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Victory in the Supreme Court: CCHR’s criticism of psychiatric abuse not without factual basis

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SALUDMENTAL ( Original in Spanish ) The Plenary Session of the Civil Division of the Supreme Court, in its ruling STS 960/2024 of July 9th and published on the 12th in response to the appeal after its defeat in the Provincial Court of the Spanish Society of Psychiatry (SEP), admits that the opinions and harsh criticism that the Citizens’ Commission on Human Rights (CCDH and CCHR) makes of psychiatric abuses such as those made with the use of psychotropic drugs, involuntary institutionalisation, electroshock, psychosurgery and others, “are not devoid of a sufficient factual basis”, and therefore decides to protect the right to express them, even in a harsh manner, as they are of “undoubted general interest”, as transcribed in this extract from the judgment:

“The publications in question deal with a matter of undoubted general interest: the debate on certain practices in the field of psychiatry. The extensive documentation submitted by the defendants clearly shows the existence of this debate. The reports of the UN rapporteurs submitted by the defendants (specifically, the 2017 ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ and the 2018 ‘Annual Report of the United Nations High Commissioner for Human Rights’ on ‘Mental Health and Human Rights’) are a good illustration of the important social, political and scientific debate on the issues covered by the questioned publications.

The debate on certain psychiatric practices and, in particular, on involuntary institutionalization, the use of psychotropic drugs, especially when the patients are children or adolescents, or surgical or electroconvulsive treatments, is of particular importance in today’s society.”

Furthermore, the high court affirms, “despite the crudeness of some of its expressions (…), its content is directly connected to the public debate in a democratic society (…) And is part of the conduct observed by CCDH of actively intervening in the social debate on psychiatry through its publications.”

On this basis, the Supreme Court has ruled that the Spanish Society of Psychiatry (SEP) must bear the criticism of the Citizens Commission on Human Rights. (CCHR) and Comisión Ciudadana de Derechos Humanos de España (CCDH).

Salvador Fernández, President of the Spanish Citizens’ Commission on Human Rights, after learning of the sentence declared that:

“it is important that there be protection so that the innumerable abuses that are committed in the field of psychiatry are made known, and the time has come to carry out the drastic reforms called for by the WHO, the UN, and above all the victims, of a century-old system that has brought more pain than glory, we thank all those who work in one way or another to expose and put an end to psychiatric abuse, and from our team we encourage society to not remain silent and to denounce through www.saludmentalyderechos.org any and all abuses in the field of psychiatry, whether it be the labelling and administration of dangerous psychotropic drugs to children, forced treatment, lack of informed consent, involuntary institutionalization or the use of electroshock, which has been described as torture on numerous occasions by doctors and human rights experts.”

CCHR was co-founded in 1969 by the Church of Scientology and Professor Emeritus of Psychiatry Dr. Thomas Szasz as an independent mental health watchdog at a time when patients were institutionalized, mistreated, stripped of their constitutional, civil and human rights, and left to fend for themselves.

As stated by CCHR co-founder Thomas Szasz:

“They were then the only organization, and they still are the only organization, who were active in trying to free mental patients who were incarcerated in mental hospitals with whom there was nothing wrong, who had committed no crimes, who wanted to get out of the hospital. And that to me was a very worthwhile cause; it’s still a very worthwhile cause. We should honor CCHR because it is really the organization that for the first time in human history has organized a politically, socially, internationally significant voice to combat psychiatry. This has never happened in human history before.”

CCHR and national and local affiliates around the world have long fought to restore basic inalienable human rights in the field of mental health, including, among others, full informed consent to the medical legitimacy of psychiatric diagnosis, the risks of psychiatric treatments, the right to all available medical alternatives, and the right to refuse any treatment deemed harmful.

In the judgement of the Provincial Court of Madrid 64/2024 of February 10th, appealed by SEP, the courts explained that CCHR and CCDH:

“aims to fight against abuse in psychiatry and especially against the prescription by these professionals of drugs for the treatment of mental illnesses and diseases and its work has been recognised by the Special Rapporteur of the UN Commission on Human Rights who in 1986 stated that it had helped to pass numerous laws in the field of mental health in defence and preservation of the rights of individuals according to the Universal Declaration of Human Rights, members of the Committee on the Rights of the Child at the United Nations and various members of the US House of Representatives and the California State Congress and Senate.”

