From Stigma to Structural Reform: Reimagining Mental Health Through Rights and Equity

Mental health is too often framed as a question of individual pathology, as though distress arises in isolation from the conditions of people’s lives. Yet decades of research demonstrate that mental health is profoundly shaped by the social world: by structures of inequality, by the organisation of care, and by the ways in which societies include or exclude those experiencing distress (Patel et al., 2018; Marmot, 2020). To understand mental health outcomes, then, we must look not only to clinical interventions but also to the broader contexts in which lives unfold.

A central concept here is stigma. Link and Phelan (2001) define stigma as a process of labelling, stereotyping, and separation that is enacted through power to enforce exclusion. In this sense, stigma is not merely a matter of unkind words or interpersonal prejudice but a structural phenomenon with material consequences. Hatzenbuehler et al. (2013) provide compelling evidence that discriminatory laws and policies—forms of what they term structural stigma—are directly associated with population-level disparities in psychiatric morbidity. Similarly, Clement et al. (2015) demonstrate in a meta-analysis that anticipated stigma acts as a powerful barrier to help-seeking, deterring individuals across diagnoses and contexts.

The notion of structural violence, first articulated by Galtung (1969), offers a useful analytic lens. Structural violence refers to social arrangements that systematically harm individuals by constraining opportunities and resources necessary for wellbeing. Applied to mental health, it draws attention to how stigma and inequality undermine citizenship, belonging, and recovery itself (Kaufman, 2024).

Yet stigma is only one mechanism by which injustice manifests. Broader social determinants of mental health—including poverty, housing, education, employment, and social connection—are equally influential. The World Health Organization (2014) has underscored that these determinants are foundational drivers of inequality in mental health, while Marmot (2020) highlights the “social gradient” in which each step down the socioeconomic ladder corresponds to worse outcomes. Loneliness, too, has emerged as a determinant in its own right, with large-scale studies showing it predicts the onset of depression and anxiety (Mann et al., 2017).

Taken together, these literatures suggest that mental health cannot be understood outside its social, political, and cultural contexts. In this article, we draw on contemporary scholarship to examine stigma, social determinants, intersectionality, carers and peer support, trauma-informed and culturally safe practice, and rights-based frameworks, before outlining pathways toward justice-oriented mental health systems. Our central claim is that meaningful reform requires moving beyond narrow biomedical models toward approaches that dismantle stigma, address structural inequalities, and enshrine citizenship and rights as central to recovery. The next section develops this argument by reframing stigma not as an interpersonal slight but as a form of structural violence.

Stigma as Structural Violence

Stigma is commonly understood as prejudice at the interpersonal level—derogatory language, stereotyping, or social rejection. While these experiences are real and damaging, they represent only part of the picture. Link and Phelan (2001) argue that stigma is most consequential when it is “enacted through power” to enforce exclusion, making it a structural rather than merely individual phenomenon.

The concept of structural violence (Galtung, 1969) helps illuminate this dynamic. Structural violence describes the way social arrangements systematically disadvantage certain groups by restricting access to resources, rights, or opportunities. In mental health, stigma functions as structural violence when it manifests through discriminatory laws, policies, or institutional practices that constrain participation in society. For example, Hatzenbuehler et al. (2013) analysed U.S. states with and without same-sex marriage bans and found higher rates of psychiatric morbidity in jurisdictions with discriminatory policies, demonstrating how structural stigma directly harms population-level mental health.

Empirical research further shows that stigma operates through multiple pathways. Clement et al. (2015), in a meta-analysis of 144 studies, found that anticipated stigma—fear of discrimination—was one of the most consistent barriers to help-seeking across different mental health conditions. Beyond deterring service use, stigma infiltrates the design of care systems themselves. Studies of psychiatric services show that coercive practices such as forced medication, seclusion, and involuntary hospitalisation are disproportionately used against those experiencing severe mental illness, reinforcing perceptions of dangerousness while eroding trust (Szmukler, 2015; Sweeney et al., 2018).

The media plays a critical role in reproducing stigma at scale. Wahl (1995) first documented how portrayals of “madness” in newspapers and television skewed heavily toward violence and incompetence. More recent systematic reviews (e.g., Stuart, 2016) confirm that such narratives persist, shaping public perceptions and contributing to discrimination in housing, employment, and healthcare. These representations not only stigmatise individuals but also provide justification for restrictive policies, embedding exclusion into institutional practices.

