A/HRC/34/32 women.18 In some countries, the absence of community-based mental health care means the only care available is in psychiatric institutions, which are associated with gross human rights violations, including inhuman and degrading treatment and living conditions.19 A. The experience of living with mental health conditions 1. Barriers to the enjoyment of economic and social rights and the underlying determinants of mental health 12. While statistics are important to understanding the breadth of the challenges presented by mental health conditions, it is the individual who should remain the central figure in the discourse around these questions. The experience of living with mental health conditions is shaped, to a great extent, by the historical and continuing marginalization of mental health in public policy. This manifests itself in, among other areas, social life, inequality of access to opportunities and the overrepresentation of persons with mental health conditions in populations living in poverty. 20 Indeed, today, one of the most important health and human rights challenges is to enhance enjoyment of the right to health for those living in poverty. 21 13. Mental health is not merely a health issue. There is a strong link between mental health and poverty, as well as between mental health conditions and the economic hardship resulting from the inadequate realization of economic, social and cultural rights, such as the rights to education, work, housing, food and water. 22 These and other rights are also underlying determinants of mental health and, consequently, the extent to which they are realized affects the enjoyment of the right to mental health. The failure to adopt policy approaches which take account of these and other determinants of mental health is, similarly, a major barrier to the realization of the right to mental health. 14. According to the Special Rapporteur on the right to health, the “tendency to undermine the importance of economic, social and cultural rights has led, and continues to lead, to a detrimental combination of poverty, inequalities and disempowerment of large groups of population, who will consequently suffer from poor health status and barriers to accessing health-care services. 23 The interruption of and restricted access to education experienced by many persons with mental health conditions, for instance, limits the opportunities available for obtaining qualifications which would facilitate gainful employment. Difficulty in securing employment and remaining in work or otherwise generating income has negative consequences for the ability to access and retain adequate housing. Taken together, these challenges perpetuate social inequality and have a ruinous and enduring impact on the enjoyment of the right to an adequate standard of living and, consequently, on mental health and access to health services. 18 19 20 21 22 23 6 Kristian Wahlbeck and others, “Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders”, British Journal of Psychiatry, vol. 199, No. 6 (December 2011). See also Stephen C. Newman and Roger C. Bland, “Mortality in a cohort of patients with schizophrenia: a record linkage study”, Canadian Journal of Psychiatry, vol. 36, No. 4 (June 1991). See A/HRC/22/53, paras. 59, 63-70. See Florida Council for Community Mental Health, “Mental illness and poverty: a fact sheet” (January 2007), available from www.fccmh.org/resources/docs/MentalIllnessandPovery.pdf. See also Sally McManus and others “Adult psychiatric morbidity in England, 2007. Results of a household survey”, NHS Information Centre for Health and Social Care (2009). See A/HRC/4/28, para. 20. A/HRC/29/33 para. 28. Ibid., para. 53.