In its text, the Supreme Court’s judgement includes, on the one hand, the video documentaries where CCHR shows its evidence and strong statements, opinions and concerns:

“On the other hand, the website www.cchr.org.es, whose content is owned and managed by CCHR (Citizens Commission on Human Rights), provides access to 8 documentaries that explain what they consider ‘psychiatric abuse’.”

And also, the “informative material” found on the website https://www.ccdh.es of the Comisión Ciudadana de Derechos Humanos de España (CCDH) where there are 19 leaflets with very strong titles, such as “Child Drugging. Psychiatry destroying lives. Report and recommendations on fraudulent psychiatric diagnosis and enforced drugging of youth”; “Deadly restraints. Psychiatric ‘therapeutic’ assault. Report and recommendations on the violent and dangerous use of restraints in mental health facilities”; “Brutal Therapies. Harmful Psychiatric ‘Treatments’. Report and recommendations on the destructive practices of electroshock and psychosurgery”; or “Psychiatric Malpractice, the subversion of medicine. Report and recommendations on psychiatry’s destructive impact on health care», among others.

The Spanish Society of Psychiatry complained about demonstrations in which CCDH and others claimed that  “psychiatrists are criminals, precursors of genocides, responsible for the erosion of education and justice, inciters of drug addiction, drug traffickers, fraudulent practitioners or managers of violence and terrorism, that some psychiatrists sexually abused their patients and even that ‘[t]here are an undetermined number of coercive abortions in Spain by psychiatrists’, involvement of German psychiatrists in the Nazi holocaust [for which the German Psychiatric Association has publicly apologised], racial discrimination” and other descriptions and statements of fact.

The First Civil Chamber of the Supreme Court concluded that the judgment appealed by SEP had correctly applied the case-law criteria to resolve the conflict between freedom of expression and the right to honour.

And with regard to the context in which the statements in question were made, despite the fact that some of them could be considered serious, says the ruling, CCDH’s conduct in making these publications is part of a public debate of great importance in today’s society, so that agreeing to remove such publications would be an excessive restriction on freedom of expression that would not be justified by an imperative social need.

The SEP also complained about statements, such as that of psychiatrist Dr. Thomas Szasz when he says “Psychiatry is probably the most destructive force that has affected society in the last 60 years’, or ‘Psychiatry serves as a social control machine that sometimes becomes an agent of social and political revenge”, among other imputations.

The SEP argued that freedom of expression should not cover such statements, which the Supreme Court has contradicted, finding that the statements and criticisms of CCDH and CCHR are disseminated in a public debate on psychiatry.

The Supreme Court’s ruling reiterates the importance of freedom of expression in the context of debates of public interest, even when criticism may be offensive to certain entities or professionals, in line with what was said by the court of appeal. And it is here that the Supreme Court states that:

“This prevalence of freedom of expression over the right to honour when expressing opinions on matters of general interest occurs even when the expression of opinion is made in a rude, unkind or hurtful manner and may annoy, disturb or upset the person affected by the statements in question, as this is required by pluralism, tolerance and a spirit of openness, without which there is no democratic society.

As the judgments of the ECHR of 8 November 2016, Magyar Helsinki Bizottság v. Hungary, 13 March 2018, Stern Taulats and Roura Capellera v. Spain, 20 November 2018, Toranzo Gómez v. Spain, and 11 May 2021, Halet v. Luxembourg state, freedom of expression does not only protect ideas that are favourably received or considered inoffensive or indifferent, ‘but also those that offend, shock or disturb’. And Constitutional Court judgment 226/2016, of 22 December, citing previous judgments, states that ‘within the broad framework granted to freedom of expression are protected, according to our doctrine, “those manifestations which, although they affect the honour of others, are revealed as necessary for the presentation of ideas or opinions of public interest”’.

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How To Build Resilient Health Systems – Coordinated European Responses

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Many individuals and communities rely on effective health systems, particularly during crises. To ensure maximum efficiency and better outcomes, you must focus on developing coordinated responses across Europe. This approach not only strengthens your local health infrastructure but also fosters collaboration among nations, enabling a more robust response to public health challenges. In this guide, you’ll learn the necessary steps to enhance resilience in your health system, paving the way for a healthier future.

