A/HRC/35/21 mental health services and experts from various non-medical disciplines.14 In that context, the 2005 WHO Resource Book on Mental Health, Human Rights and Legislation, developed using human rights guidelines at the time, was highly influential in the development of mental health laws that allowed “exceptions”. Those legal “exceptions” normalized coercion in everyday practice, widening the space for human rights violations to occur and it is therefore a welcome development to see the laws being revisited and the Resource Book formally withdrawn, as a result of the framework brought about by the Convention on the Rights of Persons with Disabilities. 15 24. The status quo in current psychiatry, based on power asymmetries, leads to the mistrust of many users and threatens and undermines the reputation of the psychiatric profession. Open and ongoing discussions within the psychiatric profession about its future, including its role in relation to other stakeholders, is critical. 16 The Special Rapporteur welcomes and encourages such discussions within the psychiatric profession and with other stakeholders, and he is convinced that the search for consensus and progress is to the advantage of everyone, including psychiatry. The active involvement of the psychiatric profession and its leaders in the shift towards rights-compliant mental health policies and services is a crucial element for success in positive global mental health changes. 25. Conventional wisdom based on a reductionist biomedical interpretation of complex mental health-related issues dominates mental health policies and services, even when not supported by research. Persons with psychosocial disabilities continue to be falsely viewed as dangerous, despite clear evidence that they are commonly victims rather than perpetrators of violence.17 Likewise, their capacity to make decisions is questioned, with many being labelled incompetent and denied the right to make decisions for themselves. That stereotype is now regularly shattered, as people show that they can live independently when empowered through appropriate legal protection and support. 26. Asymmetries have been furthered by the financial power of, and alliances with, the pharmaceutical industry. Where financial resources for research and innovation are absent, the industry fills the gap with little transparency in drug approval processes or in doubtful relationships with health-care professionals and providers. That context illustrates how overreliance in policy on the biomedical model has gone too far and is now so resistant to change.18 C. Biased use of evidence in mental health 27. The evidence base in support of mental health interventions has been problematic throughout history. That situation continues, as the evidence base for the efficacy of certain psychotropic medications and other biomedical psychiatric interventions is increasingly challenged from both a scientific and experiential perspective. 19 That these interventions 14 15 16 17 18 19 See the WHO MiNDbank, available from www.mindbank.info/collection/type/mental_health_strategies_and_plans/all. See www.who.int/mental_health/policy/legislation/en/. See Heinz Katschnig, “Are psychiatrists an endangered species? Observations on internal and external challenges to the profession”, World Psychiatry, vol. 9, No. 1 (February 2010). See Jillian K. Peterson and others, “How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness?”, Law and Human Behavior, vol. 38, No. 5 (April 2014). See Ray Moynihan, Jenny Doust and David Henry, “Preventing overdiagnosis: how to stop harming the healthy”, BMJ, vol. 344 (May 2012). See Peter Tyrer and Tim Kendall, “The spurious advance of antipsychotic drug therapy”, The Lancet, vol., No. 9657 (January 2009); Lex Wunderink and others, “Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy”, JAMA Psychiatry, vol. 70, No. 9 (2013); Joanna Le Noury and others, “Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence”, BMJ, vol. 351 (September 2015); and Andrea Cipriani and others, “Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis”, The Lancet, vol., 388, No. 10047 (August 2016). 7