No health without mental health: Prioritizing global mental health
Mental health problems, including alcohol and substance abuse pose a pressing burden worldwide, especially in low and middle-income countries (LMICs) where barriers to care prevail. In 2013, major depression, anxiety disorders, schizophrenia, dysthymia and bipolar disorder appeared in the top 20 causes of the global burden of disease defined by years of life lived with disability (YLDs). Depression, which affects millions worldwide, currently creates the third highest disease burden and is predicted to provide the highest burden by 2030. Despite the major burden mental ill health presents, it remains a low global health priority. This existing “burden-to-priority” mismatch exists within a context where a clear disconnect exists between funding and burden measured by both mortality and disability. Moreover, the current epidemiological transition from infectious to non-communicable diseases experienced by LMICs should be a stimulus for the global health community to reassign its priorities. In the global health agenda, mental ill health has often been overlooked as it doesn’t present itself as a “visible” killer compared to diseases such as HIV and malaria. However, this is exactly where the greatest danger lies. Mental ill health impacts span across the individual, community and even national level. In fact, if left untreated, many mental disorders are highly disabling as they affect day-to-day functioning and often lead to socioeconomic isolation. The disabling nature of mental ill health combined with lack of adequate resources to tackle it can undermine productivity which ultimately can drive unemployment. In fact, the lack of investment in mental health is one of many key drivers of poverty and inequity in low- and middle-income countries. With the rise of chronic and disabling diseases in LMICs, forced migration due to war, natural disasters and the widening gap between the most and the least privileged, mental ill health is positioned to pose a growing and serious threat to the world’s most vulnerable people.
In most low- and middle- income countries, annual spending on mental health is less than US$ 2 per capita compared to 200$ per capita in Canada in 2003. The lack of investment in mental health is apparent in the current treatment gap. In fact, despite evidence of the high burden of mental disorders in LMICs, most people affected do not have access to treatment: in LMICS, between 76% and 85% of people with severe mental disorders receive no treatment for their mental health problem.
As stand alone disorders, many mental disorders are highly disabling, reducing the quality of life of those affected. The burden of mental ill health translates into reduced quality of life for those affected, as well as the loss of productivity and income due to disability or death which is a driving force of poverty in LMICs. Of greater concern, mental disorders can often increase the risk for both communicable and non-communicable diseases and contribute to unintentional and intentional injury. In fact, depression and substance abuse have been shown to increase the risk of hazardous sexual behaviour as well as other life-threatening behaviours. In Rwanda, mental ill health has been recognized as a factor related to non-adherence of antiretroviral medication in psychiatric HIV youth patients. Poor treatment adherence in psychiatric patients can be explained by the cognitive impairment caused by mental ill health and/or by the lack of awareness of ill health.
Many physical health conditions also increase the risk for mental disorders. Stigmatized conditions such as HIV/AIDS or severe physical disability often lead to social isolation which increases the risk for mental ill health. Lastly, daily life stressors such as poverty and political instability also increases risk for mental disorders and trauma.
In addition to being a pressing global health problem, mental health also constitutes a human rights issue. Left unprotected under the law due to the lack of comprehensive national mental health policies, mental health patients in LMICs are often at the mercy of human rights abuses. There have been reports of neglect, physical, and sexual abuse of mental health patients. In fact, the lack of effective treatment and comprehension of ill mental health has led to the incarceration and even chaining of mental health patients to trees in some areas of the world.
Despite the challenges many LMICs face, new efforts at improving mental health conditions have emerged in the past decade. In Zimbabwe, the Grand Challenges initiative The Friendship Bench has proven itself to be an innovative and cost-effective therapy to alleviate mental illness symptoms. Since 2012, The Friendship Bench has been a tool for positive mental and emotional health. The benches are used as listening and problem-solving therapy guided by local lay counsellors and have so far demonstrated their ability to alleviate depression and other mental illness symptoms among HIV-AIDS and other patients.
Partners in Health has also been an important actor in the field of global mental health. Given the common co-morbidities that exist between mental health and other diseases, Partners in Health has made central the need for mental health care to be integrated within their primary health care services. To do so, the organization has primarily focused on a community-based model of care integrated within primary health care systems notably in Haiti where such model has been implemented in response to the 2010 earthquake.
Given the interconnectedness of mental ill health and other disorders, it can be easily argued that there is no health without mental health. Further action is needed to ensure the protection of mental health patients. There is an urgent need for mental health to be integrated into all aspects of health, social policy and services delivery particularly in LMICs. For the first time in history, the United Nations has acknowledged and set mental health as a priority for global development through the 2015 Sustainable Development Goals. While this acknowledgement comes as an historical step to addressing the problem, it is my hope to see priority-setting translated into tangible and concrete action in the near future.
About the Author:
Aurore holds a Bachelor’s degree in Molecular Cell Biology and African Studies from McGill University. Her interests lie in meaningful youth-driven social change, African development, Global Health equity and social justice. Aurore is a Global Health advocate, who has worked abroad as well as locally in Youth Health Education and Health Promotion. She is also a member of Partners in Health Canada Spark Education committee.
