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Fewer African Students Came to Russia in 2020

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As federal government scholarships are highly limited, Russia’s educational institutions are ready to train more and more specialists on tuition paying basis for Africa. There are plans to boost the number of African students, but currently, approximately 60% of the total African students are on private contracts in the Russian Federation.

“The present and the future of Russia-Africa relations is not about charity, it’s about co-development,” stated Evgeny Primakov, Head of the Russian Federal Agency for International Humanitarian Cooperation (Rossotrudnichestvo)and also a member of the Secretariat of the Russia-Africa Partnership Forum.

The Secretariat of the Russia-Africa Partnership Forum was created last year and it works under the Russian Foreign Ministry. It has, under its aegis, three coordination councils namely business, public and scientific councils. Primakov heads the humanitarian council that deals with education and humanitarian questions for the Foreign Ministry.

While talking about initiatives especially the sphere of education in the relationship between Russia and Africa, Primakov explicitly underlined the changing state of affairs in education and added that the number of Russian state scholarships for African citizens – for the whole continent made up of 54 African countries – has only increased from 1765 in 2019 to 1843 in 2020. At the same time, the number of applications submitted has decreased.

According to Primakov, due to the coronavirus outbreak, some African governments have decided not to launch the application campaign for Russian universities for the academic year 2020/2021 as there are difficulties with transportation, safety, and financing scholarships allocated in the African state’s budget.

He suggested that the Russian system of higher education needs to be adapted to the new realities so that it could gain more value on the international market. For many observers, it is necessary to build future links today, so Russia has to facilitate Africa’s openness to this sphere of education. In various ways, Russian educational institutions could open their doors to the growing number of African elites, estimated at 350 million, almost the same size of the United States and double the population size of Russia.

Reports made available indicate that the Russian Federal Agency for International Humanitarian Cooperation currently operates eight representative offices in Africa: Egypt, Zambia, Morocco, Republic of the Congo, Tunisia, Tanzania, Ethiopia and South Africa.

During Russia-Africa inter-party conference held late March 2021, under the theme “Russia – Africa: Reviving Traditions” which was organized and hosted the United Russia Party, Foreign Minister Sergei Lavrov offered an assuring signal in his speech that Russia is stepping up efforts to engage in multifaceted developments with Africa.

That Russia has a lot to offer to African countries in terms of mutually beneficial cooperation as it traditionally maintains very close relations with many of these countries in the continent.

Lavrov told the online gathering “in the past few years, Russia-Africa cooperation has been noticeably stepped up. We are deepening our political dialogue, developing inter-parliamentary ties, promoting cooperation between ministries and departments and expanding scientific and humanitarian exchanges.”

With education and training of specialists for Africa, Lavrov said that “over 27,000 African students study in Russian universities.” Understandably, this represents a significant increase by 9,000 students, up from approximate 18,000 as given figure in October 2019.

Just about four or five months after the first Russia-Africa summit, World Health Organization(WHO) declared coronavirus pandemic, nearly all countries locked down and civilian (passenger) air transport or aviation links completely paralyzed throughout 2020.

Statistics on African students are, in fact, still staggering. When contacted, the Russia’s Ministry of Science and Higher Education declined to give the current substantive figure for Africa.

In a transcript posted to the official website, Foreign Minister Sergei Lavrov, answering questions at a meeting with the students and staff of Moscow State Institute of International Relations (MGIMO) University, in September 2019, nearly two months before Sochi summit, pointed out that there were 15,000 Africans studying in Russia, and about a third (that is 5,000) of them had received scholarships provided by the Russian state.

That same year during the inter-parliamentary conference, Chairman of the State Duma, Viacheslav Volodin, was convinced that cultural and educational cooperation could be equally important areas needed to be developed and intensified in Russian-African relations.

Volodin further suggested to continue discussing the issues of harmonizing legislation in the scientific and educational spheres, and reminded that hundreds of thousands of African students studied in the Soviet Union and Russia, and that approximately 17,000 African students, majority of them on private contracts, were studying in the Russian Federation.

On June 21, 2019, Dmitry Medvedev spoke at the opening of the 26th annual shareholders’ meeting of the African Export-Import Bank. One of the aspects of the relationships, he mentioned educational projects as particularly important, and informed that 17,000 African students are studying in Russia, but hope that this figure will increase in future.

