A/HRC/35/21 persons. Many within those populations are needlessly medicalized and suffer from coercive practices, based on inappropriate and harmful gender stereotypes. 59. Special attention should be paid to women, who suffer disproportionately from mental health practices that are based on paternalistic and patriarchal traditions, inappropriate and harmful gender stereotypes, medicalization of women’s feelings and behaviour, and coercion. Women who have suffered from violence and inequalities within their families, communities and societies, and who have mental health conditions very often face situations in mental health settings that amount to violence, coercion, humiliation and disrespect for their dignity. It is unacceptable that after suffering from violations in family and other settings, women suffer from violations again within services that are supposed to promote their mental health. In that regard, it is very important to emphasize that violations of sexual and reproductive health rights have a direct, negative impact on the mental health of women. Quality 60. Mental health services must be of good quality. That requires the use of evidencebased practices to support prevention, promotion, treatment and recovery. 41 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 overprescription of psychotropic medications and the use of coercion and forced admissions, compromise the right to quality care. Prioritizing the scaling-up of community-based psychosocial services and mobilizing social resources that can support everyone throughout their life course, will enhance the quality of services. 61. The element of quality compels going beyond the idea of users as mere recipients of care towards their full consideration as active holders of rights. To stop discriminatory practices, States should rethink the way they provide mental health care and support (see A/HRC/34/58). 62. In particular, children and adults with intellectual disabilities and with autism too often suffer from institutionalized approaches and excessively medicalized practices. Institutionalizing and medicating children with autism, based on their impairment, is unacceptable. Autism represents a critical challenge to modern systems of care and support, as medical attempts to “cure” the condition have often turned out to be harmful, leading to further mental health deterioration of children and adults with the condition. Support for them should not only address their right to health, but their rights to education, employment and living in the community on an equal basis with others. G. Informed consent and coercion 63. Informed consent is a core element of the right to health, both as a freedom and an integral safeguard to its enjoyment (see A/64/272). The right to provide consent to treatment and hospitalization includes the right to refuse treatment (see E/CN.4/2006/120, para. 82). The proliferation of paternalistic mental health legislation and lack of alternatives has made medical coercion commonplace. 64. Justification for using coercion is generally based on “medical necessity” and “dangerousness”. These subjective principles are not supported by research and their application is open to broad interpretation, raising questions of arbitrariness that has come under increasing legal scrutiny. “Dangerousness” is often based on inappropriate prejudice, rather than evidence. There also exist compelling arguments that forced treatment, including with psychotropic medications, is not effective, despite its widespread use. 42 41 42 14 WHO Mental Health Action Plan 2013-2020, p. 9. See Steve R. Kisely and Leslie A. Campbell, “Compulsory community and involuntary outpatient treatment for people with severe mental disorders”, Cochrane database system (December 2014); and