Understanding Resilient Health Systems

To truly comprehend what constitutes a resilient health system, you must acknowledge its ability to respond effectively to various challenges while maintaining necessary health services. A resilient health system can withstand shocks, whether they stem from public health emergencies, such as pandemics, or other systemic pressures like economic downturns. The resilience of such systems is not merely in their robustness, but in their agility and adaptability to changing circumstances, allowing them to bounce back swiftly from disruptions while continuing to deliver high-quality care to all.

Key Characteristics of Resilience

Assuming you want to identify the key characteristics that define resilience in health systems, you will find that flexibility, adaptability, and resourcefulness are paramount. These characteristics enable health systems to adjust to evolving needs, manage unpredictable demands, and deploy resources efficiently in response to crises. Furthermore, an emphasis on collaboration within and between health services enhances the ability to share knowledge, skills, and resources, significantly strengthening overall health system resilience.

Importance of Coordination in Health Responses

While addressing health emergencies, you must understand that coordination plays a vital role in the effectiveness of responses. The integration of efforts across various health sectors ensures a unified approach that maximises the use of available resources and minimises redundancies. This coordinated effort not only fosters better communication among stakeholders—such as health officials, government entities, and non-governmental organisations—but also enhances your ability to implement interventions swiftly and at scale, ultimately saving lives and preserving health infrastructure during crises.

Another key consideration is that effective coordination facilitates the alignment of objectives and strategies across different organisations and regions, allowing for a more focused deployment of efforts. This integration can lead to improved health outcomes by ensuring that the right resources reach the right places at the right time. By establishing clear communication channels and protocols, you can greatly enhance the synergy between health services and stakeholders, creating a robust framework that fosters not just immediate responses, but long-term improvements in health system resilience.

Factors Influencing Resilient Health Systems

Now, the resilience of health systems is shaped by a myriad of factors that hold significant importance in fortifying their ability to withstand shocks and respond effectively. You must consider several key elements that play a vital role in shaping these systems:

  • Governance
  • Policy Frameworks
  • Financial Sustainability
  • Resource Allocation
  • Collaboration

This multifaceted approach to understanding resilience allows for a comprehensive strategy in health system development.

Governance and Policy Frameworks

If you want your health system to be resilient, you need to ensure that robust governance and sound policy frameworks are in place. Effective governance involves not only strategic oversight but also the empowerment of local health authorities to make decisions that best serve their populations. The policies that underpin health systems must be flexible enough to adapt to emerging challenges, including pandemics and economic crises.

Additionally, transparent decision-making processes and stakeholder engagement are integral to building trust within the community. Your governance structures should promote accountability and encourage feedback from both health workers and the public, ensuring that policies remain relevant and effective in the face of unforeseen circumstances.

Financial Sustainability and Resource Allocation

Assuming financial sustainability is a foundational pillar for resilient health systems, it’s crucial that adequate resources are allocated to meet both current and future healthcare needs. You should scrutinise funding modalities and ensure that they are directed towards vital areas that enhance system strength, such as infrastructure, human resources, and technology. An effective resource allocation strategy can determine your health system’s capacity to respond to crises and maintain crucial services.

To succeed in financial sustainability, it is imperative that you prioritise investment in preventive care and community health initiatives. Underfunding these areas can result in significant long-term costs for your health system. Additionally, consider exploring diverse financing options, including public-private partnerships, which can bolster your system’s financial base. An effective allocation of resources not only promotes equity and access but also enhances the overall resilience of your health framework, allowing you to better navigate challenges as they arise.

How to Build Resilient Health Systems

Clearly, building resilient health systems is paramount for ensuring a responsive and robust healthcare environment capable of withstanding various challenges, including pandemics, natural disasters, and sudden shifts in population health needs. A resilient health system not only effectively manages immediate health crises but also lays the groundwork for long-term sustainability and adaptability, fostering an environment where health services can continue to operate under stress. This involves a multi-faceted approach that integrates resources, technology, and human capital, all while maintaining a clear focus on the health outcomes of the population.

In achieving an effective health system, the coordination of various elements such as policy-making, financing, and service delivery is vital. Thus, it becomes imperative to ensure that health systems are designed with flexibility in mind, enabling them to evolve according to the changing needs and expectations of the communities they serve. By promoting collaboration between public and private sectors and engaging a broad array of stakeholders, resilient health systems can be established that prioritise equitable access and quality care.

