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Global Mental Health 101

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Mental Health protest – Image from: The Center for Global Mental Health

In writing my next blog post I realized that a good number of my readers may have not talked to me about my degree or may just need a crash course in order to understand my passion and what I am talking about.  So welcome to my version of Global Mental Health 101.

Let me break it down and start with some basic definitions and distinctions as well as my two cents.  Then I’m going to slip in slightly revised parts of my practicum plan (with references) for your information.

I am completing my master in public health.  No, I am not a nurse.  I am not a doctor.  I am not a clinician.  Public Health is a field that focuses, not on the health of specific individuals, but of the health of populations. This means that public health professionals work in the planning, evaluation and motoring of health programs and services as well as health policy and health system reform. Public health also has the tendency to focus on preventative services that prevent people from getting sick rather than curative services that treat people once they sick.  In looking at health from a preventative stand point more and more attention has begun to be paid to the social determinants of health. These social determinants of health recognize there is more to health than simple biology and anatomy.

My interests lie in mental health and addictions. I like to think my view is captured by the following statement by the World Health Organization “there is no health without mental health” (WHO, 2005).  Within a public health framework, this means I do not plan on being a front line worker or a mental health clinician – a counsellor, psychiatrist, or psychologist.  Instead, I am interested in looking at and working on larger programs, systems and policies that relate to mental health and addictions.  For example:

  • Public awareness and education campaigns aimed at increasing awareness and decreasing the stigma of mental illness or
  • Advocating for policy regarding the implementation of publically funded evidence based treatment for mood disorders (depression and bipolar).
  • Developing and creating outreach,  life skills and employment programs

Furthermore, my interests in mental health and addictions are not limited to the North American or ‘Western’ contexts. Within public health is the field of Global Health.  Global health is not international health or the health of ‘developing’ countries. Global health refers to the public health activities that address health conditions that cross borders.  This means that global health professionals look at a wide range of issues from infectious diseases like HIV/AIDs issues, malaria and TB; chronic diseases like diabetes, heart disease and obesity, food security and nutrition, maternal and child health, genetic conditions,  traffic accidents, environmental and occupational health and of course my interest mental health and addictions.

It wasn’t until late in the 20th century that mental disorders (also known as mental illnesses or neuropsychiatric disorders which also includes addictions/substance use disorders) were recognized as things that were ‘real’ (Patel, 2012).  A Canadian estimate states that one in five people will personally experience a mental illness at some point in their lives (CMHA, 2013). Mental illnesses occur in individuals in all countries, all age groups, across gender, socioeconomic status (rich/poor) and urban and rural divides (WHO, 2009; WHO & Wonca 2008). Mental health concerns are just now starting to be recognized as a silent global epidemic. It is currently estimated that 450 million people worldwide suffer from a mental illness, accounting for an estimated 13-14% of the current global burden disease, with almost 75% of this burden falling in low- and middle- income countries (LMIC) (WHO, 2010).  This means that 13-14% of healthy years lost to early death and disability in the world are a result of mental illness.  90% of one million suicides that occur every year are linked with a mental disorder (WHO, 2009).

Furthermore, individuals suffering from mental illness are more at risk for suffering physical illness and more likely to participate in unhealthy and risky behaviours (WHO, 2009; WHO & Wonca 2008). Mental disorders are associated with social disadvantage, including poverty, violence, gender disadvantage, conflicts, and disaster (Patel, 2012;WHO 2010) as well as experiences of crippling stigma, discrimination, rampant abuse and human rights violations (Bass et al., 2012; Patel, 2012).

Mental illness has staggering economic cost in addition to its social costs (Bas et al., 2012; WHO, 2010; WHO, 2009). It is estimated that over the next 20 years the global economic cost of neuropsychiatric disorders alone will account for $US 16.1 trillion in loss productivity (not counting costs to quality of life) (Bass et al., 2012).  In low resource countries, as a result of the lack of publically funded supports and health care services the social and economic burden of these disorders fall on the shoulders of families (WHO, 2009).  When individuals fail to receive treatment they and their families often become marginalized and may descend into cycles of poverty and homelessness (Bass et al., 2012; WHO, 2009).

Despite the common place of mental illness and the huge costs associated with them, many countries fail to have adequate mental health systems and services (WHO, 2010; WHO, 2009; WHO & Wonca 2008). There are global shortages of trained mental health care workers and less than 28% of countries have budgets specifically for mental health (WHO, 2009). Moreover, when resources are earmarked for mental health, they often fail to go to services and care that are close to where people live (WHO & Wonca 2008). Thus, the majority of individuals affected by neuropsychological disorders globally do not have access to treatments that have evidence supporting their efficacy (Bass et al., 2012; Patel, 2012; WHO, 2010; WHO, 2009; WHO & Wonca 2008).  This is often referred to as the mental health “treatment gap.”  In Sub-Saharan Africa this gap is estimated to exceed 90%; meaning that 90% of individuals affected by mental illness (including those who suffer from most severe and debilitating mental disorders like Schizophrenia and bipolar disorders) do not receive the treatment they need (Patel, 2012).

A primary goal of Africa Mental Health Foundation and a number of organizations and projects around the world is to increase access to psychological treatments to those who need it, but ultimately to improve the lives of those who suffer from mental illness and addictions by decreasing levels of stigma and discrimination and advocating for comprehensive mental health legislation, policies and national mental health plans. My aim of this practicum and my degree in general is to learn how local people and ideas can mobilize and lead to the fulfillment of these goals.

Thanks for reading

C~

Resources:

Bass JK, Bornemann TH, Burkey M, Chehil S, Chen L, et al. (2012) A United Nations General Assembly Special Session for Mental, Neurological, and Substance Use Disorders: The Time Has Come. PLoS Med.v9(1)

Patel, V. (2012) Global Mental Health: From Science to Action. Harv Rev Psychiatry.v20(1), p.1-12.

World Health Organization (2010) mhGAP Intervention Guide for mental, neurological and substance use disorders. WHO press. Geneva, Switzerland.

World Health Organization (2009) Improving health systems and services for mental health. WHO press. Geneva, Switzerland

World Health Organization (2005) Facing the challenges, Building Solutions. Ministerial Conference on Mental Health. EUR/04/5047810/6. Helsinki/London: World Health Organization.

World Health Organization and World Organization of Family Doctors (Wonca)(2008).Integrating mental health into primary health care. WHO press. Geneva, Switzerland