THERE are over 400 million people with mental disorders globally. Yet most are not being provided with even basic treatment. This is especially true in poor parts of the world. Most aid agencies do not even consider proposals to treat mental health problems; those that do think of it as a minor player, overshadowed by the pressing need to save lives by treating physical illness.
This is a tragedy. Mental health can improve overall well-being and prevent other illnesses. And since mental health problems have a serious economic impact on vulnerable communities, making them a priority can save lives and markedly improve people鈥檚 quality of life. Poverty and mental well-being are intricately linked, so mental health should be an integral, inseparable component of public health.
The vast majority of people with mental disorders live in countries that command only a fraction of global mental health resources. Numerous studies and reports since the 1990s show that mental health problems such as depression are more common among the poor (Bulletin of the World Health Organization, vol 81, p 609). Also, rapid social change and urbanisation in developing countries has led to rising suicide rates, particularly in rural areas of countries like China. (Culture, Medicine and Psychiatry, vol 23, p 25).
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These disorders have a significant impact on physical and economic well-being. For example, depression reduces people鈥檚 ability to work, and increases healthcare costs. Typically, people with depression go to their doctors with symptoms that don鈥檛 have a physical cause; in south Asia these might be tiredness and vaginal discharge. But doctors then treat these symptoms as if they are the result of a physical ailment, leading to unnecessary costs and overuse of antibiotics, while failing to address the underlying mental health problem. This leads to a vicious cycle of deprivation and mental illness, not unlike the vicious cycles of deprivation and infectious diseases.
There are practical steps that can be taken. For example, there is good evidence that people with alcohol problems (a mental illness in its own right) are more likely to practise unsafe sex, risking infection with HIV. People infected with HIV in turn suffer high rates of depression, cognitive impairment and dementia. So it makes sense to target alcohol abuse to reduce the risk of people catching HIV. There is also a strong case for treating the mental health consequences of HIV infection, because treatment should be about improving quality of life. It may also help HIV patients persist with the long-term drug regimes they need, perhaps even prolonging their lives.
Another group of people for whom mental and physical health are intricately intertwined are mothers and children. Several recent studies from south Asia have demonstrated that the babies of mothers who are depressed during pregnancy and after childbirth are more likely to suffer poor growth, poor development and a higher risk of physical health problems, even where food programmes are in place. In some areas, as many as 25 per cent of mothers may be suffering from mental health problems (British Medical Journal, vol 328, p 820). Failure to thrive is one of the most pressing public health challenges in south Asia, affecting more than 1 in 3 babies.
Or take stress and depression, which predispose people to heart attacks or strokes and worsen the prospects of recovery. Up to half of the people who suffer a stroke or heart attack subsequently develop depression and dementia. This year鈥檚 World Health Report published by the WHO focuses on the rise in road traffic accidents. Mental disorders, particularly substance abuse, significantly increase the risk of road accidents 鈥� and depression and post-traumatic stress disorders often follow. Take another global health priority: the reduction of domestic violence. Alcohol abuse and personality disorders are often precursors to depression, followed frequently by violence, self-harm and suicide. It is the same story with just about every major public health issue.
My point is that there is no health without mental health. It makes practical sense to treat people as whole human beings. Some mental health advocates use the term 鈥渃o-morbidity鈥� to describe the coexistence of mental and other health problems. Yet this very phrase perpetuates a false dichotomy.
Mental well-being is often regarded as an optional extra by public health planners. Even organisations and aid agencies that do consider mental health projects have only meagre funds, and treat it as a separate category. It is blatantly not so. Mental health should be integral to all public health matters, especially for developing countries.
The travesty is that good mental health is often not expensive, and can be achieved with simple interventions. The evidence is clear. It is wrong not to act on it.