Engaging Stakeholders Effectively

You play a pivotal role in engaging stakeholders to create a robust health system. Effective stakeholder engagement means identifying key partners including healthcare professionals, policymakers, community organisations, and the public. It is vital to communicate clearly and frequently, establishing trust and fostering teamwork throughout the entire health landscape. Regular dialogue allows for the sharing of ideas and concerns, ultimately leading to shared ownership of health priorities and strategies. Involving stakeholders in decision-making processes ensures that the systems developed reflect the true needs and nuances of the communities they are intended to serve.

Moreover, cultivating strong relationships with your stakeholders enhances the sustainability of initiatives aimed at improving health systems. Engaging in active listening and collaborative problem-solving fosters a culture of inclusivity and respect. You can benefit from leveraging local knowledge and expertise, and in doing so, catalyse innovative solutions that are both creative and effective, ultimately leading to a better health system.

Implementing Evidence-Based Practices

Stakeholders are responsible for implementing evidence-based practices, which are vital for driving improvements in health systems. It is vital to integrate the best available research evidence into clinical decision-making and healthcare policies. By using data-driven strategies, you can ensure that interventions are not just implemented but are also evaluated for their effectiveness, allowing for ongoing improvements and refinements to service delivery. This provides a structure for moving away from anecdotal practices towards more scientifically validated approaches that can significantly enhance patient outcomes.

Effectively utilising evidence-based practices requires a strong commitment to continuous learning and adaptation. Health professionals and organisations should prioritise up-to-date training and education, encouraging them to seek out and apply new findings from research and clinical studies. Establishing a culture of inquiry within your health system enables quick adoption of successful practices while simultaneously identifying and mitigating potential risks, all of which contribute positively to the overall health landscape.

Tips for Coordinated Responses in Health Systems

Keep in mind the following strategies to enhance the coordination of your health system responses:

  • Focus on establishing clear roles and responsibilities.
  • Encourage ongoing training and capacity building.
  • Promote inter-sectoral collaboration.
  • Share data and insights regularly across stakeholders.
  • Engage the community to foster trust and support.

This approach will not only improve your health system’s effectiveness but also build a foundation for sustained resilience.

Establishing Effective Communication Channels

If you want to facilitate a smooth and efficient health crisis response, establishing effective communication channels is imperative. Clear and concise communication ensures that all stakeholders are informed, reducing the chances of miscommunication and enhancing the overall operation of your health response. Regular updates, shared among all participants, can help in synchronising actions and keeping the focus on the common goals of your health systems.

In addition, adopting a multi-channel approach—utilising emails, instant messaging, and formal reports—can help cater to the varying preferences of stakeholders. Make sure to gather feedback to adjust your communication methods accordingly to fit evolving needs. This proactive approach will not only strengthen relationships but also prepare your health system for future challenges.

Leveraging Technology for Enhanced Collaboration

An effective way to improve collaboration within your health system is by leveraging technology. Utilising digital platforms and tools can significantly streamline communication, foster teamwork, and enhance information sharing among professionals. Tools such as collaborative project management software or data-sharing platforms facilitate transparency and enable real-time updates, ensuring everyone is working with the latest information.

Collaboration through technology allows your health system to effectively connect various stakeholders, streamline processes, and quickly adapt to changing situations. For example, virtual meetings and telehealth solutions allow for comprehensive discussions and consultations without geographical hindrances. The potential to share critical data across borders can improve your capacity to respond to health crises even faster. Additionally, security features in modern technologies should be prioritised to protect sensitive patient information, mitigating risks associated with data breaches. Always ensure that your technology choices enhance accessibility while maintaining robust security protocols in your health system.

Evaluating Resilience and Adaptability

Your ability to evaluate the resilience and adaptability of health systems is vital for ensuring that they can withstand and respond to crises. Resilience in healthcare implies a system’s capacity to absorb shocks, adapt to challenges, and drive recovery efforts effectively. To build a robust health system, it is important to focus on both qualitative and quantitative measures that underscore operational efficiency, stakeholder engagement, and the system’s capacity to learn from past experiences.

Your approach should incorporate feedback mechanisms that facilitate continuous evaluation and adjustment. Through simulations, scenario-based assessments, and stakeholder interviews, you can gain insights into how well the system has performed during stress events. This conscious back-and-forth process ultimately leads to a healthier and more prepared health system that safeguards public wellbeing.