Stigma also becomes internalised. Corrigan and Rao (2012) found that individuals who adopt society’s negative stereotypes about mental illness often experience diminished self-esteem, hopelessness, and reduced motivation for recovery. Qualitative studies reinforce this, with service users reporting that diagnostic labels undermine self-worth and create a sense of being permanently “othered” (Livingston & Boyd, 2010). Internalised stigma, combined with structural barriers, traps individuals in a cycle of exclusion that limits opportunities to work, form relationships, and participate fully in civic life.

The cumulative evidence is clear: stigma is not only an interpersonal slight but a form of structural violence that shapes access to care, constrains social participation, and undermines recovery. Recognising stigma in this way shifts the focus from individual attitudes to systemic determinants. Tackling stigma, therefore, requires not only public education but also structural reforms that dismantle discriminatory policies and practices. This brings us naturally to the wider field of social determinants of mental health, where the drivers of inequality are not symbolic but material.

Social Determinants of Mental Health

If stigma can be understood as the wall that keeps people out, the social determinants of health shape the ground beneath their feet. These determinants—income, housing, education, employment, and social connection—are the conditions in which lives unfold. They are not peripheral to mental health but constitutive of it. The World Health Organization (2014) highlights that social determinants are the primary drivers of health inequities globally, while Marmot (2020) demonstrates that wellbeing follows a social gradient: each step down the socioeconomic ladder corresponds with an increased risk of mental distress.

Poverty, housing, and employment

Economic disadvantage is among the most powerful determinants. Lund et al. (2018), in a systematic review of 115 studies, concluded that poverty, debt, and unemployment consistently predict depression and anxiety, while secure housing and income support act as protective factors. Sawyer et al. (2024), using longitudinal Australian data over fourteen years, further show that unemployment and financial strain during adolescence and young adulthood have long-term impacts on psychiatric outcomes. Housing insecurity in particular has been linked to elevated rates of psychological distress, with Bentley et al. (2016) demonstrating a dose–response relationship between rental stress and mental ill health.

Loneliness and social connection

Social connection is another determinant with profound consequences. Mann et al. (2017), analysing population-level data from over 6,000 participants, found that loneliness significantly increased the risk of developing depression and anxiety over time, independent of other risk factors. Holt-Lunstad et al. (2015), in a meta-analysis of 70 studies, concluded that social isolation and loneliness increased mortality risk to a degree comparable to smoking or obesity. More recently, the Global Mind Project (2024) identified belonging as one of the strongest predictors of mental wellbeing across 40 countries, underscoring its universality.

Refugee and migrant experiences

For refugees and migrants, the social determinants of mental health often take the form of post-migration stressors. Steel et al. (2009), in a meta-analysis of 161 studies, demonstrated that resettlement challenges such as insecure housing, poverty, and discrimination were stronger predictors of psychiatric morbidity than pre-migration trauma. Fazel et al. (2012) reinforced this finding, showing that refugees in high-income countries had elevated risks of psychosis and depression primarily due to post-migration disadvantage. Recent reviews emphasise the compounded effects for refugees with intersecting marginalised identities, including women, LGBTQ+ individuals, and people with disabilities (Hynie, 2018).

Structural inequality and cumulative disadvantage

Importantly, social determinants rarely act in isolation. Poverty, unemployment, and discrimination intersect to create cumulative burdens, with effects that are multiplicative rather than additive. Patel et al. (2018) argue that mental health should be seen as central to the Sustainable Development Goals, since inequality, poor education, and inadequate healthcare combine to drive psychiatric distress worldwide. Similarly, Allen et al. (2014) highlight that policies targeting multiple determinants simultaneously—such as housing, education, and employment—produce the most significant improvements in mental wellbeing.

Synthesis

The evidence is unequivocal: mental health is shaped as much by social and economic conditions as by clinical factors. Poverty, housing insecurity, loneliness, and migration-related exclusion are not background issues but central determinants of who thrives and who struggles. If stigma represents structural violence enacted through exclusion, social determinants represent the inequitable environments that sustain distress. Understanding these dynamics requires us to consider how disadvantage compounds across identities and systems—an intersectional perspective to which we now turn.

