A/HRC/34/32 9. The human rights-based approach derived from these norms calls for States to ensure that health facilities, goods and services for mental health are available in sufficient quantity and are accessible and affordable on the basis of non-discrimination. They are also required, among other things, to be gender-sensitive, scientifically and medically appropriate, of good quality and respectful of medical ethics, such as respect for autonomy and agency without discrimination. An integral feature of the right to health, the meaningful participation of all stakeholders in decisions and policies on health, particularly those affected, should be ensured for persons with mental health conditions and others using mental health services through transparent processes. 11 This involves effective community action in setting priorities, making decisions, planning, implementing and evaluating strategies to achieve better health,12 including mental health. Health authorities and other duty bearers should be accountable for meeting human rights obligations in public health, including through the possibility of seeking effective remedies via complaints mechanisms or other avenues for redress. 10. The formal legal framework has been complemented by the political commitments made in the 2030 Agenda for Sustainable Development, especially Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages. Target 3.4 addresses the reduction of premature mortality from non-communicable diseases and the promotion of mental health and well-being. The prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol, fall under target 3.5, while other targets, such as those relating to universal health coverage and tobacco control, focus on areas of clear relevance, even where mental health is not specifically referenced. IV. Challenges with implications for human rights in mental health 11. The current estimates are that mental health conditions will affect one in four people throughout their lifetime. 13 However, nearly two thirds of persons with mental health conditions will not seek treatment for their condition. 14 Persons with mental conditions also experience disproportionately higher rates of poor physical health for a variety of reasons. 15 One important reason is that poor mental health is a predisposing factor for physical health problems. Another is “diagnostic overshadowing”, where symptoms of physical ill-health are erroneously attributed to mental health conditions and, consequently, either not adequately treated or ignored altogether. 16 Stigma is also a significant determinant of quality of care and access to the full range of services required by persons with mental health conditions who also have physical complaints. 17 Research shows that persons with mental health conditions have a much reduced life expectancy compared with the general population, with an estimated drop in life expectancy of 20 years for men and 15 years for 11 12 13 14 15 16 17 See A/60/348, para. 57. See Committee on Economic, Social and Cultural Rights, para. 54. Jessica Mackenzie and Christie Kesner, “Mental health funding and the SDGs. What now and who pays?”, Overseas Development Institute (2016), p. 9, and WHO mental health fact sheet (April 2016) available from www.who.int/mediacentre/factsheets/fs396/en/. WHO, Mental disorders affect one in four people www.who.int/whr/2001/media_centre/press_release/en/. WHO, “Mental health action plan 2013-2020”, para. 11. Royal College of Psychiatrists, “Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health”, occasional paper OP88, (2013), p. 28. See David Lawrence and Rebecca Coghlan, “Health inequalities and the health needs of people with mental illness”, New South Wales Public Health Bulletin, vol. 13, No. 7 (July 2002). 5