“Is mental health actually relevant to international development?”
When I was asked this by my university tutor I felt a bit taken aback. Lack of access to mental health support results in the same eventualities as any other development challenge, yet it is not treated with the same seriousness —while intended to challenge me, his comment highlighted the pervasiveness of this attitude. This article offers some insight on why this might be and shows you why we, as team three of YSI, think this is an important problem to work on.
Over the last few decades the World Health Organisation (WHO) has released numerous reports on mental health in international development. However, it was not until 2015, with the creation of the sustainable development goals (SDGs), that well-being became recognized as a global development priority.
Mental health vs physical health: The importance of mental health in development can be explained with a comparison to physical health; which is widely accepted to be a development priority. If people are physically unwell and do not receive adequate health care their standard of living becomes worse than that of well people around them. Unwell people become excluded and marginalised: Their inability to participate, if not overcome, results in violations to their human rights. Ultimately inadequate health care may result in unnecessary on-going disability, or death. People with mental health concerns (MHCs) are vulnerable to these same eventualities: Depression is the leading cause of disability worldwide; suicide is occurring at rates that qualify crisis responses; and eating disorders continue to result in death for 5% of sufferers. People with MHCs are also subject to unique stigmatisation related to their condition, resulting in further exclusion.
Despite similarities with physical health there are also some major differences:
There is an inherent subjectivity in understandings of mental health.
What is normal in one society differs greatly from what is normal in another society — a natural and important part of human diversity. The DSM has now somewhat caught up with this and recognises that any diagnosed disorder should both cause suffering and not be considered normal within the individual’s psychosocial context. Attached to these differing understandings of mental health is a research bias. The vast majority of psychological research is conducted on medium/high SES Americans. This makes it difficult to accurately determine how different regions fare in mental health outcomes.
Mental health does not reflect traditional ‘patterns of development’.
Mental health challenges the assumption that there are developed and less developed countries. Certain countries in the OECD are facing rates of mental health concerns that warrant public health crisis responses. As there is a bias in the quality of research available it is difficult to decipher spatial patterns of mental health concerns. Mental health and inequality are closely tied — we see marginalised groups faring worse. There is undoubtedly geographic inequality in mental health outcomes but these patterns are difficult to decipher; one study found people only fare worse in the rural areas if the area also had low levels of social cohesion. Geography plays a role but this can be as much a protective factor as it is a risk factor.
There is no easy fix
Unlike many physical health problems which could be prevented with a vaccination or a box of condoms, mental health is (arguably) more closely tied to sociocultural factors. Our genetics determines our susceptibility or predisposition to mental health concerns, and contextual factors determine whether these develop during our lives, and how these are managed. Our lived context is a product of the past — it is important not to overlook history and geography.
So then, why is well-being relevant to international development?
At a personal level: Our well-being (which incorporates physical, mental, emotional and spiritual health) and that of those close to us, determines our lived experiences, and how we flourish in this world.
At a population level: Well-being is a major determinant in development outcomes. Well-being is fundamental to physical health and participation, and as such is closely tied to human rights. The world’s ability to respond to the well-being needs of people determines whether patterns of inequality are reproduced and whether we can overcome many of the other challenges the world is facing.
We need well-being,
and that comes with access to the right mental health support.
Whether our project ends up focusing more at the personal level, or the population level, we know that we are working on something that is very relevant to international development. Watch this space.