Metrics for Assessment

With various metrics available, it is imperative to utilise a combination of both performance indicators and qualitative assessments to gauge resilience effectively. Key performance indicators such as patient outcomes, resource allocation efficiency, and healthcare service accessibility are important metrics to consider. Additionally, qualitative factors, including stakeholder satisfaction surveys and community engagement levels, provide a deeper understanding of the health system’s adaptability and trustworthiness.

With the right metrics in place, you can benchmark progress over time, identifying areas for enhancement and ensuring that health systems are not only responsive but also capable of evolving in the face of emerging challenges. This data-driven approach empowers you to instigate informed policy changes that can significantly improve health system resilience.

Continuous Improvement Strategies

Some effective strategies for continuous improvement include fostering a culture of open communication, encouraging innovative practices, and implementing training programs focused on crisis management. By prioritising ongoing education and professional development, you strengthen the capabilities of healthcare professionals, ensuring they are equipped to tackle unforeseen challenges effectively.

The key to developing a more adaptable health system lies in integrating lessons learned into everyday practices. This might involve establishing dedicated task forces to analyse past incidents, soliciting feedback from frontline employees, or leveraging technology for data analytics. By focusing on continuous improvement, you ensure that your health system not only survives crises but also flourishes in its aftermath. This proactive stance is instrumental in building public confidence and promoting a healthier society overall.

Future Directions for Health System Resilience

Despite the challenges faced during recent health crises, there remains a significant opportunity to enhance the resilience of health systems across Europe. You may find it insightful to explore the Building a European Health Union initiative, which aims to coalesce efforts among member states, strengthening not only the capability to respond to future health emergencies but also ensuring a consistently high standard of care throughout the continent. Emphasising collaboration and unity among countries is imperative as health threats know no borders, requiring a unified approach to healthcare delivery. Understanding these future directions will equip you with the insights necessary to navigate evolving health landscapes.

Innovations in Health Care Delivery

Now, the integration of innovative technologies in health care delivery is swiftly transforming the way services are provided. From telemedicine to AI-driven diagnostics, these advancements enable you to access healthcare more efficiently during challenging times. Innovations like remote consultations can significantly reduce the burden on physical healthcare facilities while providing timely medical support, enhancing patient outcomes. As such technologies continue to develop, you will likely see a shift towards a more patient-centred healthcare model, empowering individuals to take charge of their own health.

Strengthening International Collaboration

An imperative component of building resilient health systems is the enhancement of international collaboration. This involves sharing knowledge, resources, and best practices among nations to tackle shared health challenges effectively. As you consider the importance of such partnerships, it becomes evident that collaborative efforts can lead to more rapid responses in times of crisis, and ensure that there is a collective approach in maintaining public health. Strengthening these ties is vital, especially as globalisation continues to influence health dynamics.

It is imperative to recognise that effective international collaboration not only supports immediate responses to health emergencies but also paves the way for long-term strategic planning. By pooling resources and expertise, countries can identify emerging public health threats, thus preventing potential future crises. This global solidarity is not just beneficial but necessary, as it strengthens your local health systems while ensuring a resilient response to health challenges faced worldwide. Ultimately, reinforcing international connections will allow you to contribute to a more stable and healthy future for everyone.

To wrap up

Taking this into account, you should recognise that building resilient health systems is not just a goal but a necessity in the face of evolving global health challenges. By fostering coordinated responses across Europe, you can ensure that resources are optimally shared, knowledge is effectively exchanged, and best practices are implemented to enhance your health sector’s robustness. It is vital that you actively contribute to these collaborative efforts, whether through local initiatives or wider networks, to create a more united and prepared healthcare system.

Your role in this process involves advocating for policies that support integration, investment in health infrastructure, and strengthening partnerships across borders. By prioritising these aspects, you can help cultivate a health system that adapts swiftly to changing circumstances, ultimately safeguarding the wellbeing of your community and beyond. Engaging with policymakers, healthcare providers, and fellow citizens will empower you to influence the direction of health system resilience, ensuring that your voice is part of the collective endeavour towards a healthier Europe.

FAQ

Q: What are resilient health systems?