“Friends, of course, we can achieve more in all areas. We simply need to know each other better and be more open to one another,” he stressed in his speech.

In addition to above, Professor Vladimir Filippov, Rector of the Russian University of People’s Friendship (RUDN), formerly Patrice Lumumba Friendship University, has underscored the fact that social attitudes toward foreigners first have to change positively, the need to create a multicultural learning environment, then the need to expand and deepen scientific ties between Russia and Africa.

Established in 1960 to provide higher education to Third World students, it later became an integral part of the Soviet cultural offensive in non-aligned countries. His university has gained international popularity as an educational and research institution located in southwest Moscow.

In order to earn revenue, Russia’s Ministry of Science and Higher Education has already launched a large-scale educational campaign abroad targeting to recruit private foreign students on tuition paying contract annually into its educational institutions across the Russian Federation.

Experts from the Moscow based Center for Strategic Research indicated in an interview with this foreign correspondent that the percentage of Russian universities on the world market is considerably low. Due to this, there is a rare need to develop Russian education export opportunities, take progressive measures to raise interest in Russian education among foreigners.

As part of the renewed interest in Africa, Russia has been working on opportunities and diverse ways to increase the number of students, especially tuition paying agreements for children of the growing elite families and middle-class from African countries at Russian universities.

Worth recalling that Russian President Vladimir Putin sent his greetings to all African leaders and participants of the first Russia-Africa Summit published on the Kremlin website in October that year, that the summit would help identify new areas and forms of cooperation, put forward promising joint initiatives. Further hoped it would bring the collaboration between Russia and Africa to a qualitatively new level and contribute to the development of our economies and the prosperity for both parties.

Later at the plenary session, Putin reiterated that by the mid-1980s, Russia had built about a hundred educational establishments in Africa and half a million Africans have been trained for work at industrial companies and agricultural facilities in African countries. And that 17,000 Africans, including some 4,000 who on federal scholarships, were studying here in the Russian Federation.

Worthy to say that Putin specifically noted the good dynamics of specialist training and education in Russian educational institutions for African countries. Russian and African participants mapped out broad initiatives in the sphere of education during the first Russia-Africa Summit in Sochi.

For the joint work, there was a final joint declaration, adopted by the participants after the Sochi summit. The document outlines a set of goals and objectives for the further development of Russian-African cooperation. The next Russia-Africa Summit, venue to be decided by African leaders, is planned for 2022.

MD Africa Editor Kester Kenn Klomegah is an independent researcher and writer on African affairs in the EurAsian region and former Soviet republics. He wrote previously for African Press Agency, African Executive and Inter Press Service. Earlier, he had worked for The Moscow Times, a reputable English newspaper. Klomegah taught part-time at the Moscow Institute of Modern Journalism. He studied international journalism and mass communication, and later spent a year at the Moscow State Institute of International Relations. He co-authored a book “AIDS/HIV and Men: Taking Risk or Taking Responsibility” published by the London-based Panos Institute. In 2004 and again in 2009, he won the Golden Word Prize for a series of analytical articles on Russia's economic cooperation with African countries.

New Social Compact

Athletes knock the legs from under global sports governance

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Sports governance worldwide has had the legs knocked out from under it. Yet, national and international sports administrators are slow in realizing the magnitude of what has hit them.

Tectonic plates underlying sports’ guiding principle that sports and politics are unrelated have shifted, driven by a struggle against racism and a quest for human rights and social justice.

The principle was repeatedly challenged over the last year by athletes as well as businesses forcing national and international sports federations to either support anti-racist protest or at the least refrain from penalizing athletes who use their sport to oppose racism and promote human rights and social justice, acts that are political by definition.

The assault on what is a convenient fiction started in the United States as much a result of the explosion of Black Lives Matter protests on the streets of American cities as the fact that, in contrast to the fan-club relationship in much of the world, US sports clubs and associations see fans as clients, and the client is king.

The assault moved to Europe in the last month with the national soccer teams of Norway, Germany, and the Netherlands wearing T-shirts during 2022 World Cup qualifiers that supported human rights and change. The Europeans were adding their voices to perennial criticism of migrant workers’ rights in Qatar, the host of next year’s World Cup.

