Penny Castagnimo

“Reducing the Treatment Gap” Poses Human Rights Risks


Lisa Cosgrove, Cristian Montenegro, Lee Edson Yarcia, Gianna D’Ambrozio and Julie Hannah, Health and Human Rights Journal, June 2024, Vol 26, Number 1

The United Nations (UN) officially acknowledged the “global burden” of mental disorders in September 2015, when mental health was included in the UN Sustainable Development Goals (SDGs). In so doing, the UN identified mental health as a priority for global development. The call to “close the treatment gap” was seen as a way to both uphold the right to treatment and integrate mental health into the SDGs, with many asserting that this is a human rights-based approach to transforming mental health. Although using the SDG framework is a sensible and necessary approach to catalyze action on mental health, the integration of mental health into the SDGs has sparked debates about the relevance and role of human rights frameworks in this area. For example, the latest draft resolution on mental health and sustainable development, presented by Mexico to the UN General Assembly, has been met with renewed calls to avoid the psychiatrization of the SDGs. Psychiatrization, in this context, points to the process by which “psychiatric institutions, knowledge, and practices affect an increasing number of people, shape more and more areas of life, and further psychiatry’s importance in society as a whole.” Concerns about psychiatrization stem from the fact that the focus is predominantly on scaling up the diagnosis and treatment of mental disorders, without paying attention to how a biomedical approach is limited in addressing the environmental, social, economic, and political determinants of mental health. Further, the emphasis on “closing the treatment gap” selectively deploys human rights in order to promote increased access to Western biomedical treatments. In so doing, there is a risk that the foundational principles of interdependence and indivisibility of international human rights will not be brought to fruition. What is needed is a holistic, rights-based approach that focuses not only on the clinical or individual interventions and outcomes but also on the process and contexts of implementation. That is why it is critical to ask “what type of evidence is valued (and devalued).” Thus, any discussions about the meaning and logistics of including global mental health as a priority for global development must include the voices of those most affected. Read more

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Guest speaker presentation: Mental illness and identity, Dr Milutin Kostic – 24 april 2024

Date: 24 April 2024

Time: 8AM (EDT)/1PM (GMT)

Chair: Lisa Cosgrove

Location: Zoom 

Recent decades have seen the rise of mental health speak in the general population and social media.  Even though most is done with the best intentions, this cultural change poses many questions and potential dangers that have been completely marginalized.  During this time awareness and anti-stigma campaigns have presented the story of mental health as the same as physical health, however there are qualitative differences that are overlooked.  One aspect that must be taken into account and that influences the cultural, scientific, clinical, social and even philosophical zeitgeist is the interplay of diagnosis and identity.  What happens in this diad and how it influences each and every aspect of our society, even when we are not completely aware of this, will be the topic of Dr Kostic’s talk.

Dr Kostic is a psychiatrist from Serbia, Head of the Day Hospital at the Institute of Mental Health in Belgrade. He completed his PhD in molecular medicine, with a focus on genetics and imaging in depression, but has in the meantime refocused his work on social and psychological aspects of diagnosis, overtreatment and overdiagnosis. Milutin is currently at the University of Massachusetts Boston on a Fulbright scholarship working with Prof. Cosgrove.

The talk will be followed by a Q&A session with members of the audience and proceedings will conclude by 9 am EDT/2 pm GMT.

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Dainius PŪras VISITS la trobe university, australia – april 2024

On 11 April, Prof Dainius Pūras, the former United Nations Special Rapporteur on the right to the highest attainable physical and mental health, joined a panel discussion at the La Trobe Law School and the Care Economy Research Institute, Australia. The panel discussed the Transformation of Mental Health Policy, Practice, and Law in Victoria and beyond. Dainius was joined on the panel by Mary O’Hagan, Executive Director Lived Experience in the Mental Health and Wellbeing Division at the Department of Health, Victoria, and Professor Lisa Brophy, Social Work and Social Policy at La Trobe University. The panel was chaired by Associate Professor Piers Gooding from the La Trobe Law School, and guests were welcomed by Professor Irene Blackberry, Director of the Care Economy Research Institute.

Photo: L-R – A/Prof Piers Gooding, Prof Dainius  Pūras, Prof Lisa Brophy, Prof Irene Blackberry

While in Australia, Dainius also met with contacts at Deakin University to discuss mental health and deafness and he also presented at the University of Melbourne on mental health policy.

