Mental illness is a global problem. More than 300 million people, 4.4% of the world’s population, suffer from depression. These alarming figures reflect the wider prevalence of mental ill-health more generally. It is estimated that mental health conditions will affect a staggering one in four people at some time in their lives.
Disparities abound, both between countries and particular groups. It is scandalous that 35-50% of people with severe mental health disorders in the Global North receive no treatment; but that figure roughly doubles to 76-85% for people living in the South.
The same disparity is seen in levels of civil society mobilisation (a vital element in any effective response). Organisations representing people with mental health problems and psychosocial disabilities are present in only 49% of low-income countries, compared with 83% of high-income countries.
Across the globe, particular groups, such as women, and people living in poverty, are disproportionately affected. So are refugees and asylum seekers, who are five times more likely to experience mental health issues than the general population. More than 61% of refugees will experience a mental health crisis or breakdown. This reflects another universal feature of mental illness: as with physical health, mental health is influenced by a wide range of social, political and economic factors. These include social and economic disadvantage and deprivation, low levels of education, unemployment or insecure employment, discrimination and violence.
Mental health in turn impacts on issues such as alcohol and substance misuse, abuse and gender-based violence. Failure to address mental health therefore has consequences for societies as a whole.
Much of all this – about the scale and the causes of the problem – has been known for some time. But the response to date, in terms of resources and political will, has been woefully inadequate. Despite the huge implications it has for global health, mental health receives a fraction of the funding of other diseases – both in allocations from Ministries of Health and development assistance.
And in terms of political prioritisation, the UK’s recently-published plan for implementing the Sustainable Development Goals provides a telling insight. True enough, in the section on plans for Goal 3 (‘Ensure healthy lives and promote well-being for all at all ages’) in the UK; the paper does commit the Government to providing the necessary support and treatment for people suffering from mental ill-health. But when it comes to our commitments to the rest of the world, the document is silent on the issue of mental health.
Civil society organisations can also do more to develop and implement adequate responses to the global challenges of mental health. One example from Health Poverty Action’s own experience was working with indigenous Mam communities in Guatemala to address violence against women. Working with local community leaders to address the lack of emotional and psychosocial support for survivors, we developed a course for local women leaders, traditional birth attendants and religious leaders.
It taught them to recognise depression and anxiety, and relate them to local cultural illnesses such as “soul loss”. It also taught basic listening techniques, and use of locally available medicinal plants to help with relaxation and stress relief. As a result, women who suffer violent abuse are able to access a trained community counsellor to whom they can talk to in their own indigenous language, and find support to begin to rebuild their lives.
Mental health services must be incorporated as a core component of health systems and must be clear in calls for comprehensive primary health care.
Most fundamentally, any response to the global challenges of mental health will only succeed if it addresses the multiple social, political and economic determinants of the problem.
This World Health Day should provide the impetus for transforming how we understand, and respond to, the problem of mental illness, to give the issue the priority it needs and deserves.