On 16 and 17 October 2014, OHCHR’s Regional Office for Europe organized in Brussels its fifth annual event dedicated to “Forgotten Europeans” – groups of rights holders who are often left out of mainstream human rights discussions. This year’s event focused on persons with psychosocial disabilities (mental health problems), whose concerns tend to be addressed by mental health policy; in practice it is mostly seen as a “niche” of its own, with a human rights perspective remaining largely absent.

The event provided an opportunity for open, non-hierarchic discussion between rights holders, service providers, experts, representatives of EU Member States, three Directorates-General of the European Commission, the EU Fundamental Rights Agency, the World Health Organization, OHCHR, and the European Psychiatric Association.

The UN Special Rapporteur on the Right to Health, Dainius Puras, highlighted that human rights considerations should always come first in mental health care. Several speakers drew on their personal experience when illustrating the challenges faced by persons with psychosocial disabilities. “Persons with psychosocial disabilities must enjoy the full protection of the Convention on the Rights of persons with disabilities,” stressed Gábor Gombos, a user/survivor of psychiatry and a former member of the UN Committee for the Rights of Persons with Disabilities. “Due to discrimination and stigma, they often face serious obstacles in the enjoyment of rights that are guaranteed to everyone. For instance, when a person has ‘a mental health diagnosis’, he or she is often denied treatment for a life-threatening physical illness due to the prejudiced view that his or her symptoms don’t have to be taken seriously.”

Particular attention was given to the issue of independent living and inclusion in the community, which is covered in article 19 in the Convention on the Rights of Persons with Disabilities (CRPD), as well as to the issue of coercion in mental health care. The co-chair of the European Expert Group on the Transition from Institutional Care, Jan Pfeiffer, emphasized the risks of half-way reforms that “replace huge old-style care institutions by smaller ones with a similar institutional culture - but this is not independent living, nor is it real inclusion in the community.”

Speakers emphasized the urgent need to provide alternative services in the community when closing psychiatric institutions and hospitals – so as not to repeat past errors and avoid that persons with psychosocial disabilities end up homeless and destitute in the streets. This perspective was shared by representatives of users, like Erik Olsen from Denmark, as well as by reformers of mental health care, like Stelios Stylianidis from Greece. Models of good practice, such as the Swedish system of personal ombudsmen – introduced by Maths Jesperson from PO Skåne – were presented and gave rise to inspiring discussions. In breakout groups, Member State representatives informed about their approaches to community care and independent living models, about current budgetary challenges, as well as on how to strengthen the role of the United Nations.

Anne-Laure Donskoy, a survivor/researcher from the University of Bristol, focused in her presentation on the antagonistic relationship between coercion and trust. The issues of substituted vs. supported decision-making (Article 12 CRPD) and of mental and legal capacity were also debated, including some of the more difficult cases involving risk of death or serious suffering due to non-treatment of otherwise treatable physical disorders.

Overall, the event brought remarkably constructive and creative dialogue between persons with different kind of expertise – human rights, health and social policy, and above all the “life expertise” of persons with psychosocial disabilities. OHCHR recalled the importance of a holistic approach to the rights of persons with psychosocial disabilities: it isn’t enough to look at legal capacity or involuntary treatment – a human rights-based approach involves ensuring the respect of all rights in the Convention (employment, privacy, voting, housing, etc). There was consensus that bridge-building should continue and that the involvement of rights-holders and the human rights community in policy debates needs to be enhanced, with the joint aim of bringing the concerns of persons with psychosocial disabilities out of a “policy silo” and into the mainstream of human rights concerns.