A/HRC/44/48 12. The Bali Declaration of August 2018, issued by Transforming Communities for Inclusion-Asia Pacific, was composed by persons with psychosocial disabilities and crossdisability supporters from 21 countries of the Asia-Pacific region. They affirmed the need for a paradigm shift in mental health towards inclusion and away from a focus dominated by the medical model. Instead of focusing efforts on reform systems that violate rights, the focus should be on developing and strengthening existing movements for the non-violent, peer-led, trauma-informed, community-led programmes, healing and cultural practices preferred by local groups of persons with psychosocial disabilities, attentive to the movement of non-medical alternatives and progressive community support worldwide. Similar approaches are shared by organizations in other regions, such as Mental Health Europe. This advocacy direction is an important means to transform the global conversation and rebalance it away from the expansion and improvement of services as the main response to mental health and from the impetus in global mental health to scale up access to mental health for all, especially in low- and middle-income countries.5 B. Participation and power: a global perspective 13. The participation of persons with mental health conditions, including persons with disabilities, in the planning, monitoring and evaluation of services, in system strengthening and in research, is now more widely recognized as a way to improve the quality, accessibility and availability of services and the strengthening of mental health systems. 6 Promising evidence and guidelines in this area exist in high-income countries:7 the Special Rapporteur has observed promising practices in “medication-free” treatment wards in Norway and in a rights-based pilot project in Sweden, where the use of peers has been employed to confront power asymmetries and support dialogical, non-coercive approaches. There is little evidence available to show where and how this has been done in low- and middle-income countries, particularly at the systems or policy level. 14. While empowerment is often referred to, power has been a neglected topic in global mental health. Recently, some attention has been paid to the need to rebalance power towards local actors to mitigate the “inappropriate application of ideas not well-suited to local needs”.8 In that context, equalizing global power dynamics is a promising pathway towards rights-based transformation across all resource settings. All States, regardless of income level, remain embryonic in their status of development towards integrating new normative frameworks and practices that can liberate the field of mental health from discriminatory and other outdated attitudes and practices. 15. However, discussions about power in global mental health decision-making, agendasetting and knowledge production remain largely absent. In addition, the global literature is less prominent in engaging with the research and literature conducted and written by those who identify as service users or psychiatric survivors, or as persons with psychosocial disabilities. Much of that research and literature originates in the global North, which means that participation does not necessarily extend to persons with disabilities living in low- and middle-income countries.9 16. Emerging power dynamics within the psychiatric profession have traditionally reinforced the status quo dominated by the biomedical paradigm. However, psychiatry is not a monolith and many members of the psychiatric community across all regions are 5 6 7 8 9 approaches to mental health in Kenya”, doctoral dissertation, Harvard T.H. Chan School of Public Health (May 2019). See Lancet Global Mental Health Group, “Scale up services for mental disorders: a call for action”, The Lancet, vol. 370, No. 9594 (October 2007). See Angela Sweeney and Jan Wallcraft, “Quality assurance/monitoring of mental health services by service users and carers”, WHO Regional Office for Europe; and Graham Thornicroft and Michele Tansella, “Growing recognition of the importance of service user involvement in mental health service planning and evaluation”, Epidemiology and Psychiatric Sciences, vol. 14, No. 1 (March 2005). National Survival User Network, “4Pi national involvement standards” (2013). See Julian Eaton, “Rebalancing power in global mental health”, International Journal of Mental Health, vol. 48, No. 4 (2019). See Pan-African Network of People with Psychosocial Disabilities, “Voices from the field. The Cape Town Declaration (16 October 2011), Disability and the Global South, vol. 1, No. 2 (2014). 5