A/HRC/39/36 recovery-based services and inclusion in the community. Mr. Njenga described the work of Users and Survivors of Psychiatry in Kenya — in documenting peer support as a tool for supported decision-making, boosting agency and autonomy for individuals as it provided a safe space for sharing of experiences and information, developing collective knowledge, and providing advice and support in risk-taking. He said that peer-support group meetings might entail discussion of day-to-day decisions and decisions with legal and financial consequences, and that members discussed medication and treatments, were informed about their human rights and were supported in claiming them (e.g. refusing treatment). He noted that, over time, members became more assertive about making their own decisions, and regaining control of their lives as empowered agents, rather than as objects of treatment. He mentioned the commitment by the Government of Kenya to scale up the operation he had described, to establish peer-support groups across the country, motivated by the findings of Users and Survivors of Psychiatry in Kenya. 29. Sashi Sashidharan, of the University of Glasgow, celebrated the paradigm shift anticipated by the Convention on the Rights of Persons with Disabilities, but regretted that there had been little progress in the area of mental health. Nonetheless, he argued that all actors involved could carry out microtransgressions of the current paradigm by engaging in practices and experiences that challenged it. He described the experience of employing persons who had real-life experience of mental health problems as part of every community mental health team, with equal pay, which made a significant difference to integrating peer support, establishing advanced directives and ensuring choice of treatment. Furthermore, Governments could set simple targets for services, in order to reduce admissions under their mental health act. Mr. Sashidharan highlighted the creation of crisis-resolution home treatment teams, available 24 hours and 7 days a week, to support people in crisis at home, which had served to decrease the number of compulsory admissions. He commended the example from Norway on medication-free alternatives. He argued that the most difficult challenge was to reform the current practice of forensic psychiatry, as there was no evidence to support its effectiveness, despite 18 per cent of mental health resources being spent on locking people up in psychiatric care. 30. During the interactive dialogue, representatives of the World Network of Users and Survivors of Psychiatry, the Indonesian Mental Health Association, the Centre for Inclusive Policy, Autistic Minority International and We Shall Overcome, and of the Plurinational State of Bolivia and the United Kingdom of Great Britain and Northern Ireland, took the floor. The issues raised included: the benefits of peer support detached from the mental health system; psychiatry as the gatekeeper for access to public services, such as housing; how to “demedicalize” resources invested in support services in the community that did not need to be attached to the mental health system; and the need to confront discrimination against autistic persons based on pathologization and diagnosis leading to prevention measures and therapies that denied the preservation of and respect for autistic identity. The Plurinational State of Bolivia addressed concerns about the funding of medicalization, and about the biomedical perspective, and the United Kingdom stressed the urgent need to tackle stigma, abuse, forced treatment, and unlawful or arbitrary institutionalization. In the context of the draft additional protocol to the Oviedo Convention, the withdrawal of Portugal from that process was commended, and a call was made to other States to follow that good example for fulfilment of the obligations enshrined in the Convention on the Rights of Persons with Disabilities. 31. Panellists gave various responses concerning psychiatry as a gatekeeper to services, emphasizing that psychiatry should be one choice among many. Panellists warned that peer work organized by psychiatrists risked legitimizing traditional treatment and might remove power from the peer movement, and emphasized the need for approaches that contributed to empowering individuals. It was affirmed that the priority should be to ensure autonomy and dignity, restoring voice, power and choice to persons with psychosocial disabilities, and also that there was a need to shift from a model of containment to a model of recovery and inclusion in mental health. Panellists presented positive examples of practices regarding peer support and peer certification, and observed that peer support helped overcome the trauma linked to having been forcibly removed from the community (through forced hospitalization). They noted the positive impact of peer support in liaising with police and hospital staff to prevent such trauma. Speakers highlighted the lack of research and 10

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