A/HRC/32/32 and adolescent-friendly services remains the exception rather than the rule. Less than one third of low- and middle-income countries have a designated youth mental health entity and most lack youth-focused mental health policies.48 Where they do exist, they often fail to meet quality standards and may even be harmful to the health and development of adolescents. Adolescents may be detained for a long time in overcrowded, in-patient facilities where little attempt is made at rehabilitation or social integration.49 These approaches violate adolescents’ human rights and worsen, rather than ameliorate, mental health conditions. 73. Public and self-stigmatizing attitudes towards mental illness, concerns about confidentiality and lack of general understanding all serve as barriers to getting help, particularly among adolescents, a problem compounded by the lack of quality mental health services in low- and middle-income countries.50 For adolescents, the attitude of service providers is more important than their technical expertise. Adolescents who seek services often experience negative or hostile responses from health-care providers, leading to a further reluctance to access help. Same-sex attraction is still considered by doctors in many countries to be a mental disorder.51 Lesbian, gay and bisexual adolescents may be subjected to harmful therapeutic interventions intended to eliminate or suppress their sexual instincts. Such therapies have been deemed unethical, unscientific, ineffective and, in some instances, tantamount to torture.52 B. Promoting effective mental health services 74. Prevention of mental health problems and promotion of mental well-being in adolescence should be a central part of national health policies. Action plans should include programmes for evidence-based interventions that are well-funded and monitored and that aim to reinforce protective factors within adolescents, their families and communities. 75. Accordingly, the focus should be on building resilience, supporting parents, stimulating adequate help-seeking behaviours, creating positive peer groups and school environments, ensuring opportunities for influence and decision-making, increasing empowerment and emotional literacy. Furthermore, such programmes can also address risk behaviours such as bullying, suicidal behaviour, domestic violence and substance use. 76. Models based on over-medicalization and institutionalization should be abandoned and replaced with early interventions and comprehensive community-based multisectoral responses. Adolescent health policies must be developed with the involvement of professionals in the health, education and social welfare sectors, who can provide a flexible network of services, including schools, community outpatient and day care mental health services rooted in the evidence-based biopsychosocial model.53 48 49 50 51 52 53 United Nations, Mental Health Matters. Vikram Patel and others, “Mental health of young people: a global public-health challenge”, The Lancet, vol. 369, No. 9569 (2007), pp. 1302-13. Amelia Gulliver, Kathleen Griffiths and Helen Christensen, “Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review”, BMC psychiatry, vol. 10, No. 1 (2010), p. 113. United Nations Development Programme and USAID, “Being LGBT in Asia: China country report” and “Being LGBT in Asia: Cambodia country report”. A/HRC/29/23. G. Thornicroft and M. Tansella, “The balanced care model for global mental health”, Psychological Medicine, vol. 43, No. 4 (2013), pp. 849-863. 15