Global Mental Health

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SEATTLE — Researchers and scholars in global mental health from all over the world gathered to launch the 2018 Lancet Commission on Global Mental Health and Sustainable Development on The University of Washington’s campus on Friday, October 19. The 28 Commissioners worked for three years to produce a comprehensive report on the status and progress of the field and how to move the global action on mental health forward.

Global Mental Health and Its Problems

There is a large gap between affordable effective treatment and government policy and funding for global mental health. According to the Commission, less than 1 percent of the budget goes to low and middle-income countries.
“The key initiative is trying to bring mental health as a public priority of agenda because mental health has various determinants and the impact really cuts across various aspects of human life,” said Director of Mental Health at the Ministry of Health in Kenya, Simon Njuguna Kahonge.

Stigma Associated With Mental Health

Mental health and substance use conditions cause more disabilities and loss of life than any other disease, impacting one in every four people. Suicide is the leading cause of death among women in India, according to the Commission.
One of the underlying reasons health outreach usually doesn’t involve mental health is the stigma. There are perceptions that persons with mental illness are dangerous or cannot live normal lives after treatment, according to Country Representative for Health for the Carter Center in Liberia and Program Lead for the Mental Health Program, Janice Cooper.
Persons with mental illness are still abused in global societies, often ostracized or incarcerated. But that can be fixed by integrating mental health in all aspects of development, according to the Commission.
“Social determinants of mental health are extremely important. Things like alleviating poverty, providing education for all, looking after young children, and taking care of people who are under stress, are some of the strategies that will have the maximum impact on preventing mental disorders and promoting health in general,” said Harvard Professor and former Director of the Department of Mental Health and Substance Abuse at the World Health Organization in Geneva, Shekhar Saxena.

Global Mental Health and Limited Resources

Mental health requires more human resources and financial resources, especially in low and middle-income countries, according to Saxena.
“The number of psychologists per capita is low. When you talk about low and middle-income countries, it’s even lower. We have three psychiatrists in our entire country, Liberia,” Cooper said.
According to Cooper, the medications that are available in low and middle-income countries are the older generation drugs, whose side effects impair patients.

Global Mental Health and Poverty

“There is a bidirectional interaction between poverty and mental disorders. Poor people are more likely to have mental disorders. If a person has a mental disorder, that drags them down into poverty—because of not working, because of spending money on treatment, and even family members sometimes have to leave their work to look after the person who has a mental disorder,” Saxena said.

Cooper advocates integrating mental health with outreach aid packages. “Liberia went through Ebola. Most of the focus was on infectious disease, not on all the trauma that was associated with having a contagious and infectious disease such as that.” Cooper said.
Both lower and higher income countries have similar problems surrounding mental health. Therefore, a global collaboration can help address these issues by using innovation such as technology and sharing limited resources, according to Kahonge.
“Mental health has to be integrated within the healthcare system at all levels, including at a primary care level. That is the big message to policymakers—increase the attention given to mental health, increase the resources, and integrate it within the overall healthcare system,” Saxena said.
According to Saxena, studies have found that $1 invested in the treatment of depression and anxiety is actually equal to gaining $4.“It makes sense to invest in mental health not only for decreasing disabilities and saving lives but also for economic reasons. The message to all countries is that they must invest more in mental health and they will reap a large number of benefits over a period of time,” Saxena said.

Mental and Physical Illnesses

People with mental illness are more likely to develop a physical illness such as cardiovascular and heart problems. People with chronic physical illness are also more likely to have a mental illness, according to the Commission.“Often patients will have depression comorbid with something like HIV, their HIV outcomes are worse,” said Director of UW Global Mental Health Program, Pamela Collins.
Collins is working with UNAIDS, a global effort to combat AIDS-related illnesses, to strategize an integrated approach and steps that countries can take to make it happen.
Collins is also working with citiesRISE, a global project with teams from Seattle, Nairobi, Kenya, Chennai, India, Bogotá, Colombia and Sacramento, CA. “The idea behind this is what can one do with the power of different kinds of mobilization. How do we mobilize youth to address mental health in different cities around the world? How do you mobilize intersective leadership in cities?” said Pamela Collins.
The project involves turning to people on the ground and asking them what the key issues surrounding mental health in their community are. According to Collins, this facilitates more intervention and addressing pressing problems by mobilizing intersectional components of cities.
“It’d be great to see funding that actually delivers these services in many different places. The integration of HIV care and mental health treatment is critical for HIV programs to achieve their goals,” Collins said.

Mental Health and Maternal Care

Mental health should be integrated with maternal care as it can gravely affect a baby in early life. A depressed mother might prevent the baby from forming a healthy attachment, a strong emotional and psychical bond critical for development, according to Christopher J.L. Murray at the UW Department of Health Metrics Sciences.
“A baby who has a good attachment experience in their first year of life is actually several times less likely, down the road, to be struggling with a mental health problem of their own,” Murray said.
Despite all these issues surrounding global mental health, the Commission has hope. “I do believe that the public health approach to mental health can have the potential of serving millions of individuals. The potential for making policy and practice change really can have a large impact on the population’s mental health,” Saxena said.

– Anna Power
Photo: Flickr

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