Julie Hannah

“Reducing the Treatment Gap” Poses Human Rights Risks

(2024)

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

Abstract:
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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‘Treatment in Liberty’ Human Rights and Compulsory Detention for Drug Use

(March 2022)

Lines, R., Hannah, J. and Girelli, G.,Human Rights Law Review. Vol 22, Issue 1, March 2022

This is the first detailed examination of compulsory detention for ‘drug treatment’ through the lens of a rapidly evolving international legal framework. It is estimated that as many as half a million people worldwide are detained for the purpose of ‘drug treatment’, many held for months or years at a time without being charged criminally or being able to challenge the legality of their detention. This is therefore a key issue sitting at the intersection of human rights, drug policy and medical ethics. The article explores arbitrary detention and involuntary committal on medical grounds within international human rights law, as well as the historical-legal evolution of drug ‘treatment’ as the term is understood within international drug control law. It assesses whether drug use or drug dependency constitute a reasonable limitation of the right to liberty, and concludes that this type of detention represents a violation of international law. Read more …

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Redefining International Mental Health Care in the Wake of the COVID-19 Pandemic

(August 2021)
Hannah, J., Barsky, B. and Pūras, D, pp 29-43 in: Mental Health, Legal Capacity, and Human Rights. Editors: Stein, M., Mahomed, F., Sunkel, C. and Patel, V., Cambridge University Press

Abstract:
The COVID-19 pandemic has exacerbated inequities for people with psychosocial disabilities producing in its wake a serious obstacle for mental health policymakers and advocates committed to upholding Article 12 of the Convention on the Rights of Persons with Disabilities. To overcome this obstacle, stakeholders must resist a common tendency in international mental health policymaking: to over-invest in interventions that arise from a biomedical conception of mental illness. Instead, the pandemic is an opportunity to look beyond the dominant biomedical framework in international mental health care – which has a record of undermining Article 12 principles like legal capacity, autonomy, and self-determination – toward one based on human rights. This shift in positionality will serve to uphold Article 12 and help fulfill the spectrum of human rights for people with psychosocial disabilities. Read more …

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Human rights and tobacco control: lessons from illicit drugs

(2020)

Hannah, J. and Barrett, D in Human Rights and Tobacco Control, Editors: Toebes, B. and Gispen, M-E., Edward Elgar Publishing

Abstract:
This contribution is a reflection on human rights and tobacco control set against the endgame of a ‘drug free world’. The elimination of illicit drugs has long been an international policy imperative, sometimes justified on human rights grounds. But the human rights costs of this endgame in terms of negative outcomes are now apparent. Meanwhile, a compelling human rights case for stronger tobacco control has been well made. It is easy, moreover, to see the health benefits of a ‘tobacco free world’ and a relatively straightforward step to argue that such a goal helps realise the right to health. But are we sure that pursuit of a tobacco free world aligns with human rights given the clear distance between human rights and the pursuit of a ‘drug free world’? Have we properly tried to anticipate any human rights costs associated with tobacco control strategies and worked to mitigate them? In asking such questions we do not suggest that tobacco control advocates envisage ‘war on drugs’ methods or that tobacco control and drug control are the same. One is a punitive suppression regime with a supply side focus, while the other is a broader regulatory framework more weighted to the demand side. But there are similarities and areas of crossover with important human rights dimensions, including issues of addiction, restrictions on individual liberties, linkages with broader social policy, controversies around harm reduction, and enforcement responses to illicit markets. As tobacco control moves towards stricter controls (including beyond the requirements of the FCTC in national contexts), as endgame strategies are pursued, and as illicit tobacco becomes a greater focus, the resemblances to drug control may become closer. Read more …

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Crisis Response as a Human Rights Flashpoint: Critical Elements of Community Support for Individuals Experiencing Significant Emotional Distress

(June 2020)

Stastny, P., Lovell, AM., Hannah, J., Goulart, D., Vasquez, A., O’callaghan, S. and Pūras, D., (2020). Health and Human Rights. 22 (1), 105-119

Abstract:
This paper proposes a set of nine critical elements underpinned by human rights principles to support individuals experiencing a serious crisis related to mental health problems or psychosocial disabilities. These elements are distilled from a range of viable alternatives to traditional community mental health approaches and are linked to a normative human rights framework. We argue that crisis response is one of the areas of mental health care where there is a heightened risk that the rights of service recipients may be infringed. We further make the case that the nine critical elements found in advanced mental health care models should be used as building blocks for designing services and systems that promote effective rights-based care and supports. Read more…

