Press Release

States in the Americas Must Take Urgent Action to Effectively Protect Mental Health and Ensure Universal Access to It in the Context of the COVID-19 Pandemic

2 de octubre de 2020

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Washington, D.C. - The Inter-American Commission on Human Rights (IACHR) and its Special Rapporteurship on Economic, Social, Cultural, and Environmental Rights (SRESCER) call upon States to take mental health into consideration when implementing healthcare policies and other measures to contain the COVID-19 pandemic, as well as to ensure universal access to adequate mental health care. Health is a fundamental and essential human right recognized in the inter-American legal framework, where it is understood as a comprehensive state of physical, mental, and social wellbeing linked to a lifestyle that enables individuals to attain integral balance. Ensuring universal access to mental health is essential for societies to be able to function adequately and for individuals to be able to fully develop their life plans, since psychological and emotional wellbeing enables individuals to use their capabilities and effectively contributes to their personal wellbeing and to the wellbeing of their communities and environments.

The IACHR notes that, in Resolutions 1/20 and 4/20, it urged States to take urgent specific action to effectively protect the right to health, including mental health, by taking into consideration the serious impact of pandemic contexts and the relevant containment measures. This explicitly integrates the right to mental health and seeks to ensure that States comply with their obligation to provide goods and services to preserve mental health without discrimination, ensuring availability, access, acceptability, and quality.

This pandemic has caused a physical health crisis, but it has also had a significant impact on the mental health of people around the Americas. It is therefore necessary to acknowledge the psychological and psychosocial vulnerability that people are currently being exposed to across the board, even if certain groups—such as healthcare workers, COVID-19 patients (as defined in Resolution 4/20), persons with disabilities, older persons and individuals with pre-existing medical conditions, women, children and adolescents, LGBTI persons, and poor persons, among others—face greater risks in the current setting.

The IACHR and its SRESCER are extremely concerned about the threats that the pandemic poses for people’s mental health by triggering or worsening psychological, neuropsychiatric, and emotional disorders; depression; disorders caused by the use of addictive substances; and anxiety, stress, panic, or suicidal risks, among others. According to the Pan American Health Organization (PAHO), an unprecedented mental health crisis is ongoing in the Americas, caused both by increased stress levels and by the abuse of alcohol and drugs triggered by restrictions on movement to contain the pandemic. This situation has been compounded because States have focused their efforts on responding to the physical consequences of COVID-19 and are allegedly neglecting people’s mental health, in a scenario marked by clearly growing needs and insufficient resources to address them.

In fact, funding for mental health services was already limited before the pandemic. A country’s income largely determined its mental health budget, and therefore the availability and quality of its mental health services. Even before the pandemic, all States in the Americas had an imbalance between their spending on mental health and the burden of the mental health disorders they faced. According to PAHO, by 2018, this burden was three times greater than spending on mental health in high-income countries, and it was up to 435 times greater in low-income countries. The regional median showed a burden that was 34 times greater than spending in this field, PAHO said. PAHO also recently reported that mental health conditions have been a silent epidemic in the Americas, and have left the region with the world’s second-highest rate of alcohol consumption, as well as making anxiety and depression the two leading causes of disability.

Considering only the pandemic’s predictable effects on mental health, the regional outlook will pose many challenges, so it is crucial to pay attention to mental health services now, in the near future, and in the longer term. According to the Economic Commission for Latin America and the Caribbean (ECLAC), we are facing “the worst economic contraction in the last 100 years.” GDP in the region is expected to contract by approximately 9.1%. An estimated 2.7 million formal small and medium-sized enterprises are expected to be lost. The unemployment rate is expected to increase significantly (with an estimated 41.1 million people left jobless). And during 2020, the number of people living in poverty is expected to increase by almost 45.4 million people, while a further 28.5 million would slip into extreme poverty. These projections imply that 230.9 million people (37.3% of all people in Latin America and the Caribbean) would be poor by the end of 2020, while a further 96.2 million (15.5% of the population) would be extremely poor.

In this context, anxiety and mental disorders are not only linked to the risk of infection with COVID-19 or to the suffering of patients and their loved ones, but also to stigma, discrimination, and lack of solidarity; to households’ lack of financial resources; to instability, and uncertainty; to unemployment; to the excessive burden of pending tasks (particularly among women, who bear the brunt of caring responsibilities); to fear of the future; to restrictions on movement and isolation; to difficulties in household dynamics and increased domestic violence; and to insufficient access to healthcare and food, water, or housing, to name but a few factors.

It is crucial for States to include mental health as a right within healthcare coverage and to not only address the physical problems and symptoms associated with COVID-19. It is also essential for mental health services to respond to the specific needs of different groups and to take a human rights approach that goes far beyond biomedical understanding. Mental health is an inextricable component of the right to health, and its realization is intrinsically linked to the full enjoyment of human rights. It is therefore essential to adopt a human rights approach that seeks to preserve the dignity and the psychological and psychosocial wellbeing of all people.

In this context, the IACHR and its SRESCER remind States of their obligation to protect the right to mental health, in keeping with the availability, access, acceptability, and quality principles highlighted by the Inter-American Human Rights System. The Commission therefore recommends the following:

1. Including comprehensive mental health services and their funding as an essential element in all healthcare systems, with a human rights approach and an intersectional perspective that incorporates gender and ethnic-cultural diversity, both during and after the current health emergency.
2. Considering mental health in the various areas where measures are taken to contain the COVID-19 pandemic (healthcare, employment, education, and taxation, among others), which must include services to ensure psychological and psychosocial wellbeing, palliative care, and treatment for addictions.
3. Actively fighting stigma and neglect concerning mental health services.
4. Ensuring the right to timely, truthful, and impartial information that is culturally appropriate and uncensored, to reduce uncertainty and the major mental effects of the pandemic on individuals.
5. Pursuing emotional and psychological wellbeing campaigns that are accessible to all people and include any necessary and appropriate accommodations to reach persons with disabilities, children and adolescents, and indigenous peoples.

The SRESCER is an office of the IACHR and was especially created to brace the Commission’s compliance with its mandate to promote and protect economic, social, cultural, and environmental rights in the Americas.

A principal, autonomous body of the Organization of American States (OAS), the IACHR derives its mandate from the OAS Charter and the American Convention on Human Rights. The Inter-American Commission has a mandate to promote respect for and to defend human rights in the region and acts as a consultative body to the OAS in this area. The Commission is composed of seven independent members who are elected in an individual capacity by the OAS General Assembly and who do not represent their countries of origin or residence.

No. 243/20