Psychiatric therapeutics is facing a major crisis that originates from its limited efficacy and dubious scientific credibility. Such a crisis requires a radical change in the paradigm that inspires psychiatric research and clinical practice. The new paradigm should integrate in a meaningful way all of the variables that mediate the aetiology and pathogenesis of psychiatric disorders: biological, psychological, developmental, behavioural and social. The essence of the evolutionary study of human psychology and behaviour is just such an integration. Therefore, evolutionary thinking has great potential to improve the clinical care of psychiatric patients. According to a modern view of medicine, the aims of therapy are not only to lessen symptoms and to reverse the pathogenic mechanisms, but also to restore the congruence between a patient’s functional capacities and the conditions of the environment. Evolutionary thinking suggests replacing symptoms with functional capacities as the primary targets of psychiatric treatment. Most mental disorders are conditions of compromised functional capacities. Therapy should aim at improving patients’ capacities necessary to enact behaviours associated with goal achievement. When treating patients, clinicians should distinguish between symptoms caused by dysfunctional mechanisms and symptoms that are adaptive reactions to environmental situations with negative cost–benefit outcomes.

Applying normative and practice-based approaches, this chapter clarifies the evolving application of human rights to mental health through the normative expansion of the right to health and the rights of persons with disabilities and the emerging psychosocial approaches to mental health services and policy. It examines the challenges mental disability poses for the full enjoyment of human rights, and the responses of the human rights framework, as well as the integration of a normative and practice-based approach to human rights and mental health. Comparing the rights defined in the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care (MI Principles) and those in the Convention on the Rights of Persons with Disabilities (CRPD), it demonstrates that the enumeration of rights defined in these two essential documents on mental health and human rights underscores that the mental health–specific provisions of the MI Principles add to the normative content of the corresponding articles of the CRPD and the latter provide legally binding force to the corresponding nonbinding pronouncements of the MI Principles. The conclusion proposes some guidelines for mental health practice and the application of human rights norms to mental health.