This week saw a new study on global mental health. To no one’s surprise, it turns out that if you are poor, you are less likely to have access to help.
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 Election last 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.
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.
Mental health issues affect 8 out of 10 doctors
Doctors have a hard job. Every day they have to deal with difficult, demanding and demeaning people—and that’s just the politicians! No wonder 82 percent of English doctors have had episodes of mental illness:
When medical students enter university, their mental health is no different from that of the rest of the population. By the end of their first year, however, it is significantly worse. Stress accumulates throughout their training and, for many, things do not improve. A new study demonstrates what a problem this has become – especially for the doctors involved.
Debbie Cohen and colleagues at Cardiff University carried out a survey of almost 2,000 British doctors at various stages of their career. Of these, 60 per cent had experienced mental illness (the figure is 82 per cent in England) but most had not sought help.
Even the doctors don’t see it coming. In the survey, most medical professionals who have never experienced mental health problems say that they would disclose any problem that arose. But attitudes change when it actually happens. “You don’t do what you think you would do,” Cohen says.
The figures differ according to stage of career. Trainees and junior doctors are less likely to admit to having a problem – perhaps unsurprisingly, given the perception that it may damage their future. Disclosure rates also differ by career track. Among GPs, 84 per cent say that they would disclose; 39 per cent do so. Trainees disclose at the same rate as GPs but are more aware that they won’t: only 62 per cent say that they would disclose a mental illness. Locums and specialist staff are the least deluded and the least open: they acknowledge the lowest likelihood of disclosure (60 per cent) and they follow through, with 38 per cent making a disclosure of an issue.
• Mental health patients wait 'years' for treatment (BBC News)
• Trafficking victims in Britain suffer mental health problems (NewsDaily)
• Tragedy as nine young people died while patients in mental health units (Mirror.co.uk)
NY Jets wide receiver Brandon Marshall envisions AI bringing mental health to the masses
New York Jets wide receiver Brandon Marshall paid a visit to Silicon Valley this week to explore opportunities and potential partnerships with tech companies around mental health issues. Part of the reason for his visit was because, in 2011, Marshall was diagnosed with borderline personality disorder. He spent three months in an outpatient program and now recognizes that what he went through wasn’t unique.
“They’re universal issues — things we go through just as young adults trying to find ourselves and navigate through the world and with all of the stresses and challenges,” Marshall told me.
Since his diagnosis, Marshall has wanted to use his celebrity status to raise awareness about mental health issues, which are still, unfortunately, stigmatized in our society. That’s ultimately the impetus for Project 375, co-founded by Marshall and his wife, Michi Marshall. With Project 375, the goal is to raise awareness around mental health issues — something one in five adults in America experienced last year, according to the U.S. Department of Health & Human Services.
“I always say, football is my platform, not my purpose,” Marshall said. “There’s a unique opportunity where there’s 100 million avid football fans that I can speak to and talk to every single day because they follow football.”
• Spiritual counseling at Turkish hospitals addresses patients' emotional needs (Daily Sabah)
• Challenges that African cultural beliefs poses to mental health (GhanaWeb)
Must a mental illness be revealed on a first date?
By “The Ethicist”—Kwame Anthony Appiah, The New York Times
When you grow close to another person, the unspoken covenant is that you’re not holding back a big, relationship-relevant secret. Unless you’ve said so, the assumption is that you’re not the princess of Ruritania, or living under witness protection, or struggling with a serious illness. Intimacy and candor have to be calibrated to some degree. One risk is that someone pulls away at once because he can’t deal with your history of mental illness, but another is that he pulls away later because you haven’t been honest.