to achieve the highest possible standards of medical care, ethics, education and
\nhealth-related human rights for all people. As such, the WMA plays a key role in promoting good
\npractice, medical ethics and medical accountability internationally.
\nThe WMA, being the reference body internationally for defining medical ethics values, believes
\nthat our contribution to the discussion on mental health and human rights is essential.
\nThe WMA welcomes the June 2017 Report on the Special Rapporteur on the right of everyone to
\nthe enjoyment of the highest attainable standard of physical and mental health, denouncing the
\nwidespread and continuous violations of the fundamental rights of persons with mental health
\nconditions. We have repeatedly advocated for the rights of persons with disabilities, including with
\nregard to their right to equal access to health services. We recently updated our Statement on
\nEthical Issues Concerning Patients with Mental Illness, in which we outline physicians\u2019
\nresponsibilities to support the well-being and rights of patients with mental health issues. We also
\nstate physicians\u2019 ethical duties in treating and caring for those patients.
\nThe general content of the Report adequately highlights aspects of the worldwide situation affecting
\npeople with mental health problems. While it appropriately considers obstacles to care, the WMA
\nwould like the Special Rapporteur to consider the following comments:
\n2. General comments
\n2.1 Biomedical vs Biological Treatment
\nBiological, biomedical, medical, and psychosocial models are not exclusive in clinical practice,
\nwhere it is may be possible to differentiate. For example, some psychiatrists, specialize in
\nneuroscientific research with a focus on biological aspects of the clinical profession. The same
\ndiversity applies to physicians in general: some physicians may restrict treatment of physical
\ndisorders to prescription drugs, but many of them adopt a holistic approach considering different
\nWMA page 2
\nneeds of their patients. Thus, we suggest the change of the word \u201cbiomedical\u201d by \u201cbiological\u201d
\nwithin the report.
\nAdditionally, considering physicians as solely advocates of a biological model and the other
\nrelevant stakeholders as solely advocates of a psychosocial model has harmed those in need of
\nmental health care. This compartmentalizes mental health treatment rather than embracing a holistic
\napproach to care. Thus, the WMA advocates for placing all stakeholders together for a balanced
\nbiopsychosocial model of care (such as in paragraph 10).
\n2.2 The Importance of Pharmacological Treatment
\nIn light of paragraph 8 of the report, we emphasize the development of specific drugs to treat mental
\nillnesses. This advancement in psychiatry and medicine as a whole decreases the need to hospitalize
\npatients suffering from mental illnesses, and combats the issue of neglected mental health.
\nAdditionally, we would like to point out that the main problem is not a \u201creductionist biomedical
\nparadigm\u201d as suggested, but rather the frugal investment in good quality public mental health
\nservices.
\nWe fully share the concerns of the Special Rapporteur that \u201cmany of the concepts supporting the
\nbiomedical model in mental health failed to be confirmed by further research\u00a0\u00bb. Nonetheless, there is
\nlacking research and evidence-based data supporting psychosocial interventions and health care
\nproviders, including psychiatrists and other mental health professionals, are waiting for proved
\nalternatives easily applicable and efficient. However, we would like to emphasize the important role
\nof pharmacological treatment, whose efficacy is widely proven by large evidence-based data.
\nWithout sufficient research evidence to support the idea that psychosocial interventions are the first-
\nline treatment option for the majority of people who experience mental health issues, this claim
\nshould not be advocated in this manner (as discussed in paragraph 80). Additionally, medication
\ncannot be proposed as a first-line \u00ab\u00a0treatment\u00a0\u00bb option considering that the majority of people who
\nexperience mental health issues (and not diagnosed illnesses) do not need pharmacological
\ntreatment, rather they need another kind of help. When considering mental illnesses, experience and
\nevidence up to this moment recommend a combination of medication and psychosocial
\ninterventions for most of them.
\n2.3 The Role of Psychiatrists and Other Physicians
\nWe want to highlight the changes in governmental policies taking place in several countries which
\nhave been making consistent efforts to reform their psychiatry model. We therefore do not support
\nthe generalization of psychiatry as related to the pharmaceutical company as stated in the following
\nsentence in paragraph 19: \u00ab\u00a0the reductionist [biological] model, with support from psychiatry and the
\npharmaceutical industry, dominates clinical practice, policy\u00a0\u00bb.
\nAlong the same lines, in paragraph 16, to oppose medical interests to a rights-based mental health
\ncare does not accurately reflect reality. Instead, it contributes to further exclude psychiatrists and
\nother physicians as part of the desirable solutions of the problems identified.
\nWe also suggest not considering mental health activists (with a political and ideological agenda) as
\ngeneral users who \u00ab\u00a0threaten[s] and undermine[s] the reputation of the psychiatric profession\u00a0\u00bb
\n(paragraph 24). Again here, the Special Rapporteur does not sufficiently include psychiatrists in the
\nreport. If he \u00ab\u00a0welcomes and encourages discussion within the psychiatric profession and with other
\nWMA page 3
\nstakeholders\u00a0\u00bb, the document needs to be inclusive to psychiatrists and not consider them one of the
\nbiggest problem affecting people’s human rights.
