A Global View of Mental Health, Part II

Photo by E. Wagele

Photo by E. Wagele

Cognitive-processing therapy is a hope in poor countries.

The article this blog is based on, Darkness Invisible – The Hidden Global Costs of Mental Illness by Thomas R. Insel, Pamela Y. Collins, and Steven E. Hyman, was almost 3,000 words. It was published in the January/February 2015 Issue of Foreign Affairs. I’ve pared it down to about one-third.

  • Mental disorders are a gateway to other costly public health problems. Suffering from a mental illness increases one’s chances of contracting HIV and of developing heart disease, pulmonary diseases, and diabetes; it raises one’s risk of homelessness, poverty, and institutionalization, including imprisonment.
  • The poorer the country, the worse the problem: the World Health Organization estimates the majority of countries at low and lower-middle levels of income devote less than two percent of their health budgets to treating mental disorders and up to 85 percent of people with severe mental illness receive no treatment at all.
  • Americans with serious mental illness are ten times as likely to be imprisoned as to be in hospitals because most states have almost completely dismantled the system of mental hospitals. As a result, many countries wind up spending on the effects of mental illness—such as unemployment, homelessness, and incarceration—rather than the underlying causes.
  • 30 percent of the country’s chronically homeless and more than 20 percent of the people incarcerated in the United States suffer from a mental disorder.

  • Almost half of the world’s population lives in countries where, on average, there is only one psychiatrist for every 200,000 people; in many African countries, there is only one psychiatrist per every one million people. 
High-income countries have, on average, nine psychiatrists for every 100,000 people.
  • People suffering from mental illness in poorer places could benefit from the so-called task-sharing approach, in which professionals train a range of providers—from nurses and social workers to peers and family members—to care for those with mental illness. Clinical experts from the United States spent five or six days training local women in how to provide cognitive-processing therapy, which focuses on helping people to stop avoiding their problems and instead solve them by changing their behavior.
  • In both Congo and Pakistan, women who received psychotherapeutic treatment showed substantial decreases in symptoms and improvements in overall health and well-being. The women who received such treatments in Pakistan were also more likely to obtain crucial vaccines for their children.
  • Safe, effective, and inexpensive treatments exist for the most prevalent mental disorders. 
Medications that relieve the most disabling symptoms of depression, psychosis, anxiety, and bipolar disorder have been available for five decades and now exist in relatively inexpensive generic formulations. Most antidepressants and anti-anxiety medications are prescribed not by psychiatrists but by primary-care practitioners.
  • More than five billion people all over the world now have access to mobile devices that could allow them to receive psychotherapeutic interventions ranging from text messages that provide self-help strategies to computer games that incentivize positive changes in behavior. The spread of basic cellular service means providers can reach far more potential patients by phone than ever before.
  • In poorer countries, one step toward better integration would be to give community health workers, who already monitor basic health needs, the ability to screen for common mental disorders. For example, nurses who help patients stick to their HIV medication regimens could incorporate mental health screening into their routines.
  • Mental health advocates are pushing for the establishment of specific targets, including a ten percent reduction in suicide by 2020 and a 20 percent increase in treatment for severe mental disorders by the same date. Meeting these goals will require political will, public and private investment, and coordination among the health, financial, social-service, and educational sectors.
  • For the measures mentioned above to succeed, policymakers and experts must first pull mental illness out of the shadows and into the center of debates about global public health.

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