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PAnel Members for New Psychiatric ‘bible’ received over $14m from industry

Study finds six in 10 US physician contributors had financial ties to industry. Findings raise questions about editorial independence

A study from the Centre’s co-Founder, Lisa Cosgrove, reported that sixty percent of US physicians serving as panel and task force members for the American Psychiatric Association’s official manual of psychiatric disorders received payments from industry totalling $14.24m, finds a study published by The BMJ.

Because of the enormous influence of diagnostic and treatment guidelines, the researchers say their findings “raise questions about the editorial independence of this diagnostic manual.”

Often referred to as the ‘bible’ of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) is the latest edition of the guide that doctors use to diagnose and treat patients. It is thus critical that authors of this psychiatric taxonomy should be free of industry ties.

But until the development of Open Payments (a database of financial relationships between companies and physicians), it wasn’t possible to determine the amount of monies received by authors of diagnostic and clinical practice guidelines.
To address this, researchers used data from Open Payments to assess the extent and types of financial ties to industry of panel and task force members of the DSM-5-TR.

Their analysis included 92 physicians based in the US who served as members of either a panel (86) or task force (6) on the DSM-5-TR from 2016-19, the time during which work was initiated and completed for the 2022 text revision.
Of these 92 individuals, 55 (60%) received payments from industry. Collectively, these panel members received a total of $14.24m (£11.21m; €12.96m). Only two of the six task force members had any payments reported in Open Payments, totaling $196.02 and $792.67 for 2016-19.

The most common types of payment were for food and beverages (91%), followed by travel (69%) and consulting (69%).

The greatest proportion of compensation by category of payment was for research funding (70%) which the authors point out was excluded from the American Psychiatric Association’s disclosure policy for the previous edition (DSM-5).

They highlight some study limitations, such as not including payments to physicians based outside the US or non-physician prescribers and acknowledge that amounts listed in the database may be imprecise.

Nevertheless, they say this study “provides novel data about the appreciable conflicts of interest in the DSM-5-TR and extends past research on this topic.”

To ensure unbiased, evidence based mental health practice, there should be a rebuttable presumption of prohibiting financial conflicts of interest among the panel and task force members of the Diagnostic and Statistical Manual of Mental Disorders, they write.

When no independent individuals with the requisite expertise are available, they suggest that those with associations to industry could consult to the panels, but they would not have decision making authority on revisions or inclusion of new disorders.

“As researchers, clinicians, policy makers, and leaders in evidence based medicine have argued, guideline writers should be free of financial relationships with industry, especially those writers who are responsible for such an influential manual on psychiatric taxonomy,” they conclude.

The full article can be found here.

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Dainius pŪras Promotes mental heaLTH LEGISLATION IN CHILE – November 2023

On 30 November 2023 Dainius Pūras, Professor at Vilnius University and former UN Special Rapporteur on the Right to Health, gave a keynote address at an International Seminar on ‘‘Mental Health and Legislation in Chile: Global lessons and Experiences’. The seminar took place at the University of Chile and was organised by the Ministry of Health of Chile and Inter-American Development Bank.

Photo of  Dainius Pũras, speaking at International Seminar on 'Mental Health and Legislation in Chile', University of Chile
Photo: Dainius Pūras, University of Chile

The convening focused on facilitating a space for discussion, reflection and learning about experiences in mental health legislative processes, together with nationally and internationally renowned experts in the field.

Welcome speeches were given by Minister of Health, Dr Ximena Aguilera and María Florencia Attademo-Hirt, IDB Representative in Chile.

Dainius’s keynote address considered the importance of comprehensive mental health legislation to improving public mental healthcare in Chile and called for the collaboration of the various stakeholders in this process, including organized civil society, experiential experts, formally trained experts, and parliamentarians to promote the progress of the legislation.

Other speakers included an address by the Undersecretary of Public Health, Andrea Albagli, Dévora Kestel of WHO and panellists from international mental health organisations and representatives from Chile’s executive, legislative and judicial branches of government.

During Dainius’s time in Chile, he also met with officials from the Ministry of Health, contacts from the School of Public Health, University of Chile and the Movement for Rights in Mental Health to discuss progress towards the introduction of mental health legislation.

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