Mental health is a worthwhile goal for United Nations Sustainable Development Agenda

 

no-health-without-mental-health

The post-2015 development goals will, as we know, set out the world’s development agenda for the foreseeable future—in the same way that the Millennium Development Goals provided a framework for global development over the past couple of decades. The United Nations is now preparing to choose its new set of sustainable development goals and the Global Mental Health community must work hard to ensure these goals include mental health.

Professors Vikram Patel and Graham Thornicroft have recently published an article in the British Medical Journal, which outlines why the case for including mental health in the UN’s new development agenda is a compelling one.

Indeed their case is compelling. When we think about it logically, it makes sense: poor mental health is a precursor to reduced resilience to conflict, they argue. In the midst of conflict, hope is a scarce resource and instead of teaching hope, “in the aftermath of war people with mental illness are often accorded the lowest priority”. If we think about the seemingly intractable global conflicts of today, from Syria and Iraq to the massacre in Gaza, the call to address mental health concerns as a priority development agenda, and as a result, rebrand mental illness and teach hope to thousands, is most pertinent.

Including mental health in the new global development agenda will also go a long way towards ending the paralyzing stigma associated with all kinds of mental illness. Not least, the most common mental disorders like depression and anxiety would be well on their way to receiving a more hopeful image globally, recognized as issues which affect us all personally and as communities, cities and countries.

Thornicroft and Patel in fact argue that if mental health is included in the new development agenda and mental health systems are globally improved, that would also “have a decisive role in making cities and human settlements inclusive, safe, resilient, and sustainable”. For addressing mental health concerns of an individual is not only beneficial to the person suffering, but when the problems associated with mental illness are given importance by society and a collective effort to address them is taken, it will inevitably create a sense of common belonging, hope, equality and indeed resilience among communities.

This would then also require addressing the income and economic inequalities faced by people who suffer from mental health problems. They have far lower rates of employment, but also, in times of economic recession, a population’s mental health is worse, argue the two professors. If we can thus promote a principle of ‘sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all,” again this too would benefit wider society as a whole.

The narrative which is understood by these arguments is that mental health problems are a global issue that impacts not only those who suffer, but wider society and large populations of human settlements. It is thus, for our collective benefit that we make treatment available to people who are suffering and in turn spread the message of hope globally.

The reasons that we need to push for the inclusion of mental health in the global development agenda are of course many, and only a few have been mentioned here.  But what is important to remember is that the proliferation of mental health problems is the result of collective ignorance of these issues over a long period of time. When we can talk freely about depression, anxiety and other mental illnesses, we can find and develop ways to tackle these issues whether it’s through modern medicine, community-building or teaching hope to young people. What we do know is that the conversation can become truly global if we can secure mental health in the Post-2015 development agenda. The BMG editorial rightly highlights that mental health is a worthwhile goal for sustainable development.

A new article written by Bidushi Dhungel

Young and Vulnerable: The biggest tragedy regarding youth mental illness is collective inaction

This year, United Nations International Youth Day (IYD), on August 12, has been designated to celebrate the importance of youth mental health with the slogan ‘Mental Health Matters’. This is an opportunity, particularly for low and middle-income countries, to highlight a vitally important—but utterly neglected—aspect of youth life. The neglect has occurred on many levels by both state and society. In a statement, UN Secretary-General Ban Ki-moon rightly highlighted the global urgency to address the stigma and discrimination of youth with mental health conditions.

For the majority of youth who suffer from mental illness, they are forced to live a life of rejection from friends, society and relatives. They are denied the status of ‘citizen’, social membership and basic human needs, robbing them of a dignified life. Around the world, mental illnesses play a significantly negative role in the development of hundreds of millions of youth and their social and economic inclusion and empowerment. In poor countries like Nepal, the young population with mental illness is in a particularly vulnerable position because of the lack of a public health approach in dealing with mental illness, the absence of basic support for their recovery from the state and the deeply entrenched stigma of their illness.

More at risk

Coinciding with the IYD 2014, the United Nations Division for Social Policy and Development, the Department of Economic and Social Affairs has published an insightful report, ‘Social Inclusion of Youth with Mental Health Conditions,’ targeting global actors involved in the field of youth empowerment. I would recommend that youth activists and development workers in Nepal and abroad read this report seriously.