Intersecting Marginalisations

While social determinants shape the conditions of life, they rarely operate along a single axis. Kimberlé Crenshaw (1989) coined the term intersectionality to capture how systems of oppression—racism, sexism, classism, heterosexism, and colonialism—interlock to produce distinct forms of disadvantage. In mental health, this means that individuals with multiple marginalised identities often face compounded risks that are qualitatively different from those experienced along any single line of inequality (Bowleg, 2023).

Indigenous peoples

For Aboriginal and Torres Strait Islander peoples, mental health cannot be separated from the historical and ongoing effects of colonisation, dispossession, and systemic racism. Dudgeon et al. (2014) emphasise that Indigenous social and emotional wellbeing is holistic, encompassing culture, spirituality, kinship, and connection to Country. National surveys consistently show that Indigenous Australians experience higher rates of psychological distress, yet these disparities are closely tied to structural determinants such as incarceration, unemployment, and intergenerational trauma (Australian Institute of Health and Welfare, 2020). Gee et al. (2014) argue that healing requires Indigenous-led frameworks that prioritise self-determination. Without this, mainstream services risk reproducing colonial power relations rather than addressing them.

Refugees and migrants

For refugees, the intersection of displacement with poverty, racism, and precarious legal status intensifies distress. Steel et al. (2009) found that post-migration stressors—such as unemployment, insecure housing, and discrimination—predicted psychiatric morbidity more strongly than pre-migration trauma. Fazel et al. (2012) similarly showed that refugees in high-income countries face higher risks of psychosis and depression, largely due to structural disadvantage. Intersectional approaches highlight that refugee women, LGBTQ+ refugees, and people with disabilities encounter layered vulnerabilities, navigating multiple axes of discrimination simultaneously (Hynie, 2018).

LGBTQ+ communities

Sexual and gender minorities also face elevated risks of mental ill health, often explained through the minority stress model (Meyer, 2003; Frost & Meyer, 2023). This model posits that chronic exposure to stigma, discrimination, and social exclusion generates sustained psychological strain. Hatzenbuehler (2016) demonstrates that structural stigma—manifested in discriminatory policies or the absence of legal protections—has measurable negative effects on mental health at the population level. A global review by King et al. (2008) found that LGBTQ+ individuals are up to twice as likely to experience depression and anxiety, with the highest risks for transgender populations. Intersectionality adds further complexity: for example, an Indigenous lesbian may encounter racism in queer spaces and homophobia in Indigenous ones, producing compounded stressors that are poorly captured by single-axis frameworks.

Gaps in research

Despite growing recognition, intersectional research in mental health remains underdeveloped. Hankivsky and Kapilashrami (2025) argue that most studies continue to treat categories such as race, gender, and sexuality as discrete variables, rather than analysing their interlocking effects. Bowleg (2023) warns that this methodological gap risks erasing those who are most vulnerable—the very populations most affected by systemic inequities.

Synthesis

Intersectional analysis reveals that disadvantage is not additive but multiplicative. Marginalised groups face distinct forms of exclusion that cannot be understood by examining race, gender, or sexuality in isolation. Intersectional feminism therefore provides more than a critique; it offers a roadmap for justice-oriented practice. By designing mental health systems around those most marginalised, services become more equitable for all. The next section turns to another group often rendered invisible in mental health systems: carers, families, and peers, whose expertise is invaluable yet persistently undervalued.

Carers, Families, and Peer Support in Unequal Systems

While policymakers and clinicians dominate mental health discourse, much of the daily work of sustaining recovery falls to carers, families, and peers. They provide emotional support, advocacy, and continuity of care, yet their contributions are frequently overlooked or undervalued within formal systems. This marginalisation reflects broader hierarchies of expertise in which professional knowledge is privileged while lived experience is treated as secondary.

Carers and families

Family members are often the first responders in crises, yet they report being excluded from decision-making and denied recognition of their expertise. Chou et al. (2020), in a systematic review, found that carers across diverse contexts described themselves as invisible within the very systems that relied on their unpaid labour. Carers also bear significant economic burdens: recent estimates suggest that unpaid mental health caregiving costs billions annually in lost productivity and healthcare savings (Meltzer et al., 2013). Qualitative studies confirm that carers experience high levels of stress, burnout, and emotional strain, exacerbated by inadequate support from services (Kuipers et al., 2010).

