A/HRC/35/21 multisectoral and inclusive engagement with stakeholders, such as users and former users of mental health services, policymakers, service providers, health workers, social workers, the legal profession, the police, carers, family members and the wider community. 43. Health settings must empower users as rights holders to exercise autonomy and participate meaningfully and actively in all matters concerning them, to make their own choices about their health, including sexual and reproductive health, and their treatment, with appropriate support where needed. 44. Participation in mental health services is a relatively recent phenomenon and is complicated by deeply entrenched power asymmetries within mental health systems. 31 It is important to facilitate the empowerment of individuals, especially those with particular mental health needs, through the support of self-advocacy initiatives, peer support networks, trialogues and other user-led advocacy initiatives, as well as new working methods, such as co-production, which ensure representative and meaningful participation in health-service development and provision. In that regard, creating space for civil society and supporting the activities of non-governmental organizations is crucial to restoring trust between care providers and rights holders using services. D. Non-discrimination 45. International human rights law guarantees the right to non-discrimination in the access to and delivery of mental health-care services and the underlying determinants of health.32 The right to mental health is also dependent on equality and non-discrimination in the enjoyment of all other human rights that can themselves be considered an underlying determinant.33 46. Multiple and intersectional forms of discrimination continue to impede the ability of individuals, including women and persons from racial and ethnic minorities with disabilities, to realize their right to mental health. Discrimination and inequality are both a cause and a consequence of poor mental health, with long-term implications for morbidity, mortality and societal well-being.34 Discrimination, harmful stereotypes (including gender) and stigma in the community, family, schools and workplace disable healthy relationships, social connections and the supportive and inclusive environments that are required for the good mental health and well-being of everyone. Likewise, discriminatory attitudes influencing policies, laws and practices constitute barriers for those requiring emotional and social support and/or treatment. Consequently, individuals and groups in vulnerable situations who are discriminated against by law and/or in practice are denied their right to mental health. 47. 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. The role of psychiatry and other mental health professions is particularly important and measures are needed to ensure that their professional practices do not perpetuate stigma and discrimination. 48. It is important to recognize the complex role that a diagnosis of mental disorder plays in people’s lives. While many people find diagnostic categories beneficial in allowing them to access services and better understand their mental health, others find them unhelpful and stigmatizing. Mental health diagnoses have been misused to pathologize identities and other diversities, including tendencies to medicalize human misery. The 31 32 33 34 See Judi Chamberlin, “User/consumer involvement in mental health service delivery”, Epidemiology and Psychiatric Sciences, vol. 14, No. 1 (March 2005). Committee on Economic, Social and Cultural Rights, general comment No. 14, para. 18; A/61/338, para. 18 and Convention on the Rights of Persons with Disabilities, arts. 25 and 26. See Committee on Economic, Social and Cultural Rights, general comment No. 20 (2009) on nondiscrimination in economic, social and cultural rights. See Kate Pickett and Richard Wilkinson, The Spirit Level: Why More Equal Societies Almost Always Do Better, (London, Penguin Books, 2010). 11