A: Resilient health systems are those that can effectively respond to a wide range of challenges, including emergencies, pandemics, and changing health needs. They maintain crucial services during crises while being adaptable to recover from disruptions. Key components include strong leadership, efficient resource management, and integrated health services that ensure continuity and accessibility for all populations.

Q: How can European countries improve their coordinated response to health crises?

A: Improving coordinated responses in Europe requires enhanced communication and collaboration among countries. Establishing common protocols for data sharing, aligning public health guidelines, and creating joint training programmes for healthcare professionals are crucial. Additionally, fostering strong partnerships between governmental agencies and public health organisations can help streamline efforts to address health emergencies across borders.

Q: What role do technology and data play in building resilient health systems?

A: Technology and data are vital for building resilient health systems as they enable real-time monitoring of health trends and facilitate rapid responses to emerging threats. Advanced data analytics can help in predicting outbreaks and understanding public health needs. Moreover, telehealth services can improve access to care, especially during crises when physical access to healthcare facilities may be limited.

Q: How can community engagement contribute to health system resilience?

A: Community engagement is crucial for health system resilience as it fosters trust and encourages local populations to participate in health initiatives. Involving communities in decision-making processes enhances awareness about health issues and ensures that services are tailored to meet local needs. Strengthened community ties can also facilitate better compliance with health measures during crises, ultimately enhancing overall public health outcomes.

Q: What are the main challenges faced by European countries in achieving coordinated health responses?

A: European countries face several challenges in achieving coordinated health responses, including disparate healthcare policies, varying levels of funding, and differences in public health capacities. Cultural differences and language barriers can impede effective communication among nations. Additionally, the varying degrees of commitment to collaboration at political and organisational levels can hinder unified efforts to build resilient health systems across the continent.

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Socioeconomic inequalities drive significant gaps in access to mental health care across the European Union

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A study presented at the European Psychiatric Association Congress 2025 reveals deep socioeconomic inequalities in reported need for mental health care across the European Union. The research highlights how financial barriers disproportionately affect lower-income individuals, with significant disparities also linked to education level, whether the person lives in a city or in the countryside, and geographic location.

Led by Dr. João Vasco Santos, a public health physician, health economist, and professor at the University of Porto, the cross-sectional analysis used data from the 2019 European Health Interview Survey (EHIS), covering 26 EU member states. The survey among others asked participants whether they had gone without needed mental health care in the previous 12 months due to financial constraints.

Measuring Unmet Needs: A Financial Lens

The EHIS captures self-reported experiences, focusing specifically on financial reasons as a barrier including to accessing mental health services.

Across the EU, the proportion of self-reported unmet needs for mental health care varied widely — from as low as 1.1% in Romania to as high as 27.8% in Portugal, with a median of 3.6%.

Dr. Santos emphasized that while many European countries have moved toward mixed health systems — blending elements of Beveridge- and Bismarck-style models — financial protection remains inconsistent. Even in countries with universal coverage, out-of-pocket costs for medications, therapy, diagnostic testing, or medical devices can create substantial barriers.

“This is not just about whether care is public or private,” explained Dr. Santos. “Even in systems that are largely public, co-payments can be a burden. And sometimes, vulnerable groups—like migrants or asylum seekers—are excluded altogether.”

Cultural Perceptions Shape Reporting

One of the most striking findings was the stark contrast between Romania and Portugal. Dr. Santos cautioned against interpreting these figures at face value.

“It’s not just about the availability of services — it’s also about awareness and cultural perception,” he said. He noted that in Portugal, “we’re increasingly open about mental health and the mental health service.”

Portugal has been one of the countries that is spearheading the new perception of mental health care. “The UN Convention on the Rights of Persons with Disabilities laid the foundation for the much-needed paradigm shift in mental health. From an exclusively medical approach to one based on the respect of the human rights of persons with mental health conditions and psychosocial disabilities,” Ms Marta Temido, Minister of Health of Portugal told during a United Nations consultation meeting in 2021.

Ms Marta Temido stressed that “In Portugal, we have been making significant efforts to align our laws, policies and practice with human rights.”

She specifically pointed out that “We have clearly made an option for community-based mental health services instead of institutionalization. We have been improving access to outreach care, through the launching of community teams for adults and for children and adolescents.”