While the young years of life are usually considered to be the most physically active, healthy and energetic of one’s life, this phase is also one when people are most susceptible to mental health problems. However, in many low and middle-income settings, the latter risk is entirely ignored. I do hope that the exposure the issue is getting this year will be instrumental in changing the outlook of mental health, particularly of youth mental health, across the globe.

Nearly one fifth of the global population is comprised of youth aged 14 to 24 years. Almost 90 percent of these live in low and middle-income countries. In a study carried out by Professor Vikram Patel and his team, it is estimated that approximately 20 percent of youth experience a mental health condition each year around the world. Because the youth years are a phase of emotional transition and a time to nurture and pursue childhood dreams, the pressure to study well, find jobs and opportunities is also high.

Drug use, emotional and learning difficulties and disappointment are common. In countries like Nepal, socio-economic disparities and practices of early marriage and strenuous labour can make the situation worse, leaving young people more at risk of experiencing mental health problems than anyone else. Many studies suggest that over 70 percent of mental disorders start before the age of 16. One in nine children attempt suicide before high school graduation and 40 percent of those are in grade school.This is clear evidence that mental health services must be developed to target young age groups.

Educating and collective action

OPRF School Planting, 2013

The prevention and promotion of mental health issues is the way to deal with the growth in mental health problems amongst the youth. Integrating mental health issues into school education is the most effective approach to prevent and promote mental well-being. With an ambition to institutionalise mental health education at the school level and teach hope from an early age, US-based entrepreneur Kathryn Goetzke and her team have just started a pioneering programme, Schools for Hope. This team strongly believes that we can teach our kids how to find pathways to hope, no matter what they experience and that ultimately, we can prevent suicide in youth and adulthood. If this programme is successful, it will be a revolutionary step forward in promoting and institutionalising emotional health and mental well-being.

The biggest tragedy regarding mental illness is collective inaction, which has perpetuated tremendous fear, uncertainty, helplessness, segregation, and hopelessness in the lives of those who suffer. Rather than the illness itself, a fear of social rejection and segregation leads almost a million people to commit suicide every year, with the majority of them young people. By promoting greater social inclusion and empowerment of youth living with mental illness in society, we can change this reality.

It is also vitally important to spread the message that effective services (both social and clinical) exist to manage all kinds of mental health problems. We need to build capacity and a knowledge base to address them. Now, we have to start demanding equitable investment for the mental well-being of the population by asking that the state make holistic mental health services available and accessible for all.

 A new article written by Jagannath Lamichhane

Lamichhane is global coordinator of the Movement for Global Mental Health

There is a strong need to transform the Movement for Global Mental Health into an inclusive movement

-Jagannath Lamichhane

Although some claim that The Movement for Global Mental Health (MGMH) is, essentially, the brainchild of the Western medical framework, a closer look at the work being done under the MGMH banner would prove contrary. I know that less powerful and low income countries and their citizenry are making important strides to define the problems and solutions related to mental health because of the work of the Movement.

against mental violence The MGMH is the first cross-continental effort to bring diverse expertise, resources and perspectives on to one platform with a common goal of addressing mental health both at the global and local level. Their representation of a global movement, rather than western brainchild, is particularly evident in the recent shift of the global secretariat of the movement from the West (Sydney, Australia) to New Delhi, India, as well as the transfer of the movement’s leadership from medical professionals to those with expertise in social and community based fields. These changes are working to accommodate the diverse concerns of civil society groups regarding the rights of the persons with psychosocial disability and mental health problems.

Contrary to traditional approaches of addressing mental health, in which ‘professionals’ thrust ‘treatment’ onto ‘patients’, the MGMH promotes the role of people with psychosocial disabilities and mental health problems as equal partners in every endeavor from the health care setting, to the community and in efforts to promote human rights, fighting stigma and discriminations. Also, the MGMH advocates greater human rights along with affordable and accessible mental health care for all by putting greater emphasis on the UN Convention on the Rights of Persons with Disabilities (CRPD).

