Mental disorders poorly handled by health systems

 By Dr. Cory Couillard

Depression and mental health disorders are extremely common, debilitating and costly – yet not enough is being done to address them. Deficient and struggling health systems are lacking the number of specialised and general health workers that deal with mental health disorders.

Nearly half of the world’s population lives where there is only one psychiatrist to serve 200 000 or more people. Other mental health providers who are trained in the use of psychosocial interventions are even scarcer.

According to the World Health Organization (WHO), “between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low- and middle-income countries”.

“The economic consequences of these health loses are equally large: a recent study estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to US$ 16.3 million between 2011 and 2030”.

Exposure to adversity at a young age is a well-established risk factor for the development of mental health disorders. It is estimated that 10% to 20% of children and adolescents experience a form of mental illness. Of those affected by a mental illness, half begin before the age of 14 and three-quarters by the mid-20s.

If untreated, these conditions can severely influence a child’s development, educational attainments and one’s potential to live a fulfilling and productive life. Additionally, children with mental disorders are often excluded and marginalized from society and live in vulnerable situations.

Mental health disorders can often cause domestic violence and abuse, further impoverishment and excessive stress, especially for young women. This cyclical process can cause persons with mental disorders to have their human rights violated and be denied economic, social and cultural rights – embedding one further into poverty.

Poverty is both a cause and a consequence of poor health. As a result, sufferers may be subject to unhygienic and inhumane living conditions, physical and sexual abuse, neglect, and even harmful and degrading treatment practices in health care facilities.

This highlights how mental health disorders and the resulting discrimination is a direct threat to the achievement of national and international development goals such as WHO’s 2015 Millennium Development Goals (MDGs).

“People with mental disorders experience disproportionately higher rates of disability and mortality. For example, persons with major depression and schizophrenia have a 40% to 60% greater chance of dying prematurely than the general population, owing to physical health problems that are often left unattended (such as cancers, cardiovascular diseases, diabetes and HIV infection) and suicide,” describes WHO’s comprehensive mental health action plan 2013 – 2020.

Effective community approaches have looked to reduce risk factors while promoting the life-skills approach. The risk factors of mental illnesses often start in childhood and school-based programmes have been found to be highly effective in improving cognitive, problem-solving and social skills of children and adolescents.

Many prevention programmes implemented across different demographics have provided evidence that depression can not only be effectively treated but also prevented – but the prevention and early detection of mental health disorders deserve more attention.

Programmes must include the promotion of healthy diets, adequate physical activity levels, sufficient amounts of sleep, and the elimination of substances of abuse such as alcohol and tobacco. Exercise programmes are highly effective to boost self-esteem, balance depression-causing hormones and prevent other health conditions such as noncommunicable diseases that can lead to depression.

Dr Couillard is an international health columnist that works in collaboration with the World Health Organization’s goals of disease prevention and control. Views do not necessarily reflect endorsement.

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