A/HRC/35/21 Availability 55. Adequate mental health services must be made available. In many countries, the limited mental health and social care available is based on a narrow biomedical model and institutionalization. The scaling-up of care must not involve the scaling-up of inappropriate care. For care to comply with the right to health, it must embrace a broad package of integrated and coordinated services for promotion, prevention, treatment, rehabilitation, care and recovery and the rhetoric of “scaling up” must be replaced with mental health actions to “scale across”. That includes mental health services integrated into primary and general health care, which support early identification and intervention, with services designed to support a diverse community. 36 Evidence-based psychosocial interventions and trained community health workers to deliver them must be enhanced. 37 Services must support the rights of people with intellectual, cognitive and psychosocial disabilities and with autism to live independently and be included in the community, rather than being segregated in inappropriate care facilities. 56. Many countries are faced with a scarcity of human resources for mental health care and must undertake efforts to develop a workforce, including specialist and non-specialist health professionals, general practitioners and community health workers, as well as other professionals, such as teachers, social workers and other peer support and community workers with appropriate skills (including human rights education). Accessibility 57. Mental health services must be geographically and financially accessible on the basis of non-discrimination. In many low- and middle-income countries they are concentrated in major cities and inaccessible to a large part of the population. The problem is acute in countries where there is inappropriate overreliance on segregated residential and in-patient psychiatric institutions, such as in Central and Eastern Europe, and a failure to develop rights-based models of care in the community. 38 Integrating mental health into general hospitals, primary care, and social care services and rights-compliant use of mobile technologies can support accessibility and enhance the enjoyment of the right to live and participate in the community. Accurate information on mental health must be made accessible to the public and evidence-based information on treatments, including side effects, must also be accessible, which requires the routine, complete and timely disclosure of all pharmacological information from clinical trials. A contextual understanding of the experiences of suffering and distress is critical for ensuring accessibility within systems of mental health care and support. Acceptability 58. Mental health services must be respectful of medical ethics and human rights, as well as culturally appropriate, sensitive to gender and life-cycle requirements and designed to respect confidentiality and empower individuals to control their health and well-being.39 They must respect the principles of medical ethics and human rights (including “first, do no harm”), choice, control, autonomy, will, preference and dignity. 40 Overreliance on pharmacological interventions, coercive approaches and in-patient treatment is inconsistent with the principle of doing no harm, as well as with human rights. Human rights capacitybuilding should be routinely provided to mental health professionals. Services must be culturally appropriate and acceptable to persons with intellectual, cognitive or psychosocial disabilities and with autism, adolescents, women, older persons, indigenous persons, minorities, refugees and migrants, and lesbian, gay, bisexual, transgender and intersex 36 37 38 39 40 Convention on the Rights of Persons with Disabilities, arts. 25-26, and J. Jaime Miranda and others, “Transitioning mental health into primary care”, The Lancet Psychiatry, vol. 4, No. 2 (February 2017). WHO, Mental Health Action Plan 2013-2020, p. 9. Natalie Drew and others, “Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis”, The Lancet, vol. 378, No. 9803 (November 2011). Committee on Economic, Social and Cultural Rights, general comment No. 14, para. 12 (c). Convention on the Rights of Persons with Disabilities, preamble and arts. 12, 15 and 19. 13