A/HRC/35/21 Mainstreaming mental health 78. The right to health requires that mental health care be brought closer to primary care and general medicine, integrating mental with physical health, professionally, politically and geographically. It not only integrates mental health services into mainstream health care so they can be accessible for everyone, it ensures that entire groups of people who are traditionally isolated from mainstream health care, including persons with disabilities, receive care and support on an equal basis with others. Inclusion also comes with socioeconomic advantages.55 Mental health concerns everyone and when needed, services should be accessible and available to all at the primary and specialized care levels. Essential psychosocial interventions 79. While psychotropic medications can be helpful, not everyone reacts well to them and in many cases they are not needed. Prescribing psychotropic medications, not because they are indicated and needed, but because effective psychosocial and public health interventions are not available, is incompatible with the right to health. For example, in most cases of mild and moderate depression “watchful waiting”, psychosocial support and psychotherapy should be the frontline treatments. 80. Despite the right to health obligation to provide psychosocial interventions and support, they are sadly viewed as luxuries, rather than essential treatments, and therefore lack sustainable investment in health systems. That is despite evidence demonstrating that they are effective. 56 These are essential interventions, which produce positive health outcomes and safeguard individuals from potentially harmful, more invasive medicalization. Importantly, they can include simple, low-cost, short-term interventions delivered within regular community health-care settings. Nurses, general practitioners, midwives, social workers and community health workers must be equipped with psychosocial skills to ensure accessibility, integration and sustainability. 57 Psychosocial interventions, not medication, should be the first-line treatment options for the majority of people who experience mental health issues. Mental distress and recovery 81. While the paradigm shift in mental health requires a move towards integrated and population-based services, mental distress will still occur and rights-based treatment responses are required. The interventions used to address serious cases are perhaps the biggest indictment of the biomedical tradition. Coercion, medicalization and exclusion, which are vestiges of traditional psychiatric care relationships, must be replaced with a modern understanding of recovery and evidence-based services that restore dignity and return rights holders to their families and communities. People can and do recover from even the most severe mental health conditions and go on to live full and rich lives. 58 82. There is no single definition of recovery, often described as a personal journey towards regaining a meaningful life and becoming more resilient. The recovery approach, when implemented in conformity with human rights, has helped to break down power asymmetries, empowering individuals and making them agents of change rather than passive recipients of care. Tremendous strides have been made in this area, with evidence and recovery-based support and services in practice across the world today that restore people’s hope (and trust) in services, as well as in themselves. 55 56 57 58 18 Lena Morgon Banks and Sarah Polack, “The economic costs of exclusion and gains of inclusion of people with disabilities. Evidence from low and middle income countries”, London School of Hygiene and Tropical Medicine (2015), part B, sect. 3. See John Hunsley Katherine Elliott and Zoé Therrien, “The efficacy and effectiveness of psychological treatments for mood, anxiety and related disorders”, Canadian Psychology, vol. 55, No. 3 (August 2014). See Clair Le Boutillier and others, “Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis”, Implementation Science, vol. 10 (June 2015). See Richard Warner, “Does the scientific evidence support the recovery model?”, The Psychiatrist, vol. 34, No. 1 (January 2010).