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Reimagining the mental health paradigm for our collective well-being

(June 2020)

Chapman, A., Williams, C., Hannah, J. and Pūras, D., Health and Human Rights. 22 (1), 1-6

When we planned the special section of this issue and distributed our call for papers, we wanted to present a collection that would reflect our view that not only is there is no health without mental health, but there is no mental health without human rights. We were hopeful that papers from around the world would illustrate human rights-based approaches to easing mental distress, critique the status quo in how we understand and respond to mental health, and illuminate the scale of suffering that arises from our unequal, racist, discriminatory, and violent world. The issue was timed to coincide with guest editor Dainius Pūras’s completion of his second and final term as United Nations (UN) Special Rapporteur on the right to health. Mental health has been a special focus of his mandate, resulting in several reports on the subject, and he also contributed to the two UN resolutions affirming mental health as a human right. In his most recent report to the UN General Assembly and in his final report to the Human Rights Council, Pūras examines the social determinants of mental health and calls for discussions and actions that are “rights-based, holistic and rooted in the lived experience of those left furthest behind by harmful sociopolitical systems, institutions and practices.” Of great relevance now to our post-pandemic world, he stresses that these discussions are needed at global, regional, and national levels to better understand the collective failures of the status quo in mental health systems. Read more …

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Drug Control and Human Rights: From Parallel Universes to Universal Parallels

(April 2020)

Hannah, J. and Lines, R., (2020). In: Research Handbook on International Drug Policy. Editors: Tinasti, K. and Bewley Taylor, D., . Edward Elgar. 978 1 78811 705 0

Abstract:
This chapter examines the engagement and progress on human rights by the United Nations drug control regime from 2008-2018 through a comparative qualitative assessment of the official work of four principle political and normative institutions: the Commission on Narcotic Drugs, the International Narcotics Control Board, the Human Rights Council and the UN human rights treaty bodies. Breaking this ten year period into three distinct stages, and using the 2016 UNGASS as a benchmark, this chapter demonstrates how human rights and drug policy has achieved significant attention within these institutions, and provides a summary interpretation of these official records that can enable scholars, policymakers, and other students to better understand how this issue has evolved across each fora. Read more …

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Prioritizing Rights-based Mental Healthcare in the 2030 Agenda

(2019)

Pūras, Dainius Hannah, J, in The Routledge Handbook of International Development, Mental Health and Wellbeing, Editor: Davidson, L., Routledge. 222- 234. 9780367027735

Abstract:
The 2030 Agenda for Sustainable Development signals an ambitious political commitment towards transforming our world into a more just, peaceful and inclusive global community. This chapter explores the importance of the consensus that mental health is a human development imperative, in addition to the need for scaled-up investments to promote health and wellbeing for all. It focuses on where this consensus fractures, using human rights, including the right to health, both to locate the debates on closing the mental health treatment gap, and to contextualise the urgent need to address the current systemic human rights crisis of contemporary mental health care. The chapter argues that the dominant biomedical model is no longer compliant with the right to health, examining how the evolving normative, social and scientific landscape demands a paradigm shift to uphold international legal obligations, strengthen the practice of medicine, and improve health and wellbeing. Read more …

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The Promotion and Protection of Economic, Social, and Cultural Rights & International Drug Control: Compilation of joint submissions by the International Centre on Human Rights and Drug Policy to the United Nations Committee on Economic, Social, and Cultural Rights 2016-201

(2018)

Hannah, J.

The Promotion and Protection of Economic, Social, and Cultural Rights & International Drug Control: Compilation of joint submissions by the International Centre on Human Rights and Drug Policy to the United Nations Committee on Economic, Social, and Cultural Rights 2016-201 Read More »

The Criminalisation of Healthcare

(June 2018)

Hannah, J., Rubenstein, L., Buissoniere, M. and Woznick, S.,(2018)

