A/HRC/44/48/Add.1 the country. Such a third-level health-care facility should not provide long-term institutional care; that reflects a systemic underdevelopment of the mental health system and calls for the urgent development of community-based care, as provided by the Convention on the Rights of Persons with Disabilities, ratified by Ecuador in April 2008. 15 The Special Rapporteur urges Ecuador to shift its approach from public investment in mental health services to community-based care, providing quality services and empowering users. That can be achieved only when modern public health principles and a human rights-based approach are applied when developing and implementing mental health policies and services. 36. While the national strategic plan on mental health and the mental health-care model constitute significant progress by conceiving mental health care from a community approach, the Special Rapporteur regrets that to date, no evaluation has been made of its implementation. He recommends conducting such an evaluation to take stock of lessons learned and to plan accordingly for future initiatives. 37. Mental health has not received the same importance as physical health in terms of financial and human resources. The number of mental health professionals remains very low (fewer than 1,000 psychologists and psychiatrists, according to information provided during the visit). The Special Rapporteur is concerned that the numbers could be even lower following the austerity measures adopted by the Government and recommends increasing the number of mental health professionals in the mental health-care system and in the health-care system in general. As indicated to the Special Rapporteur during the visit, the budget for mental health-care services only amounted to 1.3 per cent of the general budget for public health in 2019. More alarmingly, the consolidated State budget for 2020 does not allocate specific funding for mental health-care services.16 Such budget cuts may have serious consequences, not only for the mental health system but also for the wellbeing of the population in general. The Special Rapporteur urges Ecuador to consider mental health as a global health priority and recommends prioritizing funding for mental health in the national budget as a matter of urgency. 38. Despite these serious shortcomings, the Special Rapporteur believes there is still an opportunity to develop a rights-based mental health system in Ecuador. For this to occur, real political commitment and will is needed to encourage, guide and engage all stakeholders in a meaningful public debate on how to ensure the full realization of the right to mental health. Addressing the determinants of mental health – inequality, poverty, violence and discrimination – is an important element of any mental health policy. In that way, institutionalization, social exclusion and stigmatization are prevented. Mental healthcare services should be integrated into primary and specialized general health care and institutionalization and over-medicalization should be avoided. The network of outpatient community-based services needs to be strengthened throughout the country so that persons with mental health conditions, including persons with psychosocial or intellectual disabilities can receive care and support where they live. At the non-specialized level, professionals (teachers, social workers, general practitioners, paediatricians and others) need to be trained to manage mental health conditions and only in complicated cases to refer them to specialists such as psychiatrists and psychologists. Public investment should be directed not to supporting psychiatric hospitals or institutions for long-term care, which should be progressively closed, but to developing a network of community-based mental health services throughout the country. Those services should be mainstreamed within the general health-care and social care services. Children with developmental disabilities and mental health conditions should be provided with inclusive education and mental health services. 15 16 The Committee on the Rights of Persons with Disabilities emphasizes full respect for legal capacity, the absolute prohibition of involuntary detention based on impairment and the elimination of forced treatment (A/HRC/34/32, paras. 22–33). See also Convention on the Rights of Persons with Disabilities, arts. 12 and 14; and Committee on the Rights of Persons with Disabilities, general comment No. 1 (2014) on equal recognition before the law and guidelines on article 14 of the Convention. See www.finanzas.gob.ec/wp-content/uploads/2019/10/20Plan_Anual_de_Inversiones_Entidad_CUP_Egresos.pdf. 9