A/HRC/35/21 rights-based mental health system, not a luxury. Relevant action must be based upon empowerment so as to enable individuals to increase control over and improve their health. Adversity in early childhood and adolescence 73. Research has shown the damaging mental health and social impact of adversities and trauma experienced throughout childhood. 51 Toxic stress, abusive family and intimate relationships, the placement of young children in institutional care, bullying, sexual, physical and emotional child abuse and parental loss negatively affect brain development and the ability to form healthy relationships, all affecting the ability of children to fully realize their right to health as they transition into adulthood (see A/HRC/32/32, paras. 6773, and A/70/213, para. 67). 74. The Special Rapporteur highlights the devastating impact that institutionalization has on young children, particularly on their mental health and holistic development. 52 Mental health-related services for children receive inadequate investment and lack quality standards of care and staffing, thus creating an environment where abuse is common for children with disabilities or with difficulties in social and emotional development, especially for those in institutional care. There are many examples of innovative child mental health services and practices throughout the world and there is convincing research on their effectiveness in promoting mental health and preventing deterioration in mental health conditions. 53 However, those good practices often serve merely as pilot projects, owing to a lack of political will to replicate and mainstream them in general childcare services. 75. Considering that mental health services are often underfunded, the resulting lowquality residential and in-patient psychiatric services lead to over-medicalization, violence and other forms of violations of children’s rights. These must be abandoned or substantially transformed and more importantly, programmes to respond to childhood adversity must be organized around participatory frameworks that recognize children as rights holders, respect their evolving capacities and empower children and families to improve their mental health and well-being. B. Treatment: from isolation to community 76. The right to health is a powerful guide for States towards a paradigm shift that is recovery and community-based, promotes social inclusion and offers a range of rightsbased treatments and psychosocial support at primary and specialized care levels. 77. Reductive biomedical approaches to treatment that do not adequately address contexts and relationships can no longer be considered compliant with the right to health. While a biomedical component remains important, its dominance has become counterproductive, disempowering rights holders and reinforcing stigma and exclusion. In many parts of the world, community care is not available, accessible, acceptable and/or of sufficient quality (often limited to psychotropic medications). The largest concentration of mental hospitals and beds separated from regular health care is in higher-income countries, a cautionary note for lower and middle-income countries to forge a different path and shift to rights-based mental health care.54 51 52 53 54 See Department of Economic and Social Affairs, “Mental health matters: social inclusion of youth with mental health conditions” (2014). See WHO and the Gulbenkian Global Mental Health Platform, “Promoting rights and community living for children with psychosocial disabilities” (2015) and United Nations Children’s Fund, “Ending the placement of children under three in institutions: support nurturing families for all young children” (2012). International Association for Child and Adolescent Psychiatry and Allied Professions, “Textbook of child and adolescent mental health” (2015). WHO Mental Health Atlas 2014, table 4.1.1. 17