Abstract:
Long-standing principles of humanity and human dignity embodied in international humanitarian and human rights law entitle all people, regardless of their beliefs, affiliation or status, to have access to healthcare in war and in peacetime. The principle applies to wounded and sick combatants, to civilians in armed conflict, as well as to people living in societies that face threats from terrorism. The ethics of the medical profession mirror these values as practitioners have a duty to provide care without discrimination, including if a person is labelled an enemy or a terrorist. International law recognizes the imperative to enable health providers to carry out these duties without fear of punishment so that all people can receive the care they require.
In recent decades, though, and especially after the attacks of September 11, 2001, contrary to these principles, states have punished the very act of providing or seeking to provide medical care to people who are labelled terrorists or affiliated with terrorist organizations. Read more …

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The Case for International Guidelines on Human Rights and Drug Control

(March 2017)

Hannah, J., Lines, R., Schleifer, R., Barrett, D., Avafia, T. and Elliott, R., (2017), Health and Human Rights Journal. 19 (1), 231-2236

Abstract:
This special section of Health and Human Rights Journal examines some of the many ways in which international and domestic drug control laws engage human rights and create an environment of enhanced human rights risk. In this edition, the authors address specific human rights issues such as the right to the highest attainable standard of health (including health protection and promotion measures, as well as access to controlled substances as medicines) and indigenous rights, and how drug control laws affect the protection and fulfillment of these rights. Other authors explore drug control through the lens of cross-cutting human rights themes such as gender and the rights of the child. Together, the contributions illustrate how international guidelines on human rights and drug control could help close the human rights gap—and point the way to drug laws and policies that would respect, protect, and fulfill human rights rather than breach them or impede their full realization. Read more ….

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Reasons for drug policy reform: prohibition enables systemic human rights abuses and undermines public health

(January 2017)

Pūras, D. and Hannah, J. BMJ 2017, 356

Drug Prohibition, including criminalisation to regulate the supply and demand of controlled substances, has had devastating effects on human rights and public health worldwide.

Prohibition as an international policy response gives rise to illicit drug markets governed by criminal networks and regulated by violence. The poor and marginalised communities in which illicit drugs are cultivated, transited, or sold are disproportionately affected. States have responded with increased law enforcement, escalating violence and further destabilising communities. Parallel violent pursuits both to protect and to topple illicit markets have been linked to large scale displacement, femicide, and an overall decrease in life expectancy, such as in Mexico.

Mass incarceration to enforce prohibition has overburdened criminal justice systems and left countless people languishing in deplorable facilities in inhumane conditions around the world.2 Criminalisation of possession means that a fifth of … Read more …

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Human Rights, Drug Control and the UN Special Procedures: Preventing arbitrary and extra-judicial executions through the promotion of human rights in drug control

(May 2015)

Hannah, J. and Melkonyan, A. United Nations Human Rights Mechanisms & Drug Control, Legal Briefing Paper No. 2, The Special Rapporteur on Extrajudicial, Summary or Arbitrary Executions

Abstract:
Human rights violations occurring as a consequence of drug control or enforcement efforts have been well-documented by both civil society organisations and United Nations human rights monitors. These violations highlight the degree to which the framework established under the three United Nations drug conventions contributes to an environment of increased human rights risk, and in some cases directly fuels abuses. The relationship between international human rights law and international drug control law is therefore a significant issue for human rights activists and scholars, yet to date it has largely gone unaddressed. The UN drug control bodies rarely mention human rights, while the UN human rights mechanisms rarely mention drug control. In effect, the two speak different languages and hold different priorities. As the “eyes and ears” of the UN human rights system, the special procedures serve acritical role in bridging the normative gap and bringing thematic attention to this emerging human rights issue. Read more …

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Human Rights, Drug Control and the UN Special Procedures: Preventing arbitrary detention through the promotion of human rights in drug control

(January 2015)

Hannah, J. and da Silva, N., United Nations Human Rights Mechanisms & Drug Control, Legal Briefing Paper No. 1, The Working Group on Arbitrary Detention

Abstract:
The UN drug control bodies rarely mention human rights, while the UN human rights mechanisms rarely mention drug control. In effect, the two speak different languages and hold different priorities.

Research underway at the International Centre on Human Rights and Drug Policy reveals that the historical treatment of drug control issues within the special procedures system is insufficient to have an impact on current drug control policy and practice. Reporting by mandate holders on drug control has been scattered and rarely collaborative, despite the numerous intersections drug control issues present across the mandates. As the special procedures develop their programme of work for the coming year, they have an important opportunity to consider ways in which coordination across the mandates can enhance the promotion and protection of human rights while countering the world drug problem—both to have an impact on policy-making and to close the normative gaps between the two legal regimes. Read more …

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