Professor Dainius Pras:

Honourable Chair, members of the parliamentary committee, it is a great pleasure and honour for me to be here and to share my experience while discharging the UN mandate of the special rapporteur on the right to health. This mandate was established by the UN Human Rights Council in 2002. Rapporteurs may also work on other issues as there are more than 40 thematic mandates. My role as special rapporteur is to inform the UN and member states on opportunities, challenges and obstacles to the implementation of the right to physical and mental health. Special rapporteurs carry out this work through thematic reports, country missions and reports, communications procedure and also non-mandated activities such as my participation in the congress.

While discharging my mandate, I use the analytical framework developed by the first special rapporteur on the right to health, Paul Hunt. Many important themes have been developed by my predecessors, Paul Hunt and Anand Grover, for example, the themes of health systems; access to essential medicines; rights to health of vulnerable groups; and social and underlying determinants of health. Both of my predecessors also issued very powerful reports on sexual and reproductive rights and health.

In my thematic reports and country missions since my appointment in 2014, I have been addressing issues that have not been sufficiently addressed and issues that are emerging as new priorities. My reports to date have addressed the right to health in early childhood and adolescence, the right to health and sustainable development goals, SDGs, and the right to health and healthy lifestyles. I am currently finishing my thematic report to the Human Rights Council on the right to mental health.

As the committee members know, all human rights are indivisible and interdependent, and the right to health cannot be exercised effectively without protecting and promoting all other human rights. The congress I have attended in Dublin is a very good attempt to link two important parts of the right to health, namely, the right to sexual and reproductive health and the right to mental health. With regard to sexual and reproductive health and rights, I have elaborated on this in my thematic report on the right to health in adolescence of 2015, and in the statement of UN independent experts last year. One of the conclusions of my report on the right to health in adolescence is that states should adopt comprehensive sexual and reproductive health policies to ensure universal access to sexual and reproductive health care services. My main recommendations were that abortions should not be criminalised; that all adolescents should have access to confidential, adolescent-responsive and non-discriminatory sexual and reproductive health information, services and goods; and that age appropriate, comprehensive and inclusive sexuality education, based on scientific evidence, should be part of the school curriculum.

Last September, on the day of action for access to safe and legal abortion, I joined other independent experts to highlight that the criminalisation of abortion and failure to provide adequate access to services for termination of an unwanted pregnancy are a form of discrimination based on sex. Restrictive legislation which denies access to safe abortion is one of most damaging ways of instrumentalising women’s bodies and a grave violation of women’s human rights. We recommended the good practice found in many countries, which provide women with access to safe abortion services on request during the first trimester of pregnancy. We insisted on international legal requirements that women can access abortion at the very least in cases of risk to their life or health, including mental health, rape, incest and fatal impairment of the foetus during the first trimester and later.

Violations of sexual and reproductive rights, including denial of access to safe and legal termination of pregnancy, remain a worldwide problem. During all country missions I have had, I have been raising the issue of gender-based violence and violations of sexual and reproductive rights. Human rights are interrelated, and so are violations of different human rights. When sexual and reproductive rights are violated, this has a negative impact on physical and mental health. In my current report on mental health, which will be presented in June 2017 to the UN Human Rights Council, I critically assess the current situation in global mental health and psychiatry, including violations of the rights of persons with psychosocial, intellectual and cognitive disabilities. Following numerous consultations in countries across the globe, I have identified major obstacles for the realisation of the right to mental health. These include the medicalisation of mental health and overuse of biomedical interventions; huge power asymmetries in mental health care between service providers and service users; the legacy of coercion and forced treatment in psychiatry and mental health care; inadequate attention to mental health promotion and prevention; reluctance to eliminate violence, including that against women and children, in all ages and all settings; and other factors.

Now, when mental health is included in strategic development goals and Agenda 2030, it is of utmost importance not only to invest more in mental health, but also to invest in a human rights approach in mental health care and to abandon outdated concepts and power asymmetries than hinder progress in global mental health. The main priorities should be to address all human rights in all settings so that poverty, inequality and violence are effectively addressed, to target relationships rather than individuals and their brains, and to develop rights-compliant mental health services with a radical reduction of coercion in psychiatry. There will be a need for states to act as champions in the promotion of such a shift in mental health policies and services.

More information on activities while discharging the right to health mandate can be found atand.