Peer support

In contrast to the invisibility of carers, peer support has gained recognition as a model that foregrounds lived experience. Davidson et al. (2012) found that peer workers promote hope, empowerment, and engagement in services, while Chinman et al. (2021), in a systematic review of 49 studies, concluded that peer support improves satisfaction with care and social outcomes, though evidence for symptom reduction remains mixed. Importantly, peer relationships are valued not only for outcomes but for their ethos of mutuality and solidarity (Repper & Carter, 2011).

Tensions and co-option

Despite its promise, peer work faces tensions. Rose (2014) argues that when recovery language is adopted by institutions without redistributing power, peer roles risk becoming tokenistic—symbolically included but structurally constrained. A recent UK evaluation (Gillard et al., 2017) found that peer workers often encountered role ambiguity, limited career pathways, and marginalisation within clinical teams. This reflects a broader pattern in which innovations rooted in lived experience are celebrated rhetorically but co-opted in practice.

Synthesis

The evidence suggests that carers and peers are indispensable to recovery, yet they remain undervalued within mental health systems. Carers carry heavy burdens without adequate support, while peers face risks of tokenism when integrated into traditional hierarchies. Both cases highlight a fundamental imbalance: lived experience is treated as supplementary rather than as expertise in its own right. Embedding carers and peers as equal partners in mental health reform is therefore not optional but essential for building systems grounded in justice and recovery. The next section turns to two frameworks that explicitly seek to redress harm within mental health systems themselves: trauma-informed and culturally safe care.

Trauma-Informed and Culturally Safe Care

If carers and peers highlight what systems often overlook, trauma-informed and culturally safe approaches expose what systems too often reproduce: harm. Many people entering mental health services have lived through interpersonal, structural, or intergenerational trauma. When services rely on coercion, seclusion, or rigid hierarchies, they risk replicating the very conditions that caused distress in the first place.

Trauma-informed care

The Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) defines trauma-informed care as an orientation that prioritises safety, trust, choice, collaboration, and empowerment. This is not a checklist but a shift in culture. Sweeney et al. (2016) argue that trauma-informed services must explicitly recognise power imbalances and avoid practices that re-traumatise. Qualitative research with service users supports this: many describe psychiatric wards as spaces of fear and control rather than healing (Sweeney et al., 2018). Trauma-informed practice thus requires moving away from coercion toward partnership, where people feel safe and respected.

Cultural safety and structural competency

Parallel to trauma-informed practice is the demand for cultural safety. Originating in Aotearoa/New Zealand through the work of Ramsden (2002), cultural safety goes beyond cultural awareness or competence: it requires practitioners to reflect on their own power and the systemic privileging of Western norms. Research shows that without this reflexivity, cultural competence risks becoming superficial—knowledge about others rather than accountability for one’s own position (Kirmayer, 2012).

More recently, Metzl and Hansen (2014; 2020) introduced the concept of structural competency, calling on clinicians to recognise how poverty, racism, and policy shape health long before individuals enter the clinic. For example, disparities in compulsory psychiatric treatment across racial groups in Australia and the UK highlight how systemic racism infiltrates service delivery (Morgan et al., 2020). Structural competency therefore expands the clinician’s role from treating symptoms to addressing the wider forces that drive distress.

Indigenous-led frameworks

For Aboriginal and Torres Strait Islander peoples, cultural safety is inseparable from self-determination. The Social and Emotional Wellbeing framework (Gee et al., 2014) situates health within connections to culture, land, spirituality, and kinship. Dudgeon and Walker (2015) argue that mainstream services continue to underserve Indigenous populations precisely because they fail to embed these principles. Evidence from Indigenous-led programs demonstrates higher levels of engagement and satisfaction when services are designed and governed by communities themselves (Dudgeon et al., 2022). Trauma here is collective and historical, requiring responses that prioritise sovereignty and cultural continuity alongside clinical care.

Synthesis

Trauma-informed and culturally safe care converge on a simple but profound principle: safety is not merely the absence of harm, but the active presence of trust, respect, and empowerment. Both approaches challenge mental health systems to move away from doing things to people and toward doing things with them. Yet without accountability and structural change, these frameworks risk dilution into rhetoric. Embedding trauma-informed and culturally safe care requires systemic commitment, resource allocation, and genuine power-sharing with service users and communities. The next section builds on this foundation by considering recovery not only as personal healing but as a process of reclaiming rights and citizenship.

