Written by John Minto
In the run up to establishing international development targets, it is not unknown for a number of health burdens to undertake ‘special pleading’, often on the basis that without growing attention (and donor funding) on their own ‘health condition’, all other indicators will be impacted on negatively in due course
In the case of mental health, however, this ‘special pleading’ is compelling. With the current crop of Millennium Development Goals (MDGs) currently under review, a strong case is being made for the inclusion of mental health in Sustainable Development Goals for the following reasons –
- High Prevalence: One in four people will experience mental illness during their lifetime
WHO reports note that roughly 600 million people experience disability due to mental illness. As many of these people live in low and middle income settings, it remains a surprise that international development agencies (for example) have not given mental illness a higher priority in their programme planning and advocacy initiatives. As the FundaMentalSDG campaign (www.fundamentalsdg.org) has stated, ‘psychological disability is one of the most pressing development issues of our time. Poverty, hunger, conflict and trauma, poor access to health and social care, and social inequality are significant risk factors, increasing vulnerability to persons with psychological disabilities in low and middle income country contexts’,
- Human rights violations, stigma and discrimination
As the growing body of evidence from around the world shows, people living with psychosocial disabilities (especially in low and middle income countries) often experience a profound infringement of their basic human rights to health care and find themselves beaten, chained and, too frequently, imprisoned without recourse to appropriate treatment. In itself, this reflects the ‘structural discrimination’ which often sees Government allocating significantly more resources to physical (often communicable) illness than they do to non- communicable (including mental) illness,
- Growing burden of disease
Recent research has also shown that, using appropriate indicators (such as Disability Adjusted Life Years), mental and behavioural problems now account for roughly 7.5% of the global burden of disease – more than cancer and cardiovascular disease. In higher income countries, research has indicated that men with mental health problems die a staggering 20 years and women 15 years earlier than people without the same burdens. It is difficult to avoid the conclusion that this gap might even be wider in low and middle income countries and that mental problems are also genuinely cross cutting in nature. Within HIV-AIDS, for example, people living positively who also suffer from common mental disorders (anxiety, depression, substance abuse) are more likely to engage with treatment later than they should, have issues related to adherence regimes and suffer from poor overall health outcomes,
- Compelling evidence for treatment
In low and middle income countries in particular, the amount of Government spend on mental illness is so low in relation to the ‘burden of disease’ that very few are able to access the limited treatment available. This under-investment has created a ‘treatment gap’ in which most of the limited amount of treatment available is located mainly in large urban based hospital settings, far away from many of the people who need it. At the very least, this situation breaches the fundamental right to accessing health care and represents a poor way in which to address issues such as equity and economic productivity, and,
- Increasing global recognition
Over the last 2-3 years, recognition of the importance of mental health conditions has started to gain global attention and there is increasing awareness of the need for mental illness in particular to be recognised within the forthcoming Sustainable Development Targets. In part, this has been due not only to cutting edge research, but also of various approaches (focused mainly on enhancing the capacity of community based health workers to identify, treat and/or refer a range of mental health conditions) to scaling up services which have been successfully tested in a range of low and middle income countries.
Nigeria is increasingly being seen as a leader within the global mental health community, not only due to the site testing of treatment scale up projects, but also through the passing of the National Mental Health Services Delivery Policy by the National Council on Health in August 2013. However, to make a difference on a global scale, there can be no doubt that the recognition of the impact of mental illness (as well as the importance of mental health) within internationally agreed development targets is an essential part of winning wider recognition of this underserved and highly stigmatised health burden.
Written by John Minto, Managing Director of Gede Foundation – www.gedefoundation.org