On this Global Health Day, let us remember that there is no health without mental health.
Legislation and policy are often slow to respond to the international community. However, two weeks ago, Representative Barbara Lee introduced to Congress the Global Health Act, which would provide $2 billion over five years to increase the number of health workers in developing countries, improve primary care, and account for the effective use of aid money. This act must include the provision of mental health if it is to comprehensively address health.
Mental illness is the leading cause of disability worldwide. Neuropsychiatric conditions (such as schizophrenia and bipolar disorder) account for about 15 percent of the global burden of disease. But the World Health Organization (WHO) reveals that 40.5 percent of countries have no mental health policy.
Too often those that suffer from mental illness are marginalized and become victims of stigma. But ignoring or neglecting this population only hurts society as a whole.
My early work in South Africa, Sierra Leone, Liberia, Ethiopia, and Haiti have shown the abysmal conditions that those with mental disorders must suffer through when the government and community do not have the funds or initiative to invest in mental health.
Many of these global neighbors are being chained to beds or chairs in community asylum houses, tied to trees and bound by wrists and ankles in their villages, beaten to remove the Devil from their soul, forced to drink contaminated holy water by priests, scalded by burns from leaves given by traditional healers, or given expired medications or sub-standard treatment by clinicians.
The Global Health Act focuses on developing health systems focused around AIDS, malaria, maternal mortality and other treatable medical conditions. But mental illness is also treatable, and equally integral to a community's health.
Depression, for example, is the leading cause of disability, and currently the second cause of disability-adjusted-life-years (DALYs), or healthy life-years lost, in men and women between 15-44 years old. This means that affected people have a hard time contributing to the work force, participating in society in a meaningful way, have strained relationships, and may become large users of health care dollars as they also have more chronic medical issues.
Many will raise the point that there are other priorities that trump mental health. This raises the issue of stigma around mental illness, as the above shows the extent and impact of the global burden of mental disease.
The World Health Organization's Global Health Day helps raise awareness of global needs, and the Global Health Act tries to address these needs. But the world cannot continue to ignore the importance mental health and physical health, to truly understand the plight of those suffering from health disorders.
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My guess is we would all be much better off if we approached mental health with more humanity.
http://sadnessaddiction.blogspot.com/
Thank you for the comments - I'll reply to both of them in this one message. I'm not sure if I quite understand what your criticism is to the post in specific. It seems you are against western interpretation/dogma imposed on other cultures. We agree on that point.
I have read Ethan Waters' book, and was interviewed on NPR in response: (4th one down)
http://www.hereandnow.org/2010/02/rundown-212-2/#4
I agree with the need to allow communities to develop their own vernacular and to teach us their treatments for dealing with mental illness. Allowing people to have a reliance on spiritual interpretations and treatments is integral to care. But that doesn't mean we can't help in providing resources and assistance, to help integrate and improve access to mental health care.
I disagree with some parts of what Ethan Waters' says. As a clinician, it is extremely to see families bringing in a psychotic loved one, bound hand and foot, often beat, with families drained and desperate for help. We have medications and treatments that can help alleviate suffering. So I think we should integrate treatments that we know can help suffering, while fostering support for non-traditional methods of healing.
Yes, there are culture-bound syndromes to be sure. But bipolar disorder and schizophrenia, for example, cross cultural boundaries, and can be devastating for those suffering, and their families and communities.
It is really chauvinistic. So much of our mental health medicine here in the united states has not been empirically proven that to displace local methods without first proving that our way is better just reeks intollerance. .
So much of mental health is about positive interaction with other people and not about taking a pill to boost serotonin levels. Less developed cultures may need fewer pills because they a kinder, gentler societies that are able to treat their depressed, schizophrenic and bipolar people better.
http://sadnessaddiction.blogspot.com/
I have been the staff person in charge of this international campaign for 14 of its 18 years. Although its not as widely know as World AIDS day or Earth Day - it is increasing awareness around the world about mental illness and life issues. The more support it gets, the more we hope it begins to influence the way in which we see, treat and support with mental health issues.
www.wfmh.org for more info!
I will enter my medical residency this coming July, and I believe that our health care system is broken in large part because not enough physicians have followed the patient advocacy path you have clearly chosen. While I applaud your commitment to mental health advocacy, in the service of a factual representation of this issue, I must point out a serious error in your blog. Rep. Barbara Lee's Global HEALTH Act is a piece of legislation that will strengthen the global health workforce - and it certainly does include mental health services and even psychosocial support services in this pursuit.
In case your readership has not had the opportunity for a high level of legislative advocacy experience, the bill text itself can easily be downloaded from THOMAS.gov, and a simple search through the document will bring up five areas where mental health services are included in this bill.
Thank you for your insistence that America include mental health parity in all of our health work, all over the world - the Global HEALTH Act, upon a closer read, will surely rise to your call.
Congratulations on entering residency! It's a rewarding experience.
Thank you for noting the reported inclusion of mental health in the Global HEALTH Act - I was invited to congressional briefings around mental health, and Rep. Napolitano's staff stated they were in contact with Rep. Lee's, to ensure the inclusion of mental health services.
Too often mental health is the first to be cut during implementation phase, and I am not confident that these services will not be left by the wayside.
It does not just start and end with mental health though, child abuse, obesity and personal lifestyle choices are all subjected to society wide preconceived notions which creates a culture of shame and denial and only increases the suffering for the people involved.
By starting with us, you and me, we can begin to create a cultural shift in attitudes by speaking about these taboo subjects openly and honestly, empowering others to speak out as well - showing people that there is nothing to be ashamed of, only challenges to overcome and learn from.
Many thanks for a wonderful article - I am surprised that more people have not been motivated to comment.
Peace and much love
Lara Jane
Founder of the Ultimate Lifestyle Project
http://ultimatelifestyleproject.com/spiritual-quotient
Thank you for your voice and advocacy in this area. Mental illness is still unfortunately burdened by stigma by friends and family too, making it harder for people to be supported at times. Thankfully there are good organizations like NAMI that help.
very best,
Suzan.
Glad to hear that Dr Chang helped, and that your child is doing well! You're the best advocate for your child :)
very best,
Suzan.
Not a single comment 48 hours after this was posted. I guess if you'd posted about autism or vaccines you'd have had 100s of responses.
I don't know what we have to do to raise awareness and fight stigma, but it just breaks my heart that nobody is paying attention. Goodness, you even had an international incident that has mental health implications the day you posted this.
Please keep fighting the good fight. ♥
So much easier to just talk about those sociopath kids and call them crazy than look at the very real issue of the stigma of mental illness. As the late great Dixie Carter said as Julia Sugarbaker, "In the South, we don't hide our crazy people in the attic. We bring them right down to the living room and show 'em off. We don't ask if you have crazy people in your family, we just ask what side they're on."
That's the way it really should be seen. Mental illness is no different than any other kind of illness and it shouldn't be hidden.