Reclaiming Rights and Citizenship

Recovery is more than the alleviation of symptoms or the restoration of individual functioning. It is fundamentally about reclaiming one’s place in society as a full and equal citizen. Citizenship, as Rowe and Davidson (2016) describe, is the “right to have rights”: the capacity to participate in community life, exercise autonomy, and claim belonging. From this perspective, mental health reform must be as much about justice and rights as about treatment.

Citizenship and belonging

Empirical studies highlight that service users often define recovery in social rather than clinical terms. Leamy et al. (2011), in their influential CHIME framework, identified connectedness, hope, identity, meaning, and empowerment as the core dimensions of recovery, all of which are inseparable from social participation. Qualitative research consistently echoes this: people speak of recovery as being able to work, form relationships, and contribute to their communities (Slade et al., 2014). Davidson et al. (2010) similarly emphasise that recovery is not achieved in isolation but through opportunities for belonging and reciprocity.

Rights frameworks in practice

At the international level, the United Nations Convention on the Rights of Persons with Disabilities (CRPD, 2006) articulates the right to equality, autonomy, and participation. Building on this, the WHO QualityRights initiative (2019; 2023) provides practical tools for transforming services away from coercive models toward rights-based and recovery-oriented care. Evaluations of QualityRights programmes in countries such as Ghana and India demonstrate improvements in service user empowerment and reductions in coercive practices (Pathare et al., 2021).

Yet rights language is not immune to co-option. Rose (2014) warns that the rhetoric of recovery and rights can be mobilised by systems as cost-saving strategies rather than transformative agendas. Studies of recovery implementation in the UK and Australia reveal a tendency to embrace recovery discourse without redistributing power, resulting in tokenistic service-user involvement (Beresford, 2019). Authentic engagement requires not only inviting diverse and critical voices but also embedding them in decision-making at every level of governance.

Marginalised groups and uneven rights

Rights-based frameworks also expose the uneven distribution of citizenship. Hatzenbuehler (2016) demonstrates that discriminatory laws against sexual minorities are associated with population-level disparities in depression and anxiety, underscoring how rights directly affect mental health. For Aboriginal and Torres Strait Islander peoples, the right to health cannot be separated from rights to land, culture, and self-determination (Dudgeon et al., 2014). In both cases, the absence of rights translates into diminished citizenship and persistent mental health inequities.

Synthesis

The literature makes clear that recovery without rights is fragile, and rights without belonging are hollow. To achieve meaningful reform, mental health systems must embed citizenship as a foundation of recovery. This means replacing coercion with supported decision-making, centring lived experience in governance, and recognising that social inclusion is as vital to health as clinical care. As Rowe and Davidson (2016) remind us, recovery without citizenship is like “a ship without a port.” The final section of this article turns to future directions, asking what it would take to create justice-oriented mental health systems capable of addressing these structural inequities.

Towards Justice-Oriented Mental Health Systems

If stigma, inequality, and exclusion are structural, then reform must also be structural. Justice-oriented mental health systems move beyond symptom management to address the social, political, and cultural contexts in which distress occurs. Such systems are not simply more compassionate versions of the status quo but are fundamentally reconfigured to redistribute power, embed rights, and tackle inequality at its roots.

Redistributing power

Central to justice-oriented reform is the redistribution of power within services. This requires shifting from tokenistic consultation toward shared governance, where service users, carers, and peers hold decision-making authority. Empirical studies demonstrate the benefits: Ocloo and Matthews (2016) found that meaningful co-production improves service design and user satisfaction, while Slay and Stephens (2013) showed that co-production fosters innovation by drawing on diverse forms of expertise. Without structural commitment, however, participation risks being reduced to symbolic inclusion (Beresford, 2019).

Embedding rights-based practice

Replacing coercion with supported decision-making is a practical and ethical imperative. The WHO QualityRights framework provides evidence that rights-based reforms are both feasible and effective (Pathare et al., 2021). Examples include advance directives, crisis planning, and peer-run alternatives to hospitalisation, all of which respect autonomy while ensuring safety. Embedding rights also requires legal reform: repealing discriminatory laws, ensuring parity between mental and physical healthcare, and enforcing protections against workplace and housing discrimination.

