A/HRC/44/48 Participation 60. All people are entitled to active and informed participation in issues relating to their mental health, including at the level of care and support services. Meaningful peer involvement to support individuals accessing services is a critical component of rightsbased support. For many, being “heard” is pivotal to healing in crisis and requires rightsbased support that ensures that diverse, multifaceted communication methods and networks are developed and available. Equality and non-discrimination 61. Everyone, regardless of their diagnosis, the voices they hear, the substances they use, their race, nationality, gender, sexual orientation or gender identity, or other status, is guaranteed the right to non-discrimination in accessing care and support for their mental health. However, discrimination de jure and de facto continues to influence mental health services, depriving users of a variety of rights, including the rights to refuse treatment, to legal capacity and to privacy, and other civil and political rights. 62. Respecting the broad diversity of how human beings process and experience life, including their mental distress, is critical to ending discrimination and facilitating equity in mental health provision. The obligation to respect diversity requires establishing a diverse package of options for people seeking care and support. “One size fits all” care models (in the absence of alternatives), particularly those which favour a rigid biomedical narrative of psychosocial distress, are not considered compliant with the right to health. Peer-led initiatives, harm-reduction approaches, and co-produced models of care and support offer much promise in facilitating flexible, non-discriminatory and respectful therapeutic alternatives. Diversity of care: acceptable and quality responses 63. In addition to the obligation that rights-based alternatives be available in sufficient numbers and accessible, they must also be acceptable and of sufficient quality. 64. Acceptable and high-quality therapeutic relationships between providers and users of services must be based on mutual respect and trust. However, trends persist in modern mental health legislation and clinical practices worldwide that still allow the proliferation of non-consensual measures. Coercion erodes trust in mental health services and cannot be viewed as aligned with a rights-based approach. 65. Any rights-based support must be respectful of medical ethics, as well as culturally appropriate, sensitive to gender and life-cycle requirements and designed to respect confidentiality and empower individuals to control their health and well-being.42 It must respect the principles of medical ethics (including “first, do no harm”), choice, control, autonomy, will, preference and dignity. 43 Overreliance on pharmacological interventions and the use of institutional care is inconsistent with quality care provision. 66. Quality, rights-based supports require the use of evidence-based practices for treatment and recovery, particularly through continuity of care. Effective collaboration between different service providers and people using the services and their families and care partners, also supports enhanced quality of care. The abuse of biomedical interventions, including the inappropriate use or over-prescription of psychotropic medications and the use of coercion and forced admissions, compromises the right to quality care. Underlying social and psychosocial determinants of mental health 67. States must facilitate, provide and promote conditions in which mental health and well-being can be realized; that requires the provision of interventions that can protect populations from key risk factors for poor mental health. It requires action outside the traditional health sector in homes, schools, workplaces and communities. It also requires the therapeutic focus (alongside structural efforts by duty bearers) to extend beyond the individual to social healing, community strengthening and the promotion of a healthy 42 43 Committee on Economic, Social and Cultural Rights, general comment No. 14, para. 12 (c). Convention on the Rights of Persons with Disabilities, preamble and arts. 12, 15 and 19. 15