The UN Human Rights Council session last week saw mental health placed at the forefront with the report of the Special Rapporteur on the Right to Health.

The report focuses on the right of all persons to enjoy the highest attainable standard of physical and mental health. However, the discussion at the session centred more around the minimum standards to be maintained by authorities in order to attain this lofty goal.

The 38^th session of the Human Rights Council is taking place from 18 June to 6 July. The report and corresponding discussion on 18 June drew from the health conditions of persons deprived of liberty and those confined. It was combined with the Special Rapporteur’s report on the elimination of discrimination against persons affected by leprosy and their family members.

The report, and other documents on this, are available here from the OHCHR.

The plea for Wikileaks head Julian Assange to be able access healthcare, made by the International Association of Democratic Lawyers (IADL), captured headlines. But it also highlighted the permanently damaging impact of confinement on physical and mental health. IADL argued during the session that no person should have to make a choice between the right to life and the right to health.

Many countries also emphasised that rights of children and women, especially pregnant and young mothers, should be prioritized over other prisoners and confined persons. In fact, Dainius Puras, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, a Lithuanian psychiatrist, called for the confinement of children to be abolished altogether except in exceptional cases.

Puras, in his report as special rapporteur, drew a distinction between deprivation of liberty and confinement, deprivation of liberty was characterised as that which is legally grounded and generally a judicial sentence without consent of the party. Confinement on the other hand is that which is linked to health and social welfare goals. The discussion combined quarantine or confinement for diseases like leprosy and tuberculosis with conditions of prisoners highlighting common issues.

Alice Cruz, the UN Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, best captured the lasting impact and distinction in her speech, stating that leprosy was curable but not healable. The latter term was associated with the restoration of mental health to the condition existing before the occurrence of such a disease or confinement. She pointed out that such experiences and social stigmatization even after recovery and release leave a lasting impact preventing the person from healing mentally.

The report also says that such deprivation of the liberty of movement is a tool of social control to promote public safety, be it to prevent criminal activity, spread of diseases and even so-called immoral behaviour. As per the report, such behaviour has included drug use, LGBTQ persons and even women exercising their right to prevent and terminate pregnancy.

This drew criticism and the European Region of International Lesbian and Gay Association called for more engagement with their community than mere mention. It was noted by the special rapporteur that this tool of social control is slowly changing with the decriminalization of drug use in certain cases and more reformative practices.

Nonetheless, facts from the report showed that around 10 million adults were imprisoned. Many others were being held in similarly restrictive settings including around a million children, half a million adults in compulsory drug detention and thousands of women in hospitals for non-payment of bills.

These figures from the report highlight the importance of the Nelson Mandela and Bangkok Rules. The Mandela Rules reflect the UN minimum standard of treatment of prisoners. Botswana and South Africa reiterated that the report frowns upon practices like administrative detention and solitary confinement, and requires that prisoners have access to qualified professionals for both mental and physical health conditions. Similarly, the Bangkok Rules focus on women prisoners and non-custodial measures for women offenders. Many countries welcomed the special attention acknowledging that women are more vulnerable to abuse due to their gender.

Amongst the recommendations discussed in the session, community-based care especially for diseases, as recommended by the WHO, was seen as possibly being able to achieve results comparable to hospitalization. States were urged by the special rapporteur to redistribute their funds to focus more on enhancing public health systems than detention facilities.

The report also called upon the international community to support community-based interventions to safeguard individuals from discriminatory, arbitrary, excessive or inappropriate confinement. If the States are to still lawfully confine persons, it ought to be done in accordance to the UN rules for minimum standards.

On a parting note, Puras mentioned that the forthcoming report of the special rapporteur on the right to health would focus on migrants, refugees and asylum seekers.