\n2.4 Scaling Up and Scaling Across
\nAs discussed in paragraph 55, the scarcity of mental health services as well as diverse and good
\nquality mental health care is a worldwide phenomenon. Thus, calling \u00ab\u00a0scaling up\u00a0\u00bb of a rhetoric does
\nnot properly defend a broad package of integrated and coordinated services. Furthermore, replacing
\n\u201cscaling up\u201d with \u201cscaling across\u201d does not completely address the issue because \u201cscaling up\u201d and
\n\u201cscaling across\u201d are not mutually exclusive. Rather, they should both be enhanced. Thus, we
\nsuggest both scaling up appropriate care and scaling across sectors to improve care provisions.
\n2.5 Lack of Investments in Mental Health
\nWe do not agree with the statement that \u201cmental health investment continues to be predominantly
\nfocused on a biomedical model\u201d (paragraph 12). The current problem for most countries continues
\nto be the low investment in mental health programs and the scarcity of services and adequately
\neducated people to provide mental health care.
\nWe would also like to emphasize that the issues concerning first line treatments are not due to a
\n\u201cbiomedical model of psychiatry\u201d, but rather to the burdens general physicians face in their daily
\npractice. These practitioners are the ones in charge of treating at first place the majority of the
\npopulation. Lack of adequate education and overwhelming working conditions may also contribute
\nto the misuse of first-line prescriptions. Moreover, the lack of primary health care specialized
\nmental health services exacerbates this problem. We therefore suggest to widen\/deeper the study of
\nthis problem in order to tackle this issue more efficiently.
\nAccordingly to WHO 2014 Mental Health Atlas1
\n, \u00ab\u00a0levels of public expenditures on mental health
\nare very low in low and middle-income countries (less than US$ 2 per capita)\u00a0\u00bb. There is worldwide
\nan important lack of psychiatric services available and in countries that have adopted reforms to
\nclose psychiatric hospitals, policies were not followed by enough new community services for
\nsevere mental disorders and specialized outpatients\u2019 clinics to treat the most prevalent mental
\ndisorders. In parallel, general practitioners and family doctors working in primary care services in
\nmost countries do not have the necessary education to diagnose and treat the most common mental
\ndisorders2
\n.
\n2.6 Geographical Terms
\nWe suggest the use of general geographical distribution terms such as \u00ab\u00a0many countries\u00a0\u00bb (such as in
\nparagraph 56) or \u00ab\u00a0in different regions of the world\u00a0\u00bb when referring to particular situations instead of
\nspecifying the specific location (such as \u00ab\u00a0in Central and Eastern Europe\u00a0\u00bb noted in paragraph 57).
\n2.7 Separation of Mental Illnesses
\nWhen referring to people with cognitive, intellectual and psychosocial disabilities, the WMA does
\nnot see the need to separate specified groups of patients, such as person with autism (paragraph 4).
\n1
\nhttp:\/\/www.who.int\/mental_health\/evidence\/atlas\/executive_summary_en.pdf?ua=1
\n2
\nJorm AF, Korten AE, JAcomb PA, Rodgers B, Pollitt P (1997). Beliefs about helpfulness of interventions for mental
\ndisorders: a comparison of general practitioners, psychiatrists and clinical psychologists. Australian and New Zealand
\nJournal of Psychiatry, 31: 844-851
\nWMA page 4
\n3. Conclusion
\nThe World Medical Association welcomes the discussion on mental health by the Special
\nRapporteur. We agree that mental health is often an underfunded and neglected sector which
\ncontributes to abuses in provision of mental health services. For this reason, we would like to
\nemphasize that physicians are not to blame for the current situation in mental health but rather low
\ninvestments in mental health care. Thus, we urge the Special Rapporteur to include psychiatrists and
\nother physicians in the discussion on human rights in mental health and in advocating for an
\ninclusive, biopsychosocial approach.
\n****
\nJune 2017<\/p>\n"},"caption":{"rendered":"

THE WORLD MEDICAL ASSOCIATION, INC. L\u2019ASSOCIATION MEDICALE MONDIALE, INC ASOCIACION MEDICA MUNDIAL, INC Centre International de Bureaux Immeuble A \u00ab\u00a0Keynes\u00a0\u00bb Website : www.wma.net Postal Address : 13, chemin du Levant Telephone : (33) 4 50 40 75 75 Bo\u00eete Postale 63 01210 FERNEY-VOLTAIRE Fax : (33) 4 50 40 59 37 01210 FERNEY-VOLTAIRE Cedex France […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{"sizes":{"thumbnail":{"file":"WMAContribution-SRMentalHealthReport-June2017-pdf-106x150.jpg","width":106,"height":150,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/WMAContribution-SRMentalHealthReport-June2017-pdf-106x150.jpg"},"medium":{"file":"WMAContribution-SRMentalHealthReport-June2017-pdf-212x300.jpg","width":212,"height":300,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/WMAContribution-SRMentalHealthReport-June2017-pdf-212x300.jpg"},"large":{"file":"WMAContribution-SRMentalHealthReport-June2017-pdf-724x1024.jpg","width":724,"height":1024,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/WMAContribution-SRMentalHealthReport-June2017-pdf-724x1024.jpg"},"full":{"file":"WMAContribution-SRMentalHealthReport-June2017-pdf.jpg","width":1058,"height":1497,"mime_type":"application\/pdf","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/WMAContribution-SRMentalHealthReport-June2017-pdf.jpg"}}},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/WMAContribution-SRMentalHealthReport-June2017.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/10159"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=10159"}]}}