Gareth Southgate, manager of the English national team, said the Football Association was discussing with human rights group Amnesty International tackling migrant rights in the Gulf state.

While Qatar is the focus in Europe, greater sensitivity to human rights appears to be moving beyond. Formula One driver Lewis Hamilton told a news conference in Bahrain ahead of this season’s opening Grand Prix that “there are issues all around the world, but I do not think we should be going to these countries and just ignoring what is happening in those places, arriving, having a great time and then leave.”

Mr. Hamilton has been prominent in speaking out against racial injustice and social inequality since the National Football League in the United States endorsed Black Lives Matter and players taking the knee during the playing of the American national anthem in protest against racism.

In a dramatic break with its ban on “any political, religious or personal slogans, statements or images” on the pitch, world soccer governing body FIFA said it would not open disciplinary proceedings against the European players. “FIFA believes in the freedom of speech and in the power of football as a force for good,” a spokesperson for the governing body said.

The statement constituted an implicit acknowledgement that standing up for human rights and social justice was inherently political. It raises the question of how FIFA going forward will reconcile its stand on human rights with its statutory ban on political expression.

It makes maintaining the fiction of a separation of politics and sports ever more difficult to defend and opens the door to a debate on how the inseparable relationship that joins sports and politics at the hip like Siamese twins should be regulated.

Signalling that a flood barrier may have collapsed, Major League Baseball this month said it would be moving its 2021 All Star Game out of Atlanta in response to a new Georgia law that threatens to potentially restrict voting access for people of colour.

In a shot across the bow to FIFA and other international sports associations, major Georgia-headquartered companies, including Coca Cola, one of the soccer body’s longest-standing corporate sponsors, alongside Delta Airlines and Home Depot adopted political positions in their condemnation of the Georgia law.

The greater assertiveness of athletes and corporations in speaking out for fundamental rights and against racism and discrimination will make it increasingly difficult for sports associations to uphold the fiction of a separation between politics and sports.

The willingness of FIFA, the US Olympic and Paralympic Committee (USOPC) and other national and international associations to look the other way when athletes take their support for rights and social justice to the sports arena has let a genie out of the bottle. It has sawed off the legs of the FIFA principle that players’ “equipment must not have any political, religious or personal slogans.”

Already, the US committee has said that it would not sanction American athletes who choose to raise their fists or kneel on the podium at this July’s Tokyo Olympic Games as well as future tournaments.

The decision puts the USOPC at odds with the International Olympic Committee’s (IOC) staunch rule against political protest.

The IOC suspended and banned US medallists Tommie Smith and John Carlos after the sprinters raised their fists on the podium at the 1968 Mexico City Olympics to protest racial inequality in the United States.

Acknowledging the incestuous relationship between sports and politics will ultimately require a charter or code of conduct that regulates the relationship and introduces some form of independent oversight akin to the supervision of banking systems or the regulation of the water sector in Britain, alongside the United States the only country to have privatized water as an asset.

Human rights and social justice have emerged as monkey wrenches that could shatter the myth of a separation of sports and politics. If athletes take their protests to the Tokyo Olympics and the 2022 World Cup in Qatar, the myth would sustain a significant body blow.

Said a statement by US athletes seeking changes to the USOPC’s rule banning protest at sporting events: “Prohibiting athletes to freely express their views during the Games, particularly those from historically underrepresented and minoritized groups, contributes to the dehumanization of athletes that is at odds with key Olympic and Paralympic values.”

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Disability policies must be based on what the disabled need

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Diversity policies, especially when it comes to disabled people, are often created and implemented by decision makers with very different life experiences to those who their policies affect most.

We would never expect economic policy to be crafted without input from economists and bankers. We should demand the same for disability policies, if we want to create the change needed to produce inclusive societies.

Starting in 2017, I was humbled to be given an opportunity to develop the first multi-media, audio dictionary translating Bangla to English. As a disabled individual who is visually impaired, I was uniquely placed to design such a programme, based on my lived experience. The principle of entrusting service design to those who have the most experience in that area is a logical, common-sense approach to policy, yet many governments can do more in this area. 

This has been particularly true throughout the pandemic, where it has been even more important to respond quickly and appropriately to the needs of citizens. 

For example, school children have been failed in many countries through poor or non-existent education provision. Medical professionals have been let down due to poor access to PPE.

This begs the question, why haven’t teachers created public policy regarding schools? Why haven’t Doctors and nurses been a bigger part of public policy with regards to hospital management and equipment? 

Those who have direct, lived experience should be able to formulate policy. I’m grateful that in Bangladesh and other nations, this is what is increasingly happening, with some groundbreaking results. 

If nothing else, this approach is consistent with other professions: When applying for a job, an employer will always demand evidence of past experience. There is no reason why this should not apply to policy and politics. 

You would never hire a builder to work on your house if they had never set foot on a building site: at most, you could hire an experienced interdisciplinary project manager if he or she was relying on the expertise of seasoned builders. 

The benefit of applying lived experience to problem-solving has long been established in business – governments should follow suit. 

The founders of the ‘Lean methodology’ are a great example of this, where they developed a process of continuous improvement and waste elimination that saw a failing car production company, Toyota, turn into a global market leader. 

This methodology’s pioneers, Kiichiro Toyoda and Taiichi Ohno, would demand that those working on the camper van, for example, would travel themselves in the vans they were trying to improve. This enabled them to uncover the sources of discomfort created through poor design, in a way that would have been impossible in a design office in Tokyo. 

This cannot be directly applied to disability policy – it would be unethical and impossible to ask someone to be ‘blind’ for a period of time, in order to develop better policy.

The next best thing is for policy makers to engage with those who have the experience. 

This isn’t about denigrating the policymaking experience of those in government, but it is about helping them empathise with those whom their decisions impact. When public services are not designed with empathy for the people who use them, they are useless, or even potentially harmful. 

The a2i empathy training programme, for example, arranges for relatively senior government officers to act as secret shoppers and visit citizens’ access points for services outside of their ministry or area of expertise. This exercise puts them in “citizens’ shoes” since they are forced to navigate public systems without any official or intellectual privileges. This experience helps participants develop a critical eye that they use to scrutinise their own agency’s delivery systems and improve the overall quality of services. 

This kind of real-world experience (either through engaging with service users, or by putting policy makers’ in service users’ shoes), as well as high-level expertise, should be part of governance as we move towards a ‘new normal’. 

There is no reason why Ministers for health shouldn’t be ex-Doctors, and Ministers for education can’t be ex-teachers. And there is no reason why disability policy cannot be informed by disabled people.

Public service is not rocket science, but if it was, it would make sense to entrust it to the rocket scientists. 

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New Social Compact

Reform of mental health services: An urgent need and a human rights imperative

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Already in the early stages of the COVID-19 pandemic, the World Health Organisation (WHO) was warning that substantial investment in mental health services was necessary to avert a mental health crisis. The evidence for the devastating impact of the pandemic on mental health is now overwhelming. The reasons for this are clear: the pandemic caused fear and anxiety for everyone, and many of us had to face illness, grief over lost family members, insecurity and loss of income. In addition to this extraordinary burden placed on our mental health, we were cut off from our usual support networks, friends and families, while the pandemic was also disrupting the delivery of existing mental health services themselves.

Not everyone has been affected in the same way by the pandemic, and mental health is no exception here. Among others, the mental health of certain demographics such as older persons, children and adolescents, and women, as well as that of disadvantaged groups such as persons with disabilities, LGBTI people and migrants has been affected more compared to the general population. For example, in a statement I co-signed with the UN Independent Expert on Sexual Orientation and Gender Identity and numerous other human rights experts, we alerted states to increasing mental health problems for LGBTI people, in particular youth, notably as a result of having to shelter with family members who were unsupportive of or hostile towards their LGBTI identity.

I recently published an Issue Paper entitled “Protecting the right to health through inclusive and resilient health care for all” in which I set out twelve recommendations. These include universal health coverage (of which mental health services are an essential component), more equality and dignity for patients, more participation and empowerment in relevant decision-making, the promotion of transparency and accountability throughout policy cycles, and better health communication policies. Since the right to health is defined as the right to the highest attainable standard of physical and mental health, these recommendations naturally apply to mental health care as well. Some recommendations, however, are more specific to mental health, such as those related to the need to ensure that mental health services are accessible to all when needed, of appropriate quality and affordable, to transition from an institutional to a community-based model and to eliminate coercive practices in mental health services.

