Global Mental Health

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What is Global Mental Health?

"Health is a

state of complete physical, mental and social well-being and not merely the

absence of disease or infirmity"

"Health includes

physical status, functional ability, psychological status, social interactions,

economic and social status"

Mental health: ability

t cope with life's stresses and challenges, more than an absence of distress

"Mental health is

as important as physical health to the overall well-being of individuals,

societies and countries. Yet only a small minority of the 450 million people

suffering from mental or behavioural disorders are receiving treatment"

Global Mental Health

Common definitions of

global health do not make explicit reference to mental health (but to HIV/AIDS,

TB, maternal and infant mortality)

Millennium Development

Goals: no explicit goal on mental health

Bu, mental health

contributes to 14% of total burden of disease worldwide

World Development

Report in 1993: underscored importance of mental health

Led to reports by

World Federation of Mental Health, Institute of Medicine and the WHO: need to

pay attention to well-being and mental disorders

Modern History of Global Mental Health

World War II: great

devastation and human suffering

Origin of cultural and social

psychiatry

Cultural influences in

development of personality

World Federation for

Mental Health (WFMH): 1948

NGO that linked 'grassroots'

mental health organisations and the UN

Place metal health in the same

footing as NCDs

World Health

Organisation (WHO): 1948

Key role in promoting mental

health

Surveillance

Needs of countries for mental

health policy

Efforts to reduce stigma

World Bank and WHO

influence and advocacy

World Bank 1988: Health sector

priorities review

GBD project: large burden of

mental health disorders and suicide

Advocacy, humanitarianism,

ethics

Mental Illness is Culturally Determined

Possession by spirits

(Kenya)

Punishment for

wrong-doing (Nepal)

Moral deterioration

(USA, 1792)

Moral decay/weakness

(UK Victorians)

What are the Consequences of Mental Health?

Mental health as a human right

Dignity and human

rights compromised:

Involuntary detention

Involuntary treatment

Vulnerability to abuse e.g.

people chained to trees or drowned in floods; caged beds

Political abuse e.g. in former

Soviet Union

Economic and social impact

One in four Europeans

affected every year

€436 billion per year

€2,271 per EU

household per year

Severe social and

personal consequences

Prejudice and discrimination

Employment

Partnership and marriage

Homelessness

Contact with criminal justice

system

Impact on physical health

Some evidence that

poor mental health increases risk of HIV/AIDS and perhaps TB

Tuberculosis:

Peru: 52% of those in one

programme had depressive disorders

Nigeria: 30% prevalence in TB

clinic compared with 5% in general population

Russia: isolate psychiatric

asylums TB risk

Other impacts

Kenya:

Hispital costs per patient in

1999: US$2,351

Out of pocket costs to family

members: US$51

Productivity losses of US$453

India:

Lost employment opportunities

greater than for many chronic physical illnesses

Impacts on family work, loans

to meet costs of treatment and repairing damage to property

Ethiopia, Zimbabwe:

Financial difficulties

Impacts on social life

Mental Health and Refugees

Higher rates of

depression and PTSD in refugees

Cambodian living on Thai

border: 68% depression, 37% PTSD

Bosnian refugees in Croatia:

39.2% depression, 26.3% PTSD

Rwandan and Burundese in

Tanzania: 50% serious mental illness

Iraqi refugees in Egypt: 56%

trauma and impacts on physical and mental health

Mental Disorders - Disease of Wealthy Nations?

Myth: mental health

burden large in low- and middle-income countries

Challenges in obtaining

reliable data on prevalence

Lack of information

infrastructures

Rates vary, but mental illness

prevalent in all countries

Burden of disease affects

economically active, and more common among poor (social exclusion and

poverty)

Barriers to action:

Financial resources

'Competition' by many other

disease burdens e.g. HIV/AIDS, malaria, TB, diabetes

Yet strong links between poor

physical and mental health

What is the Global Burden of Mental Disorders?

Prevalence

20% of adults affected by

mental illness every year

Lifetime prevalence:

Depression - 16% of adults

Anxiety disorders - 10% of

adults

Schizophrenia - 1% of adults

Bipolar - 2% of adults

Conduct disorder - 5% of

10-year-olds

ADHD - 2-5% of children

(disputed?)

Why Do Prevalence Estimates Vary?

Willingness to report

mental illness

Different diagnostic

criteria systems

'subjective;

diagnoses: symptom thresholds for diagnosis different across countries

Sensitivity of survey

instrument and local translation

Misclassification e.g.

in Russia in the past many people with depressive disorders given a diagnosis

of schizophrenia

Real Differences in Prevalence?

Substantive variation:

Different exposure to stressful

events

Differential vulnerabilities

Genetic differences

Culture

Global Years of Life

Lost:

Mental disorders - 0.1%

Substance use disorders - 0.4%

Additional suicide YLLs

attributable to mental and substance use disorder - 1.3%

Neurological disorders - 1.8%

Injuries - 13.5%

Non communicable disease -

40.5%

Communicable diseases - 43.7%

Global Years Lost to

Disability:

Substance use disorders - 3.9%

Neurological disorders - 5.6%

Injuries - 5.9%

Communicable disease - 15.5%

Mental disorders - 18.9%

Non communicable diseases -

50.2%

What are the Causes of Mental Health?

Poverty

Education

Gender

Social change

War and conflict

(loss, trauma and displacement)

Stress

Poor nutrition

Genetics

Mental Health and Poverty

Social causation

hypothesis - poverty leads to mental health disorders via e.g. stress or

deprivation or lower the likelihood of individuals receiving effecting

treatment

Selection hypothesis -

causation may run the other way, as poor mental health can impoverish people

through lower employment and higher health costs

Third factors effect -

related to both poverty and mental health - poor people are more vulnerable to

experience stressful life experiences such as exposure to violence and poor

physical health - which are risk……

Women and Depression

Females more likely to

have common mental disorders

Women's mental health

is not isolated from social, political and economic issues

Sufficient causes in

current social arrangements to account for the surfeit of depression and

anxiety

Multiple roles

including childbearing, running the home, caring for sick relatives, earing

income

Social position,

aspirations and domestic problems

Reproductive role:

childbearing, infertility…

Fertility

Demographics and Mental Health

Mental health measures

are positively and significantly associated with age

Mental disorders are

significantly…..

Social Change and Mental Health

Rapid economic

improvement associated with increased urbanisations

…

Suicide

Suicide rates - annual

suicide rates fluctuate with social situations therefore rough indicator of the

mental health of a society..

Economic Downturn

Higher rates of

depression

Higher rates of

suicide

Higher use of alcohol

Lower access to mental

health services

Suicide in China

Suicide rates in rural

China about 3x higher than in urban China

Major taboo and stigma

Rapid economic transition

Females complete more suicide

than men

Rural life in China

full of hardship for females

Rural females have

access to the means of a completed suicide

Suicide prevention

methods often focus on access to means in agrarian economies e.g. poison boxes

Who 'Cares' for Mental Health?