The MGMH believes in building an international civil society that can speak out and stand for the cause, and mobilise direct actions in order to overcome mental health challenges ranging from stigma, inequitable health services, social discrimination and others. This international community looks like a consolidated effort among the various stakeholder and creative partnerships among stakeholders around the world.

There are already some effective examples of partnership in promoting human rights and mental health. For example, the EMPOWER project brought together civil society groups representing all kinds of professionals working in the fields of medicine, research and human rights and together they worked not only to generate a new knowledge, but have set an example to advocate mental health in low and middle-income countries.

Towards creating a leadership community across the globe, the movement offers training and short courses like the Leadership in Mental Health, which is an annual two-week leadership course in mental health for all kinds of people interested and affected by mental health issues. The tutors in the course range from activists to researchers and psychosocial disabilities.

However, the future of MGMH is not straightforward. The divide among the stakeholders in the mental health community — some of whom prioritize the human rights elements over the medical elements and vice versa — is the greatest obstacle to fulfilling the goals of the movement.

The tussle over where the emphasis needs to be within the mental health domain has been at the centre of this divide. In fact, there is a misconstrued understanding among some stakeholders– largely non-professional groups– that the MGMH is a banner through which the medical model of psychiatry and mental health is being promoted. On the other hand, many professional groups believe that the non-professional activists and their associated movements in the realm of mental health reject the very idea of the possibilities of modern medicine in addressing mental health concerns. Some individuals and opinion makers have even labeled the MGMH as a neo-colonial project.

But these polarized views are untrue to the genuine efforts and initiatives being made across the board — by professionals and activists, and civil society groups in the field. That’s why although the major barrier for the Movement is this divide among stakeholders, I believe that these initial days of the Movement’s efforts can in fact be used to create a sense of belonging among all of those concerned. We can also hammer out the differences –among professionals, activists, researchers and psychosocial disability community – in order to come to a consensus which would benefit the hundreds of thousands of people living with mental health problems and psychosocial disability globally today.

There is no doubt in my mind that all groups are working tirelessly to find sustainable ways through which the needs of one of the most vulnerable groups in the world can be met –medically, socially, politically and economically. While making an effort to find solution, it is urgent among stakeholders to understand each other’s work and promote respect for each other.

(With support from Bidushi Dhungel)

 

Hidden Pictures and the World Health Organization: A Journey to Uncover Global Stories of Mental Health

Hidden Pictures Film

Here is a video we are all about right now at iFred. It’s a summary of the film Hidden Pictures by filmmaker and physician Delaney Ruston. Ruston’s work highlights both the serious need for global mental health resources and the power our personal stories can have

iFred joined global leaders to support the World Health Organization in crafting the Mental Health Global Action Plan by in 2012, that was then adopted by the United Nations in 2013.  Countries around the world convened to discuss implementation of the action plan for Global Mental Health Day in October, 2013, and, with policy highlighted in Ruston’s film. Have you browsed the document yet? You can read an mhGAP summery here or the entire document here. on creating social change.

Watch the WHO and Ruston’s video here and tell us what you think:

Hidden Pictures

Press Release: iFred Launches Depression News Blog to Shine Light, Advocate Hope and End the Stigma of Depression

For Immediate Release:

February 5, 2014

iFred to launch global blog to shine  light, advocate hope, and end stigma of depression

Chicago IL:  The International Foundation for Research and Education on Depression (iFred) today launches its new blog series “Seeds for Hope” at (www.ifred.org). The aim is to shine light on the leading cause of disability around the world and give hope to the 350 million depression survivors worldwide with the disease. Jagannath Lamichhane, pioneer in mental health media from Nepal, is authoring the biweekly blog in the wake of the United Nations-adopted World Health Organization’s ‘Global Mental Health Action Plan’.

Jagannath Lamichhane was chosen to author this important endeavor as he is a human rights activist and has pioneered mental health advocacy in Nepal and globally.  When Jagannath was asked about authoring, he stated, “I am thrilled to be a part of iFred’s international effort to combat the stigma against depression,” adding that he would, through the blog, try to “address the range and depth of concerns facing those who suffer from depression and other health and human rights issues surrounding the disease and disability.  I also plan to highlight the incredible work countries and individuals around the world are doing globally in helping those with depression.”