Mental health systems: a longstanding source of human rights violations

While the additional strain generated by the pandemic is new, the mental health situation and lack of services has been a neglected human rights crisis in Europe for a long time. Despite the suffering and economic burden caused by mental health problems, mental health spending in the WHO European region was estimated to amount to only 1% of total health expenditure in 2019, and the majority of that expenditure was channelled towards mental health hospitals. In a very important report in 2017, the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health was already raising the alarm over the fact that “the arbitrary division of physical and mental health and the subsequent isolation and abandonment of mental health has contributed to an untenable situation of unmet needs and human rights violations”.

In my Issue Paper on health, I called on governments to pay attention to the essential social determinants of health in order to rebuild more inclusive and resilient health care systems, notably social protection, living conditions, working environment and education. These are all the more relevant for mental health, since mental well-being is determined not only by individual attributes but also by the social environment which can prevent, cause or aggravate mental health problems. In recent decades, a human rights-based, holistic and psychosocial understanding of mental health has been emerging, but this approach still faces a lot of resistance in many of our member states, where a reductionist, biomedical paradigm remains prevalent. Further problems identified in the aforementioned report of the Special Rapporteur are power asymmetries in mental health policies and services, and the biased use of evidence in mental health. In combination, these reinforce a vicious cycle of stigmatisation, disempowerment, social exclusion and coercion.

In order to rise to the challenge posed by the pandemic for mental health services, it is essential to reform them, as well as relevant laws and policies, urgently and from the ground up. As with health policy generally, the imperative to prevent human rights violations must be the guiding principle behind these reforms.

The human rights of persons with mental health problems or psychosocial disabilities (i.e. disabilities arising from the interaction between a person with a mental health condition and their environment) are routinely violated in two significant ways. Firstly, their human rights continue to be violated by mental health services themselves, notably because they often display a tendency towards paternalism, coercion and institutionalisation. Secondly, affected patients may not have access to the care they need to achieve the highest attainable standard of health. In this connection, we should bear in mind that this right depends on the realisation of many other human rights, notably those enshrined in the UN Convention on the Rights of Persons with Disabilities (CRPD).

Coercion: a persistent source of human rights violations

In a recent report on its visit to Bulgaria, the European Committee for the Prevention of Torture (CPT) documented how patients in psychiatric hospitals were subjected to widespread and systematic ill-treatment at the hands of staff: they were slapped, pushed, punched, kicked, beaten with sticks, chained to beds and medicated without consent. While this example is particularly horrific, we should not forget that similar institutions, and the underlying approach taking coercion for granted, are still common in the majority of our member states, as demonstrated, for example, in recent exposés on the situation of psychiatric hospitals in Malta. My own Office has addressed human rights violations caused by such institutions in a large number of member states, including in an intervention before the European Court of Human Rights.

Why is this still accepted in 2021? Historically, fear, rejection and isolation have been our default response to persons with mental health problems. The ingrained fear and stigma of mental illness is still very strong, fuelling prejudice and the narrative that persons with mental health problems pose a danger to themselves and to society, against all available statistical evidence to the contrary – persons with mental health problems are in fact far more likely to be victims of violence than perpetrators. Mental health laws that normalise closed institutions and forced treatment confirm and reinforce these prejudices. Furthermore, while there is ample evidence that coercive treatment may lead to substantial trauma and that fear of coercion can actually deter persons experiencing mental ill-health from seeking help, there appears to be little scientific evidence to substantiate the supposed benefits of forced treatment.

In 2019, the Parliamentary Assembly of the Council of Europe unanimously adopted a groundbreaking Resolution calling on member states to end coercion in mental health, pointing to the fact that the number of persons subjected to coercion was still growing in Europe. It noted that so-called safeguards to prevent excessive use of coercion had not reduced but, on the contrary, seemed to have increased coercion, for example in France following a reform in 2011: what is defined as last resort in legislation often becomes the default approach, especially when resources are scarce. The corresponding report presented to the Parliamentary Assembly also reflects my observations concerning the marked differences in the level of involuntary placements between countries, but also between different regions of the same country or even from one hospital to another, suggesting that the main cause of coercion is not the inherent dangerousness of persons or therapeutic necessity, but an institutional culture that confines more out of prejudice or habit. This interpretation is supported by research.

