91¶ÌÊÓƵ

Adopted by the 47^th 91¶ÌÊÓƵ General Assembly, Bali, Indonesia, September 1995
and revised by the 57^th 91¶ÌÊÓƵ General Assembly, Pilanesberg, South Africa, October 2006,
by the 66^th 91¶ÌÊÓƵ General Assembly, Moscow, Russia, October 2015
and by the 77th 91¶ÌÊÓƵ General Assembly, Rotterdam, the Netherlands, October 2026

PREAMBLE

To achieve the highest standard of health, mental health and well-being must be valued, funded and supported equally with physical health. Well-being is defined herein as a complex combination of a person’s physical, mental, emotional and social health factors. Over one billion people live with a mental illness making it one of the largest contributors to the global burden of disease.

Anxiety and depressive disorders remain the most prevalent and rates continue to rise. Globally, over 700,000 people die from suicide each year[1]. Mental health and well-being should be treated as a public health priority and human rights imperative, reflected in parity in funding, access and outcomes.

The adoption in 2006 of the constituted a major step towards equality for all people. It aims to promote, protect and reinforce the human rights and dignity of all persons with disabilities, including those with mental health conditions. As early as 1966 the International Covenant on Economic, Social and Cultural Rights³ addressed the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

The identification of mental health and wellbeing for accelerated implementation of the World Health Organisation (WHO) 13^th General Programme of Work (GPW13) constituted a major step in reaching mental health parity[2]. The WHO warns that changing social and environmental factors, such as poverty, violence, inequality and environmental deprivation, can increase the risk of experiencing mental health conditions. The use of psychoactive substances can also contribute to their onset or exacerbate their progression. The inclusion of mental health as part of universal health coverage is now being raised as an important necessity.

In a call to action, the WHO and the Office of the United Nations High Commissioner for Human Rights (OHCHR) envisioned a world where everyone can lead healthy lives and have access to affordable, high-quality mental health services that use a mental health paradigm based on rights, centered around each person; and where persons with mental health conditions and psychosocial disabilities can fully engage in their own recovery and participate in all areas of life. In 2023 a was developed to assist countries in adopting, amending, or implementing legislation related to mental health and wellbeing. Specifically, the guidance encourages the integration of mental health into general legislation rather than the adoption of mental health-specific laws. Where a stand-alone law already exists, it should be reviewed by countries to prevent separate or distinct regulation and ensure protection of patient rights and anti-discrimination.

This statement takes a broader view, beyond the biomedical paradigm of diagnosis, medication and symptom reduction, and takes account of central ethical responsibilities, social determinants including the social, economic and physical environments people are exposed to. Structural social determinants including poverty, homelessness, discrimination, unemployment, inequality, inadequate access to education and healthcare, and involvement in the criminal justice system significantly increase the risk of mental health conditions. Environmental and life-experience factors including violent conflict, forced displacement, early childhood trauma and human rights violations contribute substantially to the global mental health burden. The mental health effects of war and armed conflict, as well as the resulting forced displacement, are evident in many regions of the world. These effects include mental illnesses such as anxiety, depression, post-traumatic stress disorder (PTSD), adjustment disorder, psychosis, and substance dependence. Civilians, especially those who have experienced life-threatening events, are at risk for PTSD. Digital environments that promote social comparison, harmful content, or social disconnection also contribute to the global mental health burden.

Therefore, an appropriate paradigm should also cover trauma-informed, recovery-oriented, and community-based approaches and address social determinants through intersectoral collaboration.

People with serious and chronic mental health conditions often have significant needs because they are more likely to live in circumstances of discrimination and vulnerability. They also commonly experience other co-morbidities. They have the same right to health care as any other patient, including equal access to preventive services and therapeutic interventions aimed at promoting health and treating non-psychiatric conditions and to medical imaging services, given the organic basis of certain disorders. The rapid expansion of digital mental health tools, telepsychiatry, and AI-enabled decision support, parallel to some benefits, introduces new ethical risks related to privacy, autonomy, algorithmic bias, and clinical accountability. Valid informed consent, data minimisation, and safeguards against discriminatory secondary use are essential.

The development and deployment of commercial algorithms designed to exploit psychiatric vulnerabilities or emotional states for profit should be prohibited, and strict regulations should be imposed against the unauthorised secondary use or monetisation of mental health data by third-party digital platforms.

