A/HRC/35/21 industry, dominates clinical practice, policy, research agendas, medical education and investment in mental health around the world. The majority of mental health investments in low-, middle- and high-income countries disproportionately fund services based on the biomedical model of psychiatry. 9 There is also a bias towards first-line treatment with psychotropic medications, in spite of accumulating evidence that they are not as effective as previously thought, that they produce harmful side effects and, in the case of antidepressants, specifically for mild and moderate depression, the benefit experienced can be attributed to a placebo effect. 10 Despite those risks, psychotropic medications are increasingly being used in high-, middle- and low-income countries across the world.11 We have been sold a myth that the best solutions for addressing mental health challenges are medications and other biomedical interventions. 20. The psychosocial model has emerged as an evidence-based response to the biomedical paradigm. 12 It looks beyond (without excluding) biological factors, understanding psychological and social experiences as risk factors contributing to poor mental health and as positive contributors to well-being. That can include short-term and low-cost interventions that can be integrated into regular care. When used appropriately, such interventions can empower the disadvantaged, improve parenting and other competencies, target individuals in their context, improve the quality of relationships and promote self-esteem and dignity. For any mental health system to be compliant with the right to health, the biomedical and psychosocial models and interventions must be appropriately balanced, avoiding the arbitrary assumption that biomedical interventions are more effective.13 B. Power asymmetries 21. The promotion and protection of human rights in mental health is reliant upon a redistribution of power in the clinical, research and public policy settings. Decision-making power in mental health is concentrated in the hands of biomedical gatekeepers, in particular biological psychiatry backed by the pharmaceutical industry. That undermines modern principles of holistic care, governance for mental health, innovative and independent interdisciplinary research and the formulation of rights-based priorities in mental health policy. International organizations, specifically WHO and the World Bank, are also influential stakeholders, whose role and relations interplay and overlap with the role of the psychiatric profession and the pharmaceutical industry. 22. At the clinical level, power imbalances reinforce paternalism and even patriarchal approaches, which dominate the relationship between psychiatric professionals and users of mental health services. That asymmetry disempowers users and undermines their right to make decisions about their health, creating an environment where human rights violations can and do occur. Laws allowing the psychiatric profession to treat and confine by force legitimize that power and its misuse. That misuse of power asymmetries thrives, in part, because legal statutes often compel the profession and obligate the State to take coercive action. 23. The professional group in psychiatry is a powerful actor in mental health governance and advocacy. National mental health strategies tend to reflect biomedical agendas and obscure the views and meaningful participation of civil society, users and former users of 9 10 11 12 13 6 See WHO, Mental Health Atlas 2014, p. 32. See Irving Kirsch, “Antidepressants and the placebo effect”, Zeitschrift für Psychologie”, vol. 222, No. 3 (February 2015) and David Healy, “Did regulators fail over selective serotonin reuptake inhibitors?”, BMJ, vol. 333 (July 2006). See Ross White, “The globalisation of mental illness”, The Psychologist, vol. 26 (March 2013). See Anne Cooke, ed., Understanding Psychosis and Schizophrenia, (Leicester, The British Psychological Society, 2014). See Nikolas Rose and Joelle M. Abi-Rached, Neuro: the New Brain Sciences and the Management of the Mind (Princeton, New Jersey, Princeton University Press, 2013) and Pat Bracken, “Towards a hermeneutic shift in psychiatry”, World Psychiatry, vol. 13, No. 3 (October 2014).