In my address to the Parliamentary Assembly prior to the adoption of this Resolution, I drew attention to how my own country work allowed me to see first-hand the vicious circles caused by a mental health approach based on coercion, which perpetuates the isolation of the very persons who need the support of their community the most, fuelling more stigma and irrational fear. The lack of community-based, voluntary mental health services also results in even more coercion and deprivation of liberty.

I have also shared my observation that safeguards supposed to protect persons from arbitrariness and ill-treatment are reduced to mere formalities because they operate in a legal system where persons with mental health problems do not even have a chance to have their voices heard, owing to the profound power asymmetry between the patient and physician in most mental health settings. Judges almost invariably follow the opinion of the psychiatrist over the wishes of the patient, when the law provides for such a possibility. At their worst, such safeguards do little more than ease the conscience of those who are in fact taking part in human rights violations.

My position on coercion in psychiatry and the Resolution of the Parliamentary Assembly should be seen against the background of a growing consensus within the international community to consider involuntary measures without the informed consent of persons with mental health problems as human rights violations, or even as possibly amounting to torture. This is in large part due to the paradigm shift operated by the CRPD when it entered into force in 2008, and the efforts of civil society, in particular of persons with lived experience of mental health problems and psychosocial disabilities, to have their say in policy-making. As a result, a growing number of relevant international and national human rights bodies are now calling for an end to coercion and its replacement by community-based treatment options based on consent. This approach is slowly making headway in the medical community as well, as can be seen in the growing body of WHO guidance to states to reduce coercion, establish community-based alternatives and integrate mental health into primary care. Similarly, the World Psychiatric Association issued a position statement on the need to reduce coercion in October 2020.

This revolution is rooted in the CRPD and it would be a mistake to cling to older Council of Europe standards that place the bar lower. In this context, it is regrettable that work is still continuing in the Council of Europe on a draft Additional Protocol to the Oviedo Convention that reflects an outdated, biomedicine-driven approach reducing mental health to mental disorders and empowering physicians to forcibly confine and treat persons without consent, with virtually no limit being set on the duration of this placement or the treatments to be used. The vagueness of the definitions in this text and the trust in the judgement of a single physician, which appears misplaced given the human rights violations we are still witnessing on a daily basis, could easily give the impression of sanctioning even the worst kinds of human rights abuses in psychiatry. The opposition of the Parliamentary Assembly, several UN bodies including the treaty body of the CRPD, the unanimous protests of representative organisations of persons with psychosocial disabilities and my own opposition to this initiative have so far been ignored.

I call on member states to stop supporting such initiatives at international level, which may create confusion and become a stumbling block to necessary progress in advancing the human rights agenda when it comes to mental health. If new international standards do not nurture the paradigm shift from institutional to community-based care, and from coercive to consent-based care, they should at least do no harm by muddying the waters.

The way forward

A number of member states have started reviewing their mental health legislation in the light of these considerations, for example in Ireland and in the UK. What I found particularly positive with these two examples is the commitment to engage with civil society, and in particular users and providers of mental health services. Initiatives by representative organisations of persons with psychosocial disabilities to promote more inclusive policy-making, for example in the ongoing trialogue in Germany, are also to be commended. The active participation of persons with lived experience of using mental health services in defining policies, in particular, is a sine qua non condition of successful mental health reform, as their exclusion from the debate so far has allowed human rights violations to continue unchecked for as long as they have. This is also a general obligation under Article 4(3) of the CRPD.