Health care professionals have the same ethical obligations to all patients, including those patients with mental health conditions, for whom some ethical obligations have particular weight and importance.

The physician’s primary obligation is to the health and well-being of the patient. Where there is an imminent and serious risk of significant harm to the patient or others, disclosure of confidential information without the patient’s consent may be necessary to safeguard a significant and overriding ethical obligation, after all other possible solutions have been exhausted and in keeping with the International Code of Medical Ethics.

RECOMMENDATIONS

The 91¶ÌÊÓƵ encourages all medical associations, governments, policy makers and other stakeholders as well as physicians and other health care personnel to:Ìý

Fulfil ethical obligations to patients affected by mental health conditions

1. Particular attention should be paid to the assessment of decision-making capacity, the use of appropriate consent mechanisms, and protection against undue influence.

2. Physicians should ensure patient treatment in accordance with the principles of the International Code of Medical Ethics and the 91¶ÌÊÓƵ Declaration of Lisbon.

3. When conducting research involving patients affected by mental health conditions, physicians are duty-bound by the Declaration of Helsinki principles. Patients with mental health conditions should be meaningfully included in research design, oversight, and dissemination in line with the provisions of the CIOMS International Ethical Guidelines for Health-related Research Involving Humans.

4. The collection, storage and use of health data of patients affected by mental health conditions must follow the Declaration of Taipei principles.

Elevate Mental Health to Equal Priority with Physical Health

5. Treat mental health and well-being as integral to achieving the highest standard of health.

6. Ensure mental health is embedded in all public health strategies and policies.

7. Ensure that patients with mental illness have equal access to the full continuum of physical health care, including screening, diagnosis, referral, and treatment and that clinical assessments are not distorted by diagnostic overshadowing.Ìý

8. Ensure that medical confidentiality is upheld, as it constitutes a fundamental safeguard of patients’ rights and an essential element of the relationship of trust between physicians and their patients.

Integrate Mental Health into Universal Health Coverage

9. Make high-quality, affordable mental health services available to all.

10. Provide care that is rights-based, patient-centred, and empowers individuals in their recovery, including access to peer support, psychosocial interventions and shared decision-making.

11. Advocate for the provision of adequate funding, capacity building, and protection of mental health budgets from reallocation.Ìý

Address Social Determinants of Mental Health

12. Encourage governments to address the social and commercial determinants of mental ill health such as adequate housing, good-quality employment and our surroundings.

13. Recognise and respond to the impacts of war and violent conflict, displacement, environmental change, and other global crises on mental health.

14. Promote protected time for training for healthcare workers to recognise and navigate these social barriers effectively.

15. Work to strengthen patient autonomy by implementing measures that reinforce the patients’ own decision-making capacity.

16. Urge governments and policymakers to establish robust, evidence-based legislative frameworks and regulatory safeguards – similar to emerging international models – to manage and restrict youth access to harmful digital platforms and social media algorithms, thereby fulfilling a public health and state obligation to protect developing minds from digital exploitation and systemic mental health risks.Ìý

Shift from a Narrow Biomedical Model to holistic careÌý

17. Develop early intervention programs, including school-based programs, to address the rise in youth mental health conditions.

18. Any measure involving care without consent must be strictly necessary and proportionate to the circumstances of the person concerned. It may only be implemented for a limited period, under the supervision of a judge and subject to regular medical reassessment.

19. Guard against harm from over-medicalisation: be mindful of medication side effects, over-treatment, and interventions that may worsen mental health. Ensure that early intervention is evidence-based and does not pathologise normal distress.

Protect and Promote Human Rights in the Treatment of Mental Health

20. Align national mental health laws with .

21. Integrate mental health and wellbeing provisions into general legislation rather than relying solely on mental health–specific laws.

22. Respect patients’ right to make decisions about their own care, including the right to refuse treatment.

23. For children and adolescents, ensure consent processes are developmentally appropriate: seek the young person’s assent, give due weight to their views according to age and maturity, and – where parental or guardian consent is legally required – involve parents/guardians while preserving the young person’s confidentiality to the greatest extent compatible with safety and legal obligations. Assess decision-making capacity on a case-by-case basis and do not infer incapacity solely from age, diagnosis, or disability.

