A/HRC/44/48 IV. Rights-based approaches to alternatives: defining features, foundational principles and the application of a normative framework 50. The Special Rapporteur has frequently been approached by mainstream service providers, lawyers, judicial officials and policymakers about how practically to promote the rights of those in the most vulnerable situations without coercion. “What is the alternative?” is a familiar question in these exchanges. What seems largely absent from global and national discussions is the promise of many alternatives in place around the world, often operating on the fringes of health systems or entirely outside them, which have for decades been transforming lives without coercion and within the community. 51. The Special Rapporteur has visited many of these “alternatives”, meeting inspiring innovators working tirelessly and often against insurmountable systemic obstacles. These peer workers, health professionals (including progressive psychiatrists), social workers and human rights defenders are to be commended for their conviction in plotting a course away from coercive medicalization towards humane, compassionate and rights-based support for those experiencing serious psychic distress. The Special Rapporteur expresses his solidarity with and gratitude and admiration for the many individuals working worldwide who contribute every day to moving the global community towards the elimination of discriminatory practices in mental health care. A. Scaling up alternatives as a core obligation under the right to health 52. The right to health contains the core obligation to ensure the “right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups”. 39 While many people have found support and healing from traditional mental health services, there are many who have not. Those who have been failed or harmed by mental health systems (including people struggling with serious psychosocial difficulties, often at the intersection of trauma, abuse, being young, being from an ethnic or racial minority, or in situations of poverty) must be viewed as belonging to a vulnerable or marginalized group. They are left furthest behind by absent or inappropriate, biomedically dominant, mental health systems in different resource settings. States, therefore, have an immediate obligation under the right to health to take action to ensure the availability of appropriate and acceptable services and rights-based support. That requires the immediate scaling-up of rights-based, non-coercive alternatives. 53. Prioritization around so-called mild (common) mental health conditions, which has been advanced by international financial institutions and global health actors, is insufficient for meeting core obligations on the right to health. The starting point for a rights-based transformation must be to address the crisis of those left languishing in coercive health systems and those entering mental health systems with intellectual, cognitive or psychosocial disabilities and unable to access community-based support because the alternatives remain woefully underinvested and unavailable. B. Alternatives models of mental health services as human rights in practice: key concepts and principles of rights-based support 54. Such alternative practices with transformative potential have been in existence for decades, with many shown to be effective. They take many shapes and forms, from the commendable global work of WHO with its QualityRights initiative on improving the quality of mental health care and services, to systems-level community health reforms in Brazil and Italy, to highly localized innovations in different resource settings around the world, such as Soteria House, Open Dialogue, peer-respite centres, medication-free wards, 39 Committee on Economic, Social and Cultural Rights, general comment No. 14 (2000) on the right to the highest attainable standard of health, para. 43. 13