Addressing social determinants

Justice-oriented systems cannot stop at service delivery. They must address the social determinants that sustain distress. Policies that expand access to affordable housing, income security, education, and employment opportunities have demonstrable mental health benefits (Lund et al., 2018; Marmot, 2020). Public health approaches, such as universal basic income pilots, show promise in reducing poverty-related stress and improving wellbeing (Forget, 2011). Mental health, in this sense, becomes a barometer of social justice: where inequality thrives, distress follows.

Intersectional accountability

Finally, justice-oriented systems must be accountable to those most marginalised. Intersectional approaches reveal how racism, sexism, homophobia, and colonialism combine to compound disadvantage. Prioritising Indigenous-led frameworks, LGBTQ+ rights protections, and refugee-inclusive policies ensures that reforms do not reproduce existing inequities. As Bowleg (2023) notes, equity is not achieved by treating everyone the same but by centring those who are most structurally disadvantaged.

Conclusion

This article has argued that mental health must be understood as a matter of justice. Stigma is not simply interpersonal prejudice but structural violence, sustained through discriminatory laws, coercive practices, and exclusionary media narratives. Social determinants—poverty, housing, education, employment, and social connection—constitute the material conditions of wellbeing, while intersectionality reveals how multiple axes of marginalisation compound disadvantage. Carers and peers provide essential expertise yet remain undervalued, while trauma-informed and culturally safe frameworks highlight the need to redress harm within services themselves. Ultimately, recovery is inseparable from rights and citizenship: without social inclusion, autonomy, and belonging, recovery is incomplete.

Justice-oriented mental health systems therefore require more than reformist tweaks. They demand structural change: redistributing power, embedding rights, addressing social determinants, and centring intersectional equity. These are not abstract ideals but practical necessities if mental health services are to move from managing symptoms to enabling flourishing lives. As Rowe and Davidson (2016) remind us, recovery without citizenship is like “a ship without a port.” Justice-oriented systems provide that port: places of belonging where individuals are not merely patients but citizens, neighbours, and participants in shared social worlds.

 References

Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health. International Review of Psychiatry, 26(4), 392–407.

Australian Institute of Health and Welfare. (2020). Aboriginal and Torres Strait Islander Health Performance Framework. AIHW.

Bentley, R., Baker, E., & Mason, K. (2016). Cumulative exposure to poor housing affordability and its association with mental health in men and women. Journal of Epidemiology and Community Health, 70(2), 170–175.

Beresford, P. (2019). ‘Public participation in health and social care: Exploring the co-production of knowledge’. Frontiers in Sociology, 3, 41.

Bowleg, L. (2023). The problem with intersectional invisibility. American Psychological Association.

Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2021). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatric Services, 72(4), 429–441.

Chou, Y. C., Kröger, T., & Pu, C. Y. (2020). The invisible workforce: A systematic review of unpaid caregiving and mental health. Health & Social Care in the Community, 28(5), 1435–1449.

Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.

Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry, 57(8), 464–469.

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine. University of Chicago Legal Forum, 1989(1), 139–167.

Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental illnesses: A review of evidence and experience. World Psychiatry, 11(2), 123–128.

Davidson, L., Tondora, J., & O'Connell, M. J. (2010). A practical guide to recovery-oriented practice: Tools for transforming mental health care. Oxford University Press.

Dudgeon, P., & Walker, R. (2015). Decolonising Australian psychology: Discourses, strategies, and practice. Journal of Social and Political Psychology, 3(1), 276–297.

Dudgeon, P., Wright, M., & Coffin, J. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In P. Dudgeon, H. Milroy, & R. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Commonwealth of Australia.

Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. The Lancet, 379(9812), 266–282.

Forget, E. L. (2011). The town with no poverty: The health effects of a Canadian guaranteed annual income field experiment. Canadian Public Policy, 37(3), 283–305.

Frost, D. M., & Meyer, I. H. (2023). Minority stress theory: Application, critique, and continued relevance. Current Opinion in Psychology, 51, 101579.

Galtung, J. (1969). Violence, peace, and peace research. Journal of Peace Research, 6(3), 167–191.

Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In P. Dudgeon, H. Milroy, & R. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Commonwealth of Australia.

Gillard, S., Foster, R., & Turner, K. (2017). Evaluating the peer workforce in England: A qualitative study. Journal of Mental Health, 26(5), 420–427.

