A Global View of Mental Health, Part I


Photo by E. Wagele

Is mental illness only a First World problem?

The original 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 the main points down to about one-third.

  • Noncommunicable diseases, such as heart disease and diabetes, now pose a greater risk than contagious illnesses. Science and medicine have made tremendous progress in combating infectious diseases during the past five decades, but noncommunicable ones are partly rooted in lifestyle and diet. Their emergence as a major risk, especially in the developing world, represents the dark side of the economic advances that have also spurred increased longevity, urbanization, and population growth.
  • More than a third of the global economic burden of noncommunicable diseases will probably be for mental illness by 2030. The direct effects of mental illness (such as spending on care) and the indirect effects (such as lost productivity) already cost the global economy around $2.5 trillion a year. By 2030 that amount will likely increase to around $6 trillion—more than heart disease and more than cancer, diabetes, and respiratory diseases combined.
  • In low-income and middle-income countries and within international organizations, officials tend to view mental illness as a “First World problem”; they worry mental health is a luxury that people living in severe poverty or amid violent conflict cannot afford.
  • In countries of all levels of wealth and development, mental illness affects almost every aspect of society and the economy. Far from lacking relevance or urgency in poor and war-torn countries, mental illness often contributes to the very dysfunctions that plague such places. Breakthroughs in therapy and treatment have significantly improved the efficacy—and lowered the cost—of caring for people who suffer from mental illness, even in places that have traditionally lacked access to mental health services.
  • Since mental illnesses are disorders of a bodily organ: the brain, they are no different from other noncommunicable diseases. 
Policymakers and public health officials, however, tend to view mental illness as fundamentally different from other medical problems.
  • Most people do not realize how common mental disorders are, in part because such illnesses are stigmatized and hidden. In 2012, 43.7 million Americans over the age of 18 suffered from some kind of mental disorder—18.6 percent of the country’s adult population. Nearly ten million of those people, or 4.1 percent of adults, struggled with serious mental illnesses, such as psychotic disorders. Many do not seek or receive care until their disorders have become chronic and disabling, 11 years, on average.
  • The World Health Organization noted that mental illnesses and behavioral disorders account for 26 percent of the time lost to disability—more than any other kind of disease.
 The impact of mental illnesses is magnified by the fact that such disorders afflict mostly young people, in contrast to other chronic noncommunicable diseases, such as heart disease or cancer, which generally appear later in life.
  • Early onset explains why mental disorders represent by far the largest source of disability—and hence lost productivity—for people between the ages of 15 and 44, a crucial period in life.
  • The American Foundation for Suicide Prevention estimates mental illness plays a role in 90 percent of suicides. The World Health Organization estimates 800,000 people commit suicide every year, 75 percent of them in low-income and middle-income countries. Globally, more than twice as many people die from suicide as die from homicide each year. Suicide is the second-largest source of mortality for people aged 15 to 29, topped only by traffic accidents.



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