World Mental Health Day occurred last week, on the same day as Indigenous People’s Day / Columbus Day: If you weren’t aware of this, you’re not alone. Some call World Mental Health Day the world’s most neglected health problem day. Despite public awareness campaigns, celebrities and other public figures discussing their struggles with psychiatric disorders and more societal acceptance about mental illness — and the World Health Organization (WHO) reporting that 1 in 4 people will require some kind of mental health care during their lives – a stigma remains.
It’s arguable that this stigma is even greater in countries whose populations have suffered, and are suffering, the traumas of war and life under repressive governments, as well as natural disasters like the epic flooding in Pakistan last year and the famine in Somalia. The direct and indirect costs of mental illness are staggering: An analysis by the World Economic Forum has found that, in 2010, such costs totaled $2.5 trillion.
The prestigious British medical journal The Lancet recently published a series of papers as a follow-up to six papers and editorials about mental illness it published four years ago. Researchers have found that there’s been progress in figuring out what needs to be done to help those suffering from mental illness. A survey of 87 countries found that more than half said there was more awareness about mental illness than in the past.
But little progress in actually helping people has been made, in no small part because of a lack of funding linked to the continuing stigma about mental illness:
For example, an analysis of programs that address poverty — a fellow traveler with mental illness — show that just giving people money, in the form of microloans or cash, often doesn’t help. The study showed more consistent improvement with interventions such as individual or group talk therapy, or psychiatric drugs.
An analysis of psychiatric aid offered to victims of traumatic situations such as war or natural disaster found that at least for adults, psychotherapy and setting up social supports like education and group discussions helps. But the authors of the report say funders often lose interest after the initial crisis passes.
That’s a common refrain. Spend any time talking to folks who work with mentally ill people in poor countries, and they’ll tell you that they consider their programs seriously underfunded, in no small part because of stigma. “Many people don’t want to be associated with mental illness,” says Julius Kayiira, who runs Mental Health Uganda. And others “think there’s no hope,” he adds.
Indeed, there is growing evidence that mental illness and poverty “interact in a negative cycle” in low-income and middle-income countries. Even more, those with mental and psychosocial disabilities face violations of their human rights according to the UN Convention on the Rights of Persons with Disabilities (CRPD).
Vikram Patel of the London School of Hygiene and Tropical Medicine and a leader of the global health movement, identifies what I think is a key point, that many still do not consider mental illnesses to be real illnesses. For instance, in September, the UN sponsored a major conference on non-communicable diseases – cardiovascular diseases, lung diseases, diabetes and cancer — but mental illnesses were barely mentioned.
Noting that “there is no health without mental health,” Secretary-General Ban Ki-moon has called on the world to allocate more resources for mental illness. How can we send the message that we must prioritize mental illness; that, just like heart disease or cancer, mental illnesses can causes untold pain and suffering and even death?
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Photo of Nekbakhat, aged 50, who had to flee her home with her husband and five children in the middle of the night when the flood came in August 2010 in Pakistan, by DFID - UK Department for International Development