Hankivsky, O., & Kapilashrami, A. (2025). Beyond the single axis: Intersectionality and health equity. Oxford University Press.

Hatzenbuehler, M. L. (2016). Structural stigma and the health of lesbian, gay, and bisexual populations. Current Directions in Psychological Science, 25(1), 27–32.

Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821.

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.

Hynie, M. (2018). The social determinants of refugee mental health in the post-migration context: A critical review. Canadian Journal of Psychiatry, 63(5), 297–303.

Kaufman, K. R. (2024). Structural violence and mental health: A global perspective. Routledge.

King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 1–17.

Kirmayer, L. J. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49(2), 149–164.

Kuipers, E., Onwumere, J., & Bebbington, P. (2010). Cognitive model of caregiving in psychosis. British Journal of Psychiatry, 196(4), 259–265.

Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445–452.

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.

Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150–2161.

Lund, C., Brooke-Sumner, C., Baingana, F., Baron, E. C., Breuer, E., Chandra, P., ... & Saxena, S. (2018). Social determinants of mental disorders and the Sustainable Development Goals: A systematic review of reviews. The Lancet Psychiatry, 5(4), 357–369.

Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., ... & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638.

Marmot, M. (2020). Health equity in England: The Marmot Review 10 years on. Institute of Health Equity.

Meltzer, H., Bebbington, P., Dennis, M. S., Jenkins, R., McManus, S., & Brugha, T. S. (2013). Feelings of loneliness among adults with mental disorder. Social Psychiatry and Psychiatric Epidemiology, 48(1), 5–13.

Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126–133.

Metzl, J. M., & Hansen, H. (2020). Structural competency in mental health and medicine. Springer.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.

Morgan, V. A., Waterreus, A., Carr, V., Castle, D., Cohen, M., Harvey, C., ... & Saw, S. (2020). Responding to challenges for people with psychotic illness: Updated evidence from the Survey of High Impact Psychosis. Australian & New Zealand Journal of Psychiatry, 54(9), 873–886.

Ocloo, J., & Matthews, R. (2016). From tokenism to empowerment: Progressing patient and public involvement in healthcare improvement. BMJ Quality & Safety, 25(8), 626–632.

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., ... & UnÜtzer, J. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553–1598.

Pathare, S., Funk, M., & Drew Bold, N. (2021). WHO QualityRights: Transforming mental health services and promoting human rights. The Lancet Psychiatry, 8(8), 647–649.

Ramsden, I. (2002). Cultural safety and nursing education in Aotearoa and New Zealand. Ph.D. Thesis, Victoria University of Wellington.

Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20(4), 392–411.

Rose, D. (2014). The mainstreaming of recovery. Journal of Mental Health, 23(5), 217–218.

Rowe, M., & Davidson, L. (2016). Recovering citizenship. Israel Journal of Psychiatry and Related Sciences, 53(1), 46–50.

Sawyer, A., Kõlves, K., & De Leo, D. (2024). The long-term impact of economic adversity during adolescence on mental health in young adulthood: A 14-year longitudinal study. Social Psychiatry and Psychiatric Epidemiology, 59(1), 123–134.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., ... & Whitley, R. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1), 12–20.

Slay, J., & Stephens, L. (2013). Co-production in mental health: A literature review. New Economics Foundation.

Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, 302(5), 537–549.

Stuart, H. (2016). Reducing the stigma of mental illness. Global Mental Health, 3, e17.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.

Sweeney, A., Clement, S., Filson, B., & Kennedy, A. (2016). Trauma-informed mental healthcare in the UK: What is it and how can we further its development? Mental Health Review Journal, 21(3), 174–192.

Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319–333.

Szmukler, G. (2015). "Capacity", "best interests", "will and preferences" and the UN Convention on the Rights of Persons with Disabilities. World Psychiatry, 14(1), 34–41.

United Nations. (2006). Convention on the Rights of Persons with Disabilities (CRPD). United Nations.

Wahl, O. F. (1995). Media Madness: Public Images of Mental Illness. Rutgers University Press.

World Health Organization. (2014). Social determinants of mental health. WHO.

World Health Organization. (2019). WHO QualityRights initiative. WHO.

World Health Organization. (2023). Guidance on community mental health services: Promoting person-centred and rights-based approaches. WHO