Depression and other mental health problems have recently been recognized as a serious global health burden.  According to a new report entitled Transforming Lives, Enhancing Communities – Innovations in Global Mental Health – edited by Professor Dr. Vikram Patel and Dr Shekhar Saxena, two renowned authorities in the field of global mental health – at least 10 percent of the world’s population is affected by one of a wide range of mental disorders. The report also reveals that depression will be the leading cause of disability worldwide by 2030.

Currently, The WHO estimates that more than 350 million people from around the world already suffer from depression and that depression is behind a large portion of the one million yearly deaths caused by suicide globally. In fact, the burden of mental illness (among which depression is the leading cause) is more than 1.5 times that of all cancers.  These past two years the World Health Organization hosted a groundbreaking effort, of which IFred participated, to develop and implement A Global Mental Health Action Plan adopted by the United Nations for which member states around the world agreed to make mental health a priority.

Kathryn Goetzke’, iFred Founder, thinks this blog is critical to efforts for hope as she states “Depression is treatable, yet according to the World Health Organization less than 50% of those needing treatment receive treatment primarily due to stigma.  This blog is going to help us communicate the issues around depression, educate mental health consumers around the world on treatment, and continue to shine a positive light of hope to help end stigma.  I first met Jagannath in Athens, Greece at an event I spoke for on rebranding depression on the Global Mental Health Movement as we worked with the BBC to raise public awareness of our work.  We met then again at the United Nations while advocating Human Rights for those with depression, so I know we are in great hands and so very fortunate to have him on board”.

iFred hopes this endeavor will yield impactful results in awareness raising and engaging communities in finding solutions to tackle the greatest challenge of our time – depression.

About iFred:

The mission of International Foundation for Research and Education on Depression (iFred) is to shine a positive light on depression and eliminate the stigma associated with the disease through prevention, research and education. Its goal is to ensure 100% of the 350 million people affected by depression seek and receive treatment.  iFred is creating a shift in society’s negative perception of depression through positive imagery and branding—establishing the sunflower and color yellow as the international symbols of hope for depression. iFred also engages with individuals and organizations to execute high-impact and effective campaigns that educate the public about support and treatment for depression.

 

About Jagannath Lamichhanejagannath 3 (190x143)

Jagannath Lamichhane: Jagannath is a psychosocial disability and human rights activist from Nepal. He is the founding chairman of the Nepal Mental Health Foundation, the only advocacy and policy focused mental health service user-run organization. He has contributed greatly to the mental health discourse, including in The Guardian and the Lancet medical journal, among others. His main areas of interest are human rights violations, legal inequality, dehumanization, and social exclusion of people with psychosocial disabilities and mental health problems. Currently, he is doing MSC in Global Mental Health at the London School of Hygiene and Tropical Medicine and Kings College London.  In his free time, he likes to meditate, watch films and hopes to see more of this beautiful world.

Seeds for Hope

Lamichhane and Goetzke at the first Global Mental Health Summit

I still remember the first day I met Kathryn Goetze, founder of the International Foundation for Research and Education on Depression (iFred). It was in Greece on the 2nd of September, 2009, during the first ever global mental health summit; the early days of my entry into the then-newly emerging field of global mental health. I guess you could say that until then, when it came to issues of mental health, my understanding was traditional and shaped by negative public perceptions.

However, it was upon hearing Kathryn speak at the summit about the need to rebrand depression and her endeavor to give depression a positive brand with the help of the image of sunflowers, that I began to understand how we can work to re-construct social understandings of mental illness and depression. I began too slowly realize that societal perceptions of mental health are constructed with negative images and that with effective campaigning, could well be re-constructed with the use of positive imagery like that of the sunflower.

Since 2009, I have remained in constant communication with Kathryn, keenly observing her work. It was in 2011 that I finally got a chance to actually work with her on her global initiative — the Field for Hope campaign, where fields of sunflowers are planted to shed light on depression and simultaneously work to give the mental health related problems a more positive image. It was, however, only recently that I thought about exactly what the motivations for Kathryn’s involvement in the sector were. I knew that she was doing wonderful and innovative work to tackle stigma against depression but didn’t know why she was doing it. I caught up with her and what I learned was telling.

