A/HRC/34/32 1. Maximum available resources 19. Despite the impact of mental health conditions on individuals, families and communities, there is insufficient investment of both financial and human resources in the area of mental health. Global annual spending on mental health is less than $2 per person and less than $0.25 per person in low-income countries. 29 This affects the provision of services, as inadequate numbers of staff, often with insufficient training, especially in the area of human rights, are required to deliver services which are in accordance with human rights standards. In addition, the largest proportion of most mental health budgets is typically allocated to psychiatric hospitals. 30 This continued investment by Governments in institutional settings, such as psychiatric hospitals, is often accompanied by a corresponding failure to invest in community-based mental health services and supports, which have been widely established as good practices, as more fully explained below. The inadequate allocation of resources and poor decisions taken as to their use, undermine the availability, acceptability, accessibility and quality of mental health services. They also fall foul of article 2 (1) of the International Covenant on Economic, Social and Cultural Rights, which requires States parties to employ their maximum available resources for the progressive realization of the rights recognized in the Covenant, including the right to health. 2. Provision of services in a segregated manner 20. Although there has been progress over the last few decades, the segregation and centralization of mental health services around psychiatric hospitals and institutions continues to pose a challenge in certain important respects. The failure to integrate interdisciplinary mental health services into primary care renders a “whole person” approach extremely difficult. In many countries, there are no mental health services available in local health clinics and general hospitals, forcing people in remote areas to travel long distances, often at high cost. Where mental health care and support services are provided in segregated systems and social care institutions, there is a higher risk of human rights violations.31 3. Valuing mental health 21. In the context of health, the concept of parity of esteem refers to valuing mental health equally with physical health.32 From a normative standpoint, the framework which establishes the right to health does not create a hierarchy where mental health is ranked lower than physical health. The strong relationship between physical and mental health calls for an approach which accords equal value to both and yet a lack of parity of esteem, where preferential consideration is given to physical health, remains the dominant perspective. Consequently, among other discrepancies, fewer financial and human resources are allocated for mental health and many mental health facilities tend to be dilapidated, with lower hygiene standards and fewer amenities. There are also significant data and research gaps in mental health, particularly in relation to the identification of the human rights situation of persons with mental health conditions and users of mental health services, and the impact of policy measures. 29 30 31 32 8 See WHO, “Mental health action plan 2013-2020”, para. 14. WHO, Mental Health Atlas 2014, p. 9. See E/CN.4/2005/51, para. 8. Royal College of Psychiatrists, “Whole-person care: from rhetoric to reality”, p. 20.