The realisation of the right to full enjoyment of the highest attainable standard of mental health depends on the realisation of many other crucial human rights. In particular, member states need to conduct the necessary reforms of their mental health legislation in parallel with reforms in two crucial areas affecting core rights enshrined in the CRPD: legal capacity (Article 12) and the right to live independently and be included in the community (Article 19). Mental health care that truly respects the autonomy, dignity, will and preferences of service users is simply not possible so long as legal systems continue to tolerate substituted decision-making or segregation in institutions. Ongoing legal capacity reforms in our member states are very important in this respect. States must ensure that persons with mental health problems or psychosocial disabilities, including children, never lose their say on decisions involving their health, if necessary by providing the appropriate supports for decision-making, in order to ensure that mental health care is provided on the basis of free and informed consent. For as long as involuntary measures remain a reality, it is also crucial to ensure full access to justice to challenge any decision, an area where there are also some good practices, for example in the Netherlands.

As for institutions, I refer to the longstanding recommendations of my Office to put an end to their use, starting with immediate moratoria on future placements. Experience shows the crucial importance of closing large psychiatric hospitals where persons are involuntarily placed. To take one example, Italy was a pioneer in this respect by initiating a process of gradual closure of psychiatric hospitals from 1978, replacing them with alternatives closer to the community. While Italy is also facing a number of problems regarding the use of coercive measures in psychiatric establishments that still need to be addressed, it should be thought-provoking that the rate of involuntary placements in Italy today appear to be lower, by orders of magnitude, than in neighbouring states.

Reduction of coercive practices in psychiatric services, including the use of restraints and forced medication, and their progressive elimination should be another immediate priority. As mentioned above, the institutional culture and habits largely determine the prevalence of such measures. For example, my predecessor recommended to Denmark in 2013 that recourse to coercion in psychiatry be drastically reduced, and I was happy to note that a psychiatric centre in Ballerup had managed to put an end to the use of restraints as a first in the country, by training staff on conflict management and increasing physical activity for residents, without augmenting medication, for the benefit of both patients and staff.

The ultimate goal must be to replace institutions and a coercion-based mental health system by a recovery- and community-based model, which promotes social inclusion and offers a range of rights-based treatments and psychosocial support options. These can take many different forms and many models exist including, for example, support provided by peers or a support network, patient advocates/personal ombudspersons, advanced planning, community crisis resolution or open dialogue. It is also crucial to deconstruct the lingering stigma associated with seeking help for mental health problems, whether this is done in the school environment, at the workplace or in primary healthcare centres, through targeted awareness-raising and outreach. Only then can mental health services, as an integral part of primary care, be universally available to individuals throughout the entire life cycle. Once more, true involvement of persons with lived experience in the design, implementation, delivery and monitoring of these services is crucial.

Member states can take inspiration from several compilations of promising practices at the European and global levels, as well as ongoing projects and research conducted into community-based delivery of recovery-oriented mental health services, such as the RECOVER-E project running in Croatia, Montenegro, North Macedonia, Bulgaria and Romania. I am also conscious of the potential impact of new technologies on mental health care, which represent both opportunities and serious risks for human rights, and I refer to my general recommendations concerning human rights and artificial intelligence.

In this context, I encourage states to pay special attention to the mental health of children and adolescents, not least because of the extraordinary strain that the COVID-19 pandemic has placed on them. Lockdown measures and prolonged school closures have deprived them, more than other groups, of their usual routines, while exposing them to isolation and an increase in violence and abuse. We should not forget that childhood and adolescence are crucial periods for life-long mental health. Mental ill-health experienced in the formative years of one’s life, for example as a result of adversities or trauma, affects brain development and the ability to form healthy relationships and life skills. Children and adolescents therefore need non-bureaucratic access to mental health support, as early as necessary and as least invasively as possible, without any shame attached. Institutionalisation of children, on the other hand, has a devastating impact on childhood development. We also need to bear in mind that suicide was one of the leading causes of death among adolescents in the European region even before the pandemic, which makes recent evidence of a marked increase in anxiety levels, depression and self-harm among young people particularly alarming. In order to prevent future burdens on mental health systems, it is crucial to expand our capacities for early psychosocial interventions for children by building on innovative and community-based child mental health services, rather than pursuing the worrying trend of ever-increasing use of psychotropic medication on children.

Mental health reform is an extremely challenging task for all our member states, given the complexity of the issues and the huge gap between agreed international standards and the reality on the ground. This, however, makes it all the more urgent. Let us turn the current challenge of the pandemic into an opportunity, by thoroughly transforming mental health services in Europe, with human rights as our guide and compass.

Council of Europe

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