A/HRC/35/21
standards, the safeguards they contained were often rendered meaningless in everyday
practice (see E/CN.4/2005/51, paras. 88-90, and A/58/181). As the right to health
guarantees freedom from discrimination, involuntary treatment and confinement, it must
also be understood to guarantee the entitlement to treatment and integration in the
community. The failure to secure that entitlement and other freedoms is a primary driver of
coercion and confinement.
33.
The Committee on the Rights of Persons with Disabilities emphasizes full respect
for legal capacity, the absolute prohibition of involuntary detention based on impairment
and the elimination of forced treatment (see A/HRC/34/32, paras. 22-33).24 That responds
to the inadequacy of procedural safeguards alone, requiring sharpened attention to noncoercive alternatives and community inclusion to secure the rights of persons with
disabilities. Within that evolving framework, not all human rights mechanisms have
embraced the absolute ban on involuntary detention and treatment articulated by the
Committee. They include the Subcommittee on the Prevention of Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment (see CAT/OP/27/2), the Committee
Against Torture 25 and the Human Rights Committee. 26 However, their interpretation of
exceptions used to justify coercion is narrower, signalling ongoing discussions on the
matter. Notably, in the United Nations Basic Principles and Guidelines on Remedies and
Procedures on the Right of Anyone Deprived of Their Liberty to Bring Proceedings Before
a Court, the Working Group on Arbitrary Detention supported the provisions of the
Convention on the Rights of Persons with Disabilities with regard to safeguards on the
prohibition of arbitrary detention (see A/HRC/30/37, paras. 103-107).
34.
At present, there is an impasse over how obligations in relation to non-consensual
treatment are implemented in the light of the provisions of the Convention on the Rights of
Persons with Disabilities, given the different interpretation by international human rights
mechanisms. The Special Rapporteur has followed these developments and hopes that
consensus can be reached to start the shift towards strengthened mental health policies and
services without delay. He seeks to participate actively in these processes and potentially
report again on the progress achieved.
V. Right to mental health framework
A.
Obligations
35.
The International Covenant on Economic, Social and Cultural Rights provides a
legally binding framework for the right to the highest attainable standard of mental health.
That is complemented by legal standards established, among others, by the Convention on
the Rights of Persons with Disabilities, the Convention for the Elimination of All Forms of
Discrimination against Women and the Convention on the Rights of the Child. States
parties have an obligation to respect, protect and fulfil the right to mental health in national
laws, regulations, policies, budgetary measures, programmes and other initiatives.
36.
The right to mental health includes both immediate obligations and requirements to
take deliberate, concrete, targeted action to progressively realize other obligations. 27 States
must use appropriate indicators and benchmarks to monitor progress, including in respect of
reducing and eliminating medical coercion. Indicators should be disaggregated by, among
others, sex, age, race and ethnicity, disability and socioeconomic status. States must devote
the maximum available resources to the right to health, yet globally, spending on mental
health stands at less than 10 per cent of spending on physical health.
24
25
26
27
See also Convention on the Rights of Persons with Disabilities, arts. 12 and14, Committee on the
Rights of Persons with Disabilities, general comment No. 1 and guidelines on article 14 of the
Convention.
See CAT/C/FIN/CO/7, paras. 22-23; CAT/C/FRA/CO/7, paras. 29-30; CAT/C/AZE/CO/4, paras. 2627; and CAT/C/DNK/CO/6-7, paras. 40-41.
See general comment No. 35 (2014) on liberty and security of person.
International Covenant on Economic, Social and Cultural Rights, art. 2 (1).
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