A/HRC/44/48 I. Introduction 1. There is no health without mental health. The rich links between mind, body and the environment have been well-documented for decades. As the third decade of the millennium begins, nowhere in the world has achieved parity between mental and physical health and this remains a significant human development challenge. An important message within that collective failure is that without addressing human rights seriously, any investment in mental health will not be effective. Attacks on universal human rights principles threaten the physical, political, social and economic environment, and actively undermine the struggle for positive mental health and well-being. 2. The global message is clear: there can be no good mental health without human rights. More than 70 years ago, the Charter of the United Nations established the three founding pillars of the United Nations system: human rights, peace and security, and development. These equally weighted elements are a framework for shared responsibility across the spectrum of multilateral activity, including mental health. Conversely, the promotion and protection of the mental health and well-being of everyone, starting from early childhood, is critical to supporting all three pillars. That indicates the significance of how stakeholders invest in mental health so that a transformative paradigm is developed to help the global community prepare for a radically different, just and more peaceful future. 3. Throughout his term, the Special Rapporteur has sought to amplify the importance of mental health within the right to health and to elevate the unique and interdependent relationship between mental health and the full enjoyment of all human rights. Since his report to the Human Rights Council in 2017 (A/HRC/35/21), mental health has continued to grow in prominence on the global stage. While that international recognition is welcome, much more is needed in the global, regional and national conversations around how to understand and respond to mental health. Those discussions and related actions must be rights-based, holistic and rooted in the lived experience of those left furthest behind by harmful sociopolitical systems, institutions and practices. In his final report to the Human Rights Council, the Special Rapporteur reflects on the progress made in the global movement towards a rights-based mental health praxis. II. Global health: progress, challenges, common ground and a fractured consensus 4. Global mental health refers to both a specific movement, the Movement for Global Mental Health, which aims to scale up access to mental health services, and to a wider more disparate field of advocacy, activism and research, including critical perspectives. How global mental health is and has been framed is of vital importance to the construction of global priorities for how global mental health is defined and delivered, and subsequently how human rights can be promoted or undermined. 1 A. Contextual entry points and priorities 5. Differences within and between low-, middle- and high-income countries provide very different entry points to understanding the meanings of, and advocacy around, mental health and related disabilities. Context is essential. Some countries have an entrenched colonial psychiatric system, while others have no formalized psychiatric system at all. Many countries have experienced colonialism, and its links to psychiatry, very differently. 6. Political and social systems provide different narratives of how good mental health can be structurally undermined by the environment upstream that political choices create. The Special Rapporteur has previously emphasized how the underlying and social determinants of health can be detrimental to the mental health of individuals and societies within and beyond mental health-care systems. Those harms can arise from systemic 1 See Alison Howell, China Mills and Simon Rushton, “The (mis)appropriation of HIV/AIDS advocacy strategies in global mental health: towards a more nuanced approach”, Globalization and Health, vol. 13, No. 44 (2017). 3