Invisible Illness
The Role of Mental Health Awareness in the Future of Global Health
Recently, Buzzfeed (a popular American media outlet) celebrated Mental Health Week with a series of videos, personal essays and informative listicles centered on promoting mental health awareness. This campaign got me thinking about how little we, as global health professionals, discuss the importance of mental health in our fight for universal health equity. As a former psychology student and as someone who has worked with the homeless population in Los Angeles, mental health has always seemed to be a clear component of public health to me. However, I’ve never prioritized mental health in a crowded field of health issues, and I believe this to be the case for most of the world. It’s time for this to change.
According to the World Health Organization (WHO), 14% of the global disease burden can be attributed to mental health diseases. Additionally, 75% of the people that have these diseases live in low-income countries and do not have access to the kind of care that they need. The WHO also recently implemented a program called Mental Health Gap Action Programme (MhGap) which “aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income.”
However, once on the ground, this is much easier said than done. According to psychologists, the biggest barrier to mental health care is stigma surrounding mental illness. This is true in every part of the world. While I was working with the homeless population in Los Angeles, I noticed that our clients were often discriminated against by landlords and housing companies because of their mental health status. Additionally, in many places around the world, the language we use to describe people with mental illness is often attached to a negative social connotation of some kind. Examples in America would be: “psycho”, “insane”, and “crazy”. These negative adjectives do not make a person suffering from mental illness feel inclined to seek treatment or talk about their situation. Finally, in the United States, mental health is most often discussed on a national level when it is associated with the aftermath of gun violence. By doing this, we are indirectly attaching mental health to violence. While mental health does need to be addressed, always associating it with violence on a national scale is harmful to the nearly 43.8 million Americans living with a mental illness of some kind. This only perpetuates negative stereotypes and stigma further. Stigma surrounding mental health manifests itself differently in different places and communities, but the overall problem with it is the misunderstanding of the major health issues at play.
I’m currently working as a Global Health Corps Fellow with Partners In Health in Neno, Malawi. We work with the Ministry of Health (MOH) here to support two district hospitals and 11 health centers. I met with the Mental Health Officer for the MOH, Grant Gonani, to pick his brain about the state of mental health care in Neno, how that relates to broader global health, and what we can do to advocate for our patients. Patients in Neno, and Malawi as a whole, have limited access to mental health professionals. This is the case with most middle and low-income countries. Currently in Malawi there are an average two physicians per 100,000 people. If this is the case with doctors, the numbers for mental health professionals are virtually non-existent. However, screenings still do happen in Neno. Gonani hosts a mental health clinic at the District Hospital each Wednesday, as well as monthly outreach clinics at health centers throughout the district.
Like any truly successful intervention, improving mental health care in places like Neno starts with the community. For example, Gonani says that raising awareness to reduce stigma, forming peer groups, and promoting mental health activities and care in both schools and workplaces would make a difference. This will help build a culture of care for mental health. When people see others being effectively and compassionately treated, stigma toward mental illness and treatments will be reduced. Furthermore, we need comprehensive medical structures to diagnose and treat mental health illnesses; an ambitious goal that will require staff training, strong clinical supply chains, and reliable operational support.
This will of course take time, and extraordinary investment. But the WHO’s recent efforts give me hope that the global community is ready to commit to the cause. So how do we begin? It can be as simple as discussing mental illness more openly, in both our personal and professional lives.
Most of us have either struggled with mental health ourselves, or know people that have and have chosen not to talk about it.
For example, two weeks into my fellowship I received news that a friend in the States had committed suicide, something that might have been prevented through open and honest conversations about mental health. As I’ve processed this personal tragedy and researched the impact mental health has globally, I’ve thought about how we can change this for people all over the world. As future leaders in global health, it is our obligation to keep mental health as part of the conversation regarding health systems change, and advocate for mental health care across the globe. Over time, stigma will begin to fade, and conversations about policy and programs will become easier.
Change is never easy, but with 14% of the global burden of disease attributable to mental health illness, this is a fight we can’t afford to ignore.
Let’s get started.
Rachel Erickson is a 2015–2016 Global Health Corps fellow at Partners in Health in Malawi. All GHC fellows, partners and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. Join the movement today.
