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

Depression and anxiety are linked to happiness and there’s plenty that can be done from a young age

In the last blog, I talked about the World Happiness Report 2013 and began to explore the links between mental health and happiness. I want to explore this in further detail here, to examine the issues which effect happiness in an individual’s life and the implications of positive mental health on these indicators. As I mentioned in the earlier post, and as the Happiness Report 2013 clarifies, mental illness is the “single biggest determinant of misery.” While the prevalence of the problems varies between countries, at any given time, around 10 percent of the world’s population suffers from some kind of mental illness. Among all the mental illnesses, depression and anxiety are most common—accounting for about a fifth of all disability globally. Naturally, this has an incredible effect on the output of individuals, societies, countries and globally! And as we’ve heard so many times before, people are not receiving treatment for these illnesses for which cost-effective treatments exist—not even in the richest of countries!

 

For depression and anxiety disorders, evidence-based treatments can have low or zero net cost, according to not only the latest Happiness Report, but a host of professionals working in the field. They can and should be made far more universally available. However, these are all post-illness measures and the majority of interventions have focused too heavily on tackling the issues surrounding mental ill health at a later stage in life, when illnesses have been brewing and developing for years.

 

But in order to successfully make the case for childhood intervention, a paradigm shift is required which would look to establish mental health as intrinsically linked to personal happiness and not just a medical illness. That is what the World Happiness Report seeks to do precisely, by pointing out that “schools and workplaces need to be much more mental health-conscious” and “directed to the improvement of happiness” in order to prevent mental illness and promote mental health.

Ifred blog photo

 

The importance of good mental health to individual well-being can be demonstrated, in fact, by reference to values, according to the World Happiness Report 2013, which sit “at the very heart of the human condition.” Here, the Report, for example, says that if the ultimate goal in life and the truest measure of well-being is happiness, it’s “hard if not impossible” to flourish and feel fulfilled in life when individuals are beset by health problems such as depression and anxiety. This couldn’t be truer. Further, an individual’s self-identity and ability to flourish are often influenced by their social surrounding, relationships and engagement with those around them, but with mental illness, these become increasing difficult to maintain and manage. Importantly, the other issue identified by the report is that once an individual loses the ability to manage thoughts, feelings and behavior, then happiness becomes a distant dream to them.

 

The focus then should be at promoting happiness in all spheres of life, at home, school, work, and, in effect, promote mental health too. This would mean fostering an environment, for example, where young people and young professionals would not be personally, professionally or socially pushed to be isolated, over-stressed, keep feelings bottled up and be accepted and nurtured to grow and develop on their strengths and manage their weaknesses.

 

Further, there is plenty of scientific evidence that links happiness (thus equating to the absence of mental illness) to healthy lifestyles, including getting plenty of exercise which releases endorphins – aka happy hormones – and eating right. Personally, meditation and yoga I believe are also great techniques which can be developed as a lifestyle to promote well-being overall. Teaching these kinds of lifestyle choices from a young age can also prove to be extremely fruitful in the long run to fight unhappiness and mental illness simultaneously. After all, while it’s necessary to further develop medical and social interventions – as is most popular today – to address mental illness, nipping the bud at the root would undoubtedly be the most effective approach!

 

Having said all of this, I am thrilled to say that iFred is already well on its way to adopting this model of intervention, through all of its work. From developing a positive image of depression globally, to educating children about the value of hope in schools, iFred’s work deserves not only praise on this account, but some serious up-scaling through global partnerships!.

 

A new article written by:

Jagannath Lamichhane

 

The Path to Happiness is Sound Mental Health

In July 2011 the UN General Assembly passed a historic resolution:  It invited member countries to measure the happiness of their people and to use this to help guide their public policies. Bhutan topped the first report published in 2012 as the ‘happiest’ country, in a shocking revelation. According to the report, “the word ‘happiness’ is not used lightly. Happiness is an aspiration of every human being, and can also be a measure of social progress.” It further goes on to take the example of the US to explain: “America’s founding fathers declared the inalienable right to pursue happiness. Yet are Americans, or citizens of other countries, happy? If they are not, what if anything can be done about it?”

Undoubtedly, this “happiness” discourse is intrinsically linked to the mental health of individuals, communities and countries. One has to wonder: Why are Mexico and Costa Rica “happier” than the US, even in the event of massive income, development and freedom deficits in the former countries? This then leads us to the idea that perhaps — just perhaps — happiness cannot be measured by wealth or external development, but rather by other factors like peace of mind, social cohesion, satisfaction, inclusion in the community and personal integrity: all factors associated with good mental health. Unsurprisingly, the 2013 World Happiness Report reveals in chapter three that mental illness is, in fact, the “single most important cause of unhappiness, but it is largely ignored by policy makers”.

The 2013 report shows that mental health is the “single most important determinant of individual happiness” (in every case where this has been studied). About 10 percent of the world’s population suffers from clinical depression or crippling anxiety disorders going by UN data.  And accordingly, that makes depression and anxiety the biggest causes of disability and absenteeism, with huge costs in terms of misery and economic waste. Most cases of depression and anxiety are easily treatable—medically and socially.

Cost-effective treatments exist as I have discussed in previous blogs, but even in advancedcountries, only a third of those who need it are in treatment according to the report. The incredibly frustrating part is that the available treatments ranging from psychotherapy (CBT, Mindfulness) to medication produce recovery rates of 50% or more, which means that effectively, fifty percent of the world’s ‘unhappy’ people could be happier and be living far more fulfilling lives!

That means that there are indeed objective benefits of subjective well-being. The Happiness Report 2013 shows a broad range of evidence showing that people who are emotionally happier, who have more satisfying lives, and who live in happier communities, are more likely both now and later to be healthy, productive, and socially connected. These benefits in turn flow more broadly to their families, workplaces, and communities, to the advantage of all.

But it seems not enough that human rights require that treatment should be as available for mental illness as it is for physical illness. The policy priority in much of the world for mental health, especially in developing countries, is incredibly low. Even politicians are marked by the terror of the stigma associated with mental illness such that mental illness is rarely expressed or internalized as a leading cause for the misery of any state’s population.

What I found particularly useful in the 2013 World Happiness Report are the solutions suggested to overcome these barriers to sound mental health and thus a happier global population. It suggests two main strategies: to provide better healthcare and social support for adults who are mentally ill. But a second is to intervene earlier — since half of adults who are mentally ill experienced the onset of their mental health problems by the age of 15, say the writers of the report. This, I suppose, would mean starting to talk about mental health as a real and substantial issue from a young age within schools and local communities. The research done on the mental health variable with regards to happiness shows the contribution of a child’s development to his/her resulting life satisfaction as a child. Basically, the emotional development of children is crucial to determining their mental health later in life. According to the research, