A/HRC/41/34
F.
Participation
32.
The realization of the right to health requires the participation of everyone,
particularly those living in poverty and those most excluded from society, in decisionmaking at all levels of public policy relating to mental health. Participation is only possible
when all populations are recognized, respected and included in social conditions and
structures. Enabling and resourcing civic space and building transparent health and social
information systems will strengthen the right to participation and are essential for engaged
and inclusive promotion of mental health. Populations and individuals must be provided
with the space and resources necessary for civic debate and community action that can
empower communities to develop strategies that shape their own well-being. Supporting
members of civil society as key stakeholders in delivering action to promote health will
foster the diversity of the community responses required to promote holistic well-being,
offering diversity and autonomy to those seeking care and support rather than paternalism
and coercion.
33.
Meaningful participation has been undermined by entrenched power asymmetries
within traditional mental health settings (see A/HRC/35/21). Trust, the bedrock of
therapeutic relationships, has been corroded, particularly where coercive and paternalistic
practices are prioritized. User-led advocacy initiatives, peer support networks and, vitally,
new working methods, such as co-production based on genuine equality for people with
lived experience of mental health conditions and services,18 are essential to restoring trust
and building new alternatives. Such alternatives should ensure representative and
meaningful participation to shape mental well-being and interventions. User-led research,
with its emancipatory traditions in the production of knowledge and evidence, should be
accorded equal standing to other approaches in the formulation of mental health policies
that are compliant with human rights obligations.
34.
Laws, policies and practices that restrict the operation of civil society are
retrogressive in nature and cannot be seen as compliant with the right to health. While
everyone has the right to participation, persons in vulnerable situations should in particular
be included in all mental health-related decision-making. This approach requires accepting
that the biomedical model in mental health care does not work for everyone, and that its
overuse has left countless people behind. Only with such acceptance, which requires
political will and decisions, can people with intellectual, cognitive and psychosocial
disabilities and other mental health conditions be empowered as active agents who can
define their experiences and the type of support they need.
35.
Innovation in the promotion of mental health must be defined and created at the
local level, with communities, individuals and families, which requires a shift to shared
policy action that does not fit easily into one silo or into one ministry. Space for such
innovation must be created in the civil, political and social realms.
G.
Non-discrimination
36.
The right to mental health is dependent on non-discrimination in the enjoyment of
all other human rights and is itself a critical determinant of mental health and well-being.
Discrimination on any ground, within and beyond mental health settings, is both a cause
and a consequence of poor mental health.
37.
Harmful stereotypes (including gender stereotypes) and stigmatization in the
community, family, school and workplace settings undermine healthy relationships,
dismantling the supportive and inclusive environments that are required for the good mental
health and well-being of everyone. Discriminatory attitudes that increasingly influence laws,
policies and practices undermine the social structures required to support well-being and
inclusion. Xenophobia and intolerance create hostile emotional and psychosocial
18
8
See Peter Beresford and Sarah Carr, eds., Social policy first hand: An international introduction to
participatory social welfare (Bristol, Policy Press, 2018). See also A/HRC/35/21.
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