A/HRC/39/36 21. Dr. Alberto Minoletti, of the University of Chile, provided an overview of mental health reform in Chile from 1990 to 2018, outlining the main achievements, which had included increased availability, accessibility and quality of community mental health services, and social inclusion for persons with psychosocial disabilities. Over the years, there had been a reduction in the number of inpatient stays in mental health facilities, as well as a reduction in levels of coercion, abuse and violence within those services. Legal reform measures had included protection of the right to informed consent for treatment and research, restrictions on involuntary hospitalization, prohibition of psychosurgery, and the establishment of a monitoring agency to protect the rights of persons using mental health services. While challenges remained, those changes had increased inclusion in the community with comparatively few resources. 22. Dr. Roberto Mezzina, of the Azienda Sanitaria Universitaria Integrata, in Trieste, described the mental health reform in Italy, which had led to a deinstitutionalization process involving the closure of psychiatric hospitals (between 1978 and 1999) and forensic hospitals (in 2017). Law No. 180 of 1978 had recognized human rights as a key tool in mental health care, which had led to a shift within psychiatry and to the wider provision of welfare and services in the community, centring on the person rather than the diagnosis. That approach required proactive and assertive care, rapid responses to crises, open doors, no restraint, and continuity of care and practices following the principles of choice, personalization and rights, the objective of which was to promote shared responsibility, dialogue, recovery, and early support. He described the model operating in the Veneto region, which had an assessment and emergency unit placed within the general hospital as a point of first contact, and a home treatment team that applied the principle of open dialogue. Some 94 per cent of the mental health budget was spent within the community. It facilitated the tailoring of recoveries in an individual way, within an overarching approach, which emphasized that liberty was not the outcome of care, but rather a precondition for it. He highlighted the need to ensure the social determinants of health in order to achieve equality and overcome exclusion, which included stability in connection with one’s home, work, income, social support and relationships. He stressed the importance of involving stakeholders, including service users, fostering therapeutic alliances that respected individuals’ will and preferences, and prioritizing participation as central to democracy and social justice. 23. A human rights expert, Dr. Amalia Gamio, referred to the persistent gap in terms of respect for human rights in the context of mental health care, owing to prejudice and stigma, which increased the risk of violations such as forced treatment, including forced sterilization. She remarked that insufficient attention was paid to equal recognition before the law, as enshrined in article 12 of the Convention on the Rights of Persons with Disabilities. She called for urgent structural reform, to explicitly prohibit institutionalization and forced treatment, to develop community-based strategies, and to ensure resources, capacity-building and monitoring at all levels. She shared a positive example of cooperation by more than 30 organizations, which had led to the successful withdrawal of the mental health bill in Mexico because it would have continued to allow involuntary internments. She commended the Political Constitution of Mexico City, which explicitly recognized the legal capacity of all individuals and which would come into force in September 2018. 24. During the interactive dialogue, representatives of the Plurinational State of Bolivia, of Ecuador, and of civil society — namely the Citizens’ Commission on Human Rights, We Shall Overcome and Salud Mental España — took the floor. The delegates from the Plurinational State of Bolivia and from Ecuador shared good practices from their respective countries to promote human rights in mental health care, which included prioritizing the quality and accessibility of services within the community, and eliminating social exclusion through participation in decision-making processes. Speakers reiterated the call to shift from the biomedical model and deprivation of liberty in mental health care, to increased focus on the root causes and social determinants to promote a recovery approach. They also called for increased attention to be paid to the multiple and intersecting forms of discrimination operating within mental health systems, which had a disproportionate impact on women with psychosocial disabilities. The representative of We Shall Overcome shared the example of the introduction of medication-free wards in Norway, an initiative that had 8