A/HRC/44/48 society. Rights-based support must embrace that ethos at the intervention level. It is critical to ensuring that immediate social, psychosocial and material needs become central components in supporting recovery. D. Accountability for systems transformation 68. Accountability is a core normative principle for supporting rights-based implementation, but has thus far failed to deliver on its emancipatory and transformative potential in the area of mental health. Far from holding duty bearers to account for systemic failures, the work of many accountability mechanisms at the global and national levels, including monitoring mechanisms, national human rights institutions and treaty monitoring bodies, have served the cross-purpose of maintaining (albeit with improvements) existing mental health systems without significant attention paid to the egregious absence of alternatives. The Special Rapporteur calls on States, civil society and a range of accountability actors to work towards improving this paradoxical dilemma: how to ensure those within existing mental health services can live in humane conditions, while at the same time strongly asserting the legal case for large-scale systems reform and community transformation. 69. To make those key principles and concepts operational in practice, a set of critical, practical elements – essential rights-based ingredients – must be distilled at the intervention level. Attention should also be drawn to recent efforts to undertake this critical step, whereby key rights-based elements to crisis response have been developed as a foundational piece of work for local communities and stakeholders to build upon.44 V. Global threats and future trends A. Mainstreaming the right to mental health in all global contexts 70. The global neglect of mental health sits entirely at odds with the right to the highest attainable standard of health, as well as the commitment in Sustainable Development Goal 3 to promote mental health and well-being. The gross neglect of mental health care and the inappropriate models of care that persist in many countries, based around segregated psychiatric institutions providing stigmatizing and human rights-unfriendly services, have rightly drawn criticism from the human rights community. However, broader contexts and social movements that are vital to mental health have often been neglected; without integrating a rights-based mental health agenda into such communities of activism, the right to health cannot be realized. Solidarity, collective activism and shared commitments to responding to global challenges are a powerful means of confronting helplessness and powerlessness, building resilience (and resistance) and promoting well-being. Having their collective voices heard is a potent antidote to power asymmetries and injustice. States must take all measures to ensure that this civic space is protected and flourishes as a key indicator for compliance with the right to health. B. Climate change 71. As climate change intensifies, its destructive effects on the right to health, and on the environment and human rights more broadly, are being felt across the globe. Already groups in marginalized situations, including indigenous peoples, children, older persons, women, persons in situations of poverty, migrants and people with pre-existing health conditions are most at risk from climate change, which threatens to exacerbate inequalities within and between countries. Severe environmental changes have profound effects on the underlying social and environmental determinants of the right to health, such as clean air, safe drinking water, adequate housing and food, economic security, social relationships and community life. 44 16 See Peter Stastny and others, “Critical elements of rights-based community supports for individuals experiencing significant emotional distress: foundations and practices”.