A/HRC/35/21 7. Forgotten issues beget forgotten people. The history of psychiatry and mental health care is marked by egregious rights violations, such as lobotomy, performed in the name of medicine. Since the Second World War and the adoption of the Universal Declaration of Human Rights, together with other international conventions, increasing attention has been paid to human rights in global mental health and psychiatry. However, whether the global community has actually learned from the painful past remains an open question. 8. For decades, mental health services have been governed by a reductionist biomedical paradigm that has contributed to the exclusion, neglect, coercion and abuse of people with intellectual, cognitive and psychosocial disabilities, persons with autism and those who deviate from prevailing cultural, social and political norms. Notably, the political abuse of psychiatry remains an issue of serious concern. While mental health services are starved of resources, any scaled-up investment must be shaped by the experiences of the past to ensure that history does not repeat itself. 9. The modern understanding of mental health is shaped by paradigm shifts often marked by a combination of improvements and failures in evidence-based and ethical care. This began 200 years ago with the desire to unchain the “mad” in prison dungeons and moved to the introduction of psychotherapies, shock treatments, and psychotropic medications in the 20th century. The pendulum of how individual pathology is explained has swung between the extremes of a “brainless mind” and a “mindless brain”. Recently, through the disability framework, the limitations of focusing on individual pathology alone have been acknowledged, locating disability and well-being in the broader terrain of personal, social, political, and economic lives. 10. Finding an equilibrium between the aforesaid extremes of the twentieth century has created a momentum for deinstitutionalization and the identification of a balanced, biopsychosocial model of care. Those efforts were reinforced by WHO in a report in 2001, in which it called for a modern public health framework and the liberation of mental health and those using mental health services from isolation, stigma and discrimination. 5 A growing research base has produced evidence indicating that the status quo, preoccupied with biomedical interventions, including psychotropic medications and non-consensual measures, is no longer defensible in the context of improving mental health. Most important have been the organized efforts of civil society, particularly movements led by users and former users of mental health services and organizations of persons with disabilities, in calling attention to the failures of traditional mental health services to meet their needs and secure their rights. They have challenged the drivers of human rights violations, developed alternative treatments and recrafted a new narrative for mental health. 11. The momentum sustained by civil society towards a paradigm shift has contributed to an evolving human rights framework in the area of mental health. The adoption of the Convention on the Rights of Persons with Disabilities in 2006 laid the foundation for that paradigm shift, with the aim of leaving behind the legacy of human rights violations in mental health services. The right to the highest attainable standard of health has much to contribute to advancing that shift and provides a framework for the full realization of the right of everyone to mental health. 12. One decade later, progress is slow. Effective, acceptable and scalable treatment alternatives remain on the periphery of health-care systems, deinstitutionalization has stalled, mental health investment continues to be predominantly focused on a biomedical model and mental health legislative reform has proliferated, undermining legal capacity and equal protection under the law for people with cognitive, intellectual and psychosocial disabilities. In some countries, the abandonment of asylums has created an insidious pipeline to homelessness, hospital and prison. When international assistance is available, it often supports the renovation of large residential institutions and psychiatric hospitals, undermining progress. 13. Public policies continue to neglect the importance of the preconditions of poor mental health, such as violence, disempowerment, social exclusion and isolation and the 5 4 See WHO, World Health Report 2001. Mental Health: New Understanding, New Hope.