In countries like Romania, stigma remains high, and is influenced by a long history of institutionalized care that fails to meet basic human standards. It should be obvious that if the psychiatric system hasn’t evolved much beyond large psychiatric institutions with reported human rights violations, one might think twice before reporting need of help.

Dr. Santos noted that in countries where mental illness is stigmatized or misunderstood, individuals may avoid reporting symptoms altogether. In some cases, people may not perceive a need for care because of limited exposure to mental health education or fear of discrimination.

Education and Inequality

The study also revealed a strong correlation between educational attainment and unmet needs. In 15 out of 26 countries analyzed, individuals with only primary education were significantly more likely to report going without mental health care than those with tertiary education.

“In Bulgaria, Greece, Romania, and Slovakia, this disparity is especially pronounced,” Dr. Santos noted. The pictures across the European countries however is quite complex, as exemplified with France where the opposite is the case. In France people with tertiary education showed a higher unmet need of mental health care. This indicate that further studies may be needed which could look at adjusting for income and other factors. The study conducted only considered the educational related inequalities.

Pandemic Impact and Future Trends

Although the study drew on pre-pandemic data (from 2019), Dr. Santos warned that the pandemic likely exacerbated existing inequalities.

“We know that mental health deteriorated during the pandemic — there was increased violence, isolation, and trauma,” he said. “At the same time, access to care was disrupted. I suspect the next wave of data will show a rise in unmet needs, particularly among lower-income and marginalized groups.”

However, he stressed that longitudinal comparisons must be made carefully, noting that changes in survey design over time can affect results.

Dr. João Vasco Santos. Credit: THIX Photo

“The goal must be to leave no one behind,” Dr. João Vasco Santos

Policy Recommendations addressing socioeconomic inequalities

To address these systemic challenges, Dr. Santos outlined a series of priorities that require coordinated action at both national and regional levels.

First, he emphasized the importance of expanding universal coverage to ensure that all individuals — including migrants and asylum seekers — have access to essential mental health services without facing financial hardship. He called for reforms that would exempt low-income and chronically ill populations from co-payments, even in systems where care is otherwise publicly funded.

Second, he advocated for a shift toward community-based care models, which improve accessibility, reduce stigma, and foster integrated, person-centered treatment approaches.

Third, Dr. Santos underscored the need for national and regional mental health strategies that incorporate public education campaigns aimed at improving health literacy.

“The goal must be to leave no one behind,” he concluded. “Health is an investment — not just in individuals, but in the resilience and equity of society as a whole.”

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More than 30 years of difference in life expectancy highlights health inequalities

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The study of the World Health Organization (WHO) reveals that they can be responsible for a Spectacular reduction in life expectancy in rich and poor countries.

For example, People living in the country with the highest life expectancy will live on average 33 years more than those born in the country with the lowest life expectancy.

An unequal world

“Our world is uneven. Where we were born, grow, live, work and age considerably influence our health and well-being, “said Director General Tedros Adhanom Ghebreyesus.

Health inequalities are closely linked to the degrees of social disadvantage and the levels of discrimination.

“” Health follows a social gradient by which the area in which people live more disadvantaged, the more their income is lowWho said.

Inequalities are particularly exacerbated in populations faced with discrimination and marginalization, such as indigenous peoples, who have lower expectations of life than their non -Aboriginal counterparts.

This is the case in high -income and low -income countries.

Key targets at risk

The study is the first to be published since 2008, when the WHO Social Health Determinants of Health Declines published its final reporting objectives for 2040 to reduce gaps between and within countries in life expectancy, childhood and maternal mortality.

It shows that these objectives are likely to be missed, and despite a rarity of data, there is sufficient evidence to show that health inequalities have often expanded.

For example, children born in poor countries are 13 times more likely to die before their fifth anniversary than in richer countries.

In addition, modeling shows that the life of nearly two million children per year could be saved by filling the gap and improving equity between the poorest and richest populations of the population in low and average income countries.

In addition, although maternal mortality has decreased by 40% between the 2000s and 2023, the majority of deaths, 94%, still occur in low and lower income countries.

Appeal to action

Who calls for collective action to deal with economic inequalities and invest in social infrastructure and universal public services.

The agency also recommends other stages, in particular on the survival of structural discrimination and the determinants and impacts of conflicts, emergencies and forced migration.

Originally published at Almouwatin.com

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