24. Actively minimise the use of non-consensual and coercive practices, such as involuntary admission and mechanical restraints, ensuring they are used only as an absolute last resort under strict, time-limited, and independent human rights and legal oversight.

25. Legal capacity: Patients living with mental health conditions have the right to exercise their legal capacity on an equal basis with others. Make supported decision-making available, including the use of advance directives and the involvement of a person of trust where the patient so wishes, and ensure that any recourse to substitute decision-making is exceptional, proportionate, limited in time and subject to independent review.

26. Wherever involuntary treatment or compulsory hospitalisation is permitted under national law, ensure that it is subject to strict procedural and substantive safeguards including a least-restrictive-option requirement, independent judicial review, the right to legal representation, and regular review and that supported decision-making alternatives are developed and promoted. The 91¶ÌÊÓƵ opposes the use of involuntary treatment as a default response to mental health conditions and calls for progressive reduction of coercive practices.

27. Where a patient’s decision-making capacity is affected, involve supported or substitute decision-makers who act in the patient’s best interest and reflect the patient’s own values and preferences.

28. Promote the recognition and use of psychiatric advance directives, allowing individuals to express their treatment preferences in advance of a potential loss of decision-making capacity, and establish supported decision-making frameworks as an alternative to substituted judgment. Use involuntary treatment only when legally authorised, ethically justified, and with the least restrictive approach possible.

29. Approach ethically complex end-of-life situations with due care and in accordance with applicable law and professional guidance.

30. Protect physicians and healthcare professionals from legal penalisation, criminalisation, or political interference when providing evidence-based, compassionate, and ethically sound mental health care to historically marginalised populations, including gender-diverse and LGBTQ+ individuals.

31. Professional boundaries: Maintain professional boundaries and avoid dual relationships – financial, supervisory, intimate, or dependency-creating – that could impair clinical judgment.

32. Minimise stigma: Actively minimise stigma: avoid language or actions that reinforce prejudice or discrimination against people living with mental health conditions.

Strengthen Global and National Commitment to Mental Health Care

33. Recognise mental health and well-being as a public health priority and a human rights imperative.

Foster Education, Health Workforce and Research in Mental Health Treatment

34. Include the appropriate knowledge and skills in medical schools, residencies, and other training programs to enable graduates to recognise, diagnose, and treat mental health conditions including depression, either as the chief complaint or with another general medical condition. Practising physicians providing clinical care should acquire and maintain the same knowledge and skills.
35. Strengthen initial and continuing physician education by integrating the social, environmental and cultural determinants of mental health, as well as the skills needed for identification, support and interdisciplinary work.

36. Provide adequate training and institutional support for physicians and frontline health care professionals to ensure safe, ethical, and non-discriminatory care, particularly in high-pressure and resource-limited clinical settings.

37. Ensure an adequate supply of psychiatrists and other specialist mental health professionals, while also building the capacity of primary care physicians and community health workers to identify, assess, and manage mental health conditions, particularly in rural, and underserved settings.

38. Support additional research involving patients with mental health conditions, in accordance with established ethical standards and safeguards.

Recognise the Importance of Physician Mental Health

39. Mandate institutional accountability to provide safe working conditions, manageable workloads, and accessible psychological support systems for health care workers, in alignment with the 91¶ÌÊÓƵ Statement on Physician Mental Health Care and the 91¶ÌÊÓƵ Statement on Physician Well-Being, recognising that structural reforms are essential to prevent professional burnout.Ìý

Protect the Rights in the Digital Era

40. Telepsychiatry may be used when clinically appropriate, acceptable to the patient, and in the patient’s best interests, including to improve access for patients facing geographical, mobility, disability-related, language, stigma, security, or resource barriers. It should include informed consent, reliable identification of patient and physician, privacy and data protection safeguards, clear clinical accountability, emergency and referral pathways, and access to in-person assessment when clinically necessary or preferred by the patient.
41. Patients have the right to be informed when artificial intelligence or automated decision-support tools are used in their assessment, diagnosis or treatment, and to a meaningful human review of any resulting decision. Such tools should be validated, monitored for bias and used in a manner that protects privacy; clinical responsibility remains with the physician and may not be delegated to an automated system.

[1] , World Health Organization, 2022

[2]