The research, published in Lancet Psychiatry, argues for greater funding, claiming that the economic benefits of treatment greatly outweigh the costs: For every dollar spent on improving treatment for depression and anxiety, the return on the investment could be fourfold or higher in terms of increased productivity and health.
"This analysis sets out, for the first time, a global investment case for a scaled-up response to the massive public health and economic burden of depression and anxiety disorders," write the authors, led by Dan Chisholm of the World Health Organization's Department of Mental Health and Substance Abuse.
Almost a third of humans experience common psychological ill-health at some point during their lifetime. The vast majority live in poor countries, but clinical care resources are predominantly found in wealthy countries. Low- and middle-income countries spend less than $2 per year per person on the treatment and prevention of mental ill-health compared with an average of more than $50 in high-income countries.
According to Nature: “A teenager in Afghanistan seeking mental-health care does so in a country that has 1 psychiatrist for every 10 million people, not 1 per 5,000, as in, for instance, Belgium. But no country has sufficient numbers of trained mental-health-service providers. Nearly one-third of the US population lacks adequate access to mental-health-care providers. There are similar shortages in parts of countries as diverse as Australia, Canada, Finland, France, Japan, New Zealand and Slovakia. Even in wealthy countries, 40–60% of people with severe mental disorders do not receive the care they need.”
Mental health has received very little attention in terms of large-scale global health initiatives compared to say malaria, or HIV. That is slowly changing. There is now some political consensus around mental healthcare, both at home—it was a hot topic in the General Electionlast year—in America, and transnationally. It’s terrific that as of last September, mental health is now included among the United Nation’s Sustainable Development Goals.
There are some impressive programmes that aim to create a more level playing field. The UK-funded Programme for Improving Mental Health Care (PRIME), for example, is a consortium of organisations brought together to scale up mental-health services in Ethiopia, India, Nepal, South Africa and Uganda, taking an informed, integrative approach in these countries with help from community advisory boards that include district health administrators, service users, traditional healers and police.
All well and good. But there are questions. Take 5:
1. Is this all window dressing, a token public relations exercise that diverts attention away from the real business of globalisation—making money and preserving power by and for those that already have it?
2. Do the big pharmaceutical companies have a hand on the lever, attempting to create and colonise large new markets for their patented medications?
3. Is the need for some kind of responsible global governance being served by unelected bodies like the World Bank, IMF and WTO which cater to the “prosperous few” at the expense of the “restless many,” in the words of Noam Chomsky, or like the UN’s WHO which, in this latest report at least, likes to regard people as mere economic units?
4. Could global mental health programmes become a form of cultural imperialism and control, as some have argued, trampling over local norms and practices and instead imposing monolithic “one-size-fits-all” western solutions?
5. If you don’t have access to drinking water say, or your children are starving, doesn’t counselling come fairly low down on the hierarchy of needs? The Indian government offers counselling to help farmers, for example--5,650 Indian farmers committed suicide in 2014, an average of 15 a day. But perhaps what they most need is better financial security. And some rain.
Overall, the growing domestic, international and global attention paid to mental health is a good thing. But the implementation needs to be done the right way. Culturally-sensitive, local, diverse “bottom-up” mental health programmes are better than imposed, dogmatic, uniform, “top-down” western solutions. The book “Global Mental Health” recommends the liberal use of anthropologists and indigenous experts.
And underscoring all initiatives should be a recognition that mental ill-health is often the symptom, and economic disadvantage the cause. Not the other way round.
Whatever your language, it’s good to talk. Every country on earth could use more counsellors.
But it’s hard to pursue happiness, or perhaps Freud’s rather more modest goal of “common unhappiness,” without safety, food and water, and a roof over your head.
No amount of counselling will take away poverty and inequality.