The Invisible problem in Development: Part 2

The World Health Organization (WHO) estimates that schizophrenia, bipolar disorder, depression, and alcohol-use disorders affect around 450 million people and account for 12 percent to 14 percent of the global burden of disease, measured in disability-adjusted life years (DALYs) (DALYs represent the total number of years lost to illness, disability, or premature death within a given population). This number doesn’t include the 47.5 million people who have dementia or those who live with social anxiety or obsessive social compulsive disorders.


Although the World Health Organisation estimates that mental and neurological disorders are the leading cause of ill health and disability globally, there is a severe lack of interest from governments and NGO’s.


One of the reasons behind this is a lack of funding in development for mental health initiatives. Due to the market-driven nature of aid, mental health isn’t appealing to donors and projects are strongly correlated to how marketable they are to the general public. Mental health charities struggle to raise money as they are not part of the three big C’s ‘cancer, cats and children’ which tug on heartstrings and consequently purse strings. With mental health it’s harder to generate empathy, mental health problems are not always obvious therefore do not always create the snapshot image for your latest fundraising event.


Social stigma surrounding mental health restricts the formation of any real social pressure to affect governments or individuals into action. A mhGap (Mental Health Gap) report lead by the WHO in 2008 states “The stigma and violations of human rights directed towards people with these disorders compounds the problem, increasing their vulnerability; accelerating and reinforcing their decline into poverty; and hindering care and rehabilitation”.


Research by Christoph Lauber in 2007 shows that comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. But the problem of social stigma is not just an issue in Asia, Nora Mweemba, who works for the WHO in Zambia, explains that many people suffering from mental health problems don't come forward for treatment because "communities still regard mental health as a misfortune in the family or some sort of punishment [from God]". The pathway to care is often shaped by scepticism towards mental health services and the treatments offered and families tend to turn to traditional healers. There are significant cultural barriers which need to be overcome and further research by organisations to deliver effective mental health policies.


Many of the countries do not have the legal infrastructure to protect those with living disabilities. Although many countries have signed the ‘Convention on the rights of persons with disabilities’ institutions still lack funding, training and the resources to adequately care for their patients. Unfortunately this leads to human rights violations where patients are locked, chained, isolated and denied their basic human rights.


One of the other barriers to the development of mental health services has been the absence of mental health from the public health priority agenda. The report for mhGap launched by the WHO research shows that this has serious implications for financing mental health care, since governments have allocated meagre amounts for mental health within their health budgets. But with so many health concerns facing developing countries mental health is not always top of the agenda.


Although mental health problems account for almost 13% of the world’s total disease burden and costs the world some $ 2.5 trillion per year, yet the amount invested in treating mental health problems is barely a fraction of this. Less than two percent of the health spending in most low and lower-middle income countries.


Gary Belkin, Executive Deputy Commissioner, New York City Department of Health and Mental Hygiene says;

“The challenge is we have in the order of a billion people on the planet who will have a mental health problem in their lifetime and not get evidence based care for it. A response to that sort of problem needs action at a global level. It needs the sorts of global structures we’ve created for malaria and HIV to be created for mental health as well”

However the problem isn’t just a medical concern, in a recent report by the APPG (All-Party Parliamentary Group) highlights how mental health problems are a brake on development as they cause (and are caused by) poverty. This is part of a wider development concern as not addressing mental health fuels social failures including poor parenting and school failure, domestic violence,and toxic stress, preventing people with problems and their families from earning a living.


Although there have been some recent efforts to raise the profile of mental health as a development issue. In 2008 the WHO launched the Mental Health Gap programme and mental health has been included within the SDG’s in 2015 (Sustainable Development Goals) . The mhGap has praised improvements in countries such as Guinea where they are running a services to support ebola survivors and improving care across disaster - affected regions such as the Philippines.


However the response to mental health in the development sector is still severely lacking. There are very few global organisations leading the way for mental health issues. Basic Needs and International Corps are two international charities which are mental health focused and are calling for governments and aid agencies to address the issue.


In order to tackle the growing mental health crises governments and NGO’s need a collective response. Mental health should not be left to the public health or development sector - schools, hospitals, community groups, charity groups and government bodies should work together to tackle mental health at a global level.