World in mental health crisis, says commission of experts
DESIGN | KEN KUSIMBA
Mental illness has increased by half in the past 25 years yet no country is responding adequately to the crisis, reveals a review by a commission of experts on mental health from around the world.
In Kenya, one in four people is likely to suffer from a mental disorder at some point in their lives, at a time when five in six Kenyans do not receive treatment partly because the country has only 62 psychiatrists serving 47 million people, according to the Mental Health Policy 2015-2030.
The team of 28 global experts assembled by the Lancet medical journal have observed that mental disorders are on the rise in every country in the world and will cost the global economy US$16 trillion by 2030. The low investment is leading to long-lasting but preventable harm to people, communities and economies. ''The dramatic increase in mental problems is partly due to rapid changes in population demographics like the significant increase in the number of children who grow into youth, a period when many mental problems have their onset while on the other end of the spectrum, the growing aging of populations when neurodegenerative conditions start,'' said the Lancet Commission’s joint lead editor, Prof Vikram Patel of Harvard Medical School, during an October teleconference.
READ: Mental illness call for more attention
The increase is causing massive disability. Mental health problems kill frequently and more often than any other cause, especially among young people. ''Deaths due to suicides, and alcohol and opioids (prescription pain medicines) abuse together kill more than any other cause in the world,'' said Patel.
''Conditions associated with social deprivation increase mental ill-health and mental problems promote poverty, costing economies more than any other condition, reveals the commission. Yet, no country is investing as much in its health budget as would reflect the burden of its mental health problems. When it comes to mental health every country is a developing country,'' said Patel.
Figures from the commission show that developed countries, on average, allocate five percent of their health budgets to mental disorders while developing nations like Kenya spend just about one percent.
Despite showing absolute annual increases in funding since 2007, development assistance for mental health has never exceeded one percent of the global development assistance for health, states the commission's report that was launched at the first-ever Global Ministerial Mental Health Summit in London, early this month. Consequently, there are no community-based mental health facilities in most countries and where they exist, they are ill-equipped.
The commission recommends that developed countries should increase spending on mental health to 10 percent of their health budgets while developing nations should allocate five percent of their health expenditures.
Shape mental health
With young people being the majority of those bearing the brunt of the global burden of mental ill-health, the commission places great emphasis on our experiences in childhood and adolescence, which shape our mental health for the rest of our lives.
The combination of mental and substance abuse disorders among children and youth are the sixth leading cause of years lost due to ill-health, disability or early death. It accounts for six percent of the total disease burden in this age group, and contributes to a quarter of disabilities in young people aged 10–24 years worldwide.
Risk factors
Childhood neglect, maltreatment, and deprivation are strong risk factors for future mental and physical health problems.
However, neurological changes during the sensitive periods of childhood and adolescence provide opportunities to positively affect the developing brain.
Most mental disorders in adult life start in childhood, yet spending on child and adolescent mental health, arguably the most important developmental phase for prevention, is just 0.1 percent of total world development assistance for health.
Past studies show that about two-thirds of adult mental conditions are chronic conditions of childhood. This makes early life intervention and prevention crucial. ''You only get two bites at the cherry. One is in the first 1,000 days when if maternal depression as well as mother and infant diet are addressed can reap dividends. The second one is schooling, when social emotion learning and providing the right environment can ameliorate many of the conditions but then we struggle in trying to contain in adulthood,'' said child psychiatrist Vishram Rahman from Liverpool University who also practises in Pakistan.
In early life there are cost-effective preventive interventions focusing on maternal mental health, mother–infant interaction, as well as play and stimulation, which have positive long-term benefits for both infants and mothers. According to the commission, interventions that promote early initiation of breastfeeding, close physical contact with the mother (e.g., kangaroo mother care), and enhanced maternal responsiveness, contribute to secure attachment and have been linked with an increase in bonding indicators such as baby–mother attachment at three months and child growth. Such programmes can also reduce the risk of child maltreatment.
Young people access mental health services less frequently than any age group because they are poor at detecting mental illness, ignorant of the condition and reluctant to seek help. Their unique position of vulnerability is further enhanced by mental health policies that focus more on the older age groups at the expense of the young. ''Mental health is the foundation of human capability that makes each life worthwhile and meaningful. It is for this reason that there can be no sustainable development without attention to mental health,'' said Patel.
Shackling and torture
The commission’s report shows that in many countries, people with mental disorders still routinely suffer gross human rights violations – including shackling, torture and imprisonment. Bringing attention to these kinds of abuse and discrimination, the commission calls for a human rights-based approach to ensure that people with mental health conditions are not denied any of their fundamental human rights – not just to health but also to employment and education, among others.
The commission recommends a wholesale shift to community-based care. It recommends the delivery of psychosocial interventions by community health workers, peers and a range of other providers, such as teachers and the clergy, as well as medical professionals working in primary care, to provide the foundation of the mental health care system. "We've seen a rise in mental illness in young people when, with all the knowledge we have, we should be seeing a decrease,'' said Prof Helen Herrman, president of the World Psychiatric Association. ''Treatment in hospitals needs to be complemented by care in the communities to bring mental health services to the masses.''
There are examples of community-based initiatives that have worked in places like Haiti and Zimbabwe. The impact of the massive 2010 earthquake in Haiti that reduced much of the country to rubble had a huge impact on mental health. In a country with just about 10 psychiatrists, medical organisations and doctors worked with faith healers to provide mental health services.
In another case, since 2006, the NGO African Mental Health Research Initiative, made up of psychiatrists, has trained over 400 grandmothers in Zimbabwe in evidence-based talk therapy, which they deliver for free in more than 70 communities in Zimbabwe. In 2017 alone, the Friendship Bench, as the programme is called, helped over 30,000 people there. ''The method has been expanded beyond the country, including New York in the US,'' said commissioner Mary De Silva from the Wellcome Trust, at the teleconference.
Kenya could use such novel initiatives.
The commission also recommended mental health to be included in universal health coverage. ''The mental health situation should be monitored at country and global levels on a regular basis. What we do not monitor, we do not improve,'' says Dr Shekhar Saxena from Harvard University.
It is in the Sustainable Development Goal on health that mental health has been specifically mentioned in a United Nations General Assembly policy document for the first time.