Kathryn had lost her father to suicide at the tender age of 19. “It was very devastating to me. He was a brilliant businessman, very close to me, and I knew there was something ‘wrong’ with him from an early age, but had no idea what it was,” she recalled. It was only after several years of study in her 20’s that she realized it was untreated depression.

By the time she was in her 30’s Kathryn began to apprehend that she too was struggling with depression, “a chemical imbalance of the brain that manifests itself in different ways through different people,” in her words. She had developed addictions – to food, alcohol and could not understand why for a long time.

That’s why when Kathryn launched her company she wanted to donate her time and resources to help educate people about depression. However, in order to do so, she would have to start a new movement herself.

The sad reality of the global context of depression is that even the non-profits and organizations working on depression are by and large straggled themselves by the negative stigmas and imageries surrounding depression. Kathryn found that “the nonprofits doing work in this area were often, ironically, depressing.” According to her, these non-profits focused more “on symptoms rather than the impact of treatment,” and fail to recognize the fact that depression is the “most hopeful disease there is — depression is treatable.” That fact is one that many societies across the world, even the most developed, are yet to come to terms with.

The majority of images of depression are depressing people–sad men and women, head bowing down, arms wrapped around the knees and almost crying, in dreadful black and white gloom. As an expert in marketing and branding, Kathryn set out to challenge and, thus, change the stigma surrounding depression. by creating an organization to help rebrand the disease through “educating other NGOs about branding and stigma, engaging celebrities and role models to talk about the disease, and teach the public about the biology of the brain.”

 

For Kathryn, it is this biology of the brain that is central to being mentally fit. “We must learn about creating and maintaining a healthy brain. Everything they think, eat, feel, and do affects the health of their brain.” According to her, the world is going to be based more and more on human intelligence, so creativity, brain health, and ability to solve problems is increasing ever more in importance. That is why Kathryn has begun this new movement to “Learn about and feed the brain in positive ways.”

 

This is not the first time such a rebranding of a disease is taking place. A major rebranding success was seen in fighting the stigma surrounding breast cancer some decades ago. Iconic symbols like the pink ribbon and the ownership of the cause by celebrities helped to quickly bring the disease to the mainstream and strip it of its negative stigma. Kathryn hopes to help enable the same for depression.

When asked what she would like to see accomplished in her life, she replied that she’d like to see an “event similar to ‘Stand Up to Cancer’, engaging celebrities from all walks of life to raise money and awareness for depression by speaking out on how to find hope when all else is going wrong.”  Further, Kathryn wants to be able to “live in a world where there are no suicides and people feel fine about getting treatment for their depression.” Her advocacy is undoubtedly on the right track to make this a reality.

In addition, Kathryn is working with companies to implement depression awareness and prevention programs in the workplace. She is also working on her Schools for Hope, “a curriculum we are developing to teach kids about how they can create Hope,” she said. Towards this end, she is also seeking support from consumer products companies.

Having been a part of the Field for Hope campaign, I can see its positive effects in encouraging communities to gather and talk about healthy brains and as a way to “honour those with depression,” as Kathryn told me. Overtime, the image of the sunflower will drown out the negative images of depression we see all-too-prevalent today. What Kathryn hopes for the future is to “have people think of a sunflower when they hear the word depression.”

Her work has been exemplary and encouraging in every way for the millions who are suffering. She vows to continue encouraging others to find the beauty in their darkness, and use the powerful force to create something full of light and inspiration for others.

I am proud to continue to be a part of her noble endeavor through my weekly blog beginning as of January 2014. I urge all to join hands to combat the greatest tragedy of the 21st century–depression.

-Jagannath Lamichhane

(With support from Bidushi Dhungel)

Jagannath Lamichhane is a mental health and human rights activist from Nepal. Currently, he is doing an MSC in global mental health, a program jointly run by Kings College London and the London School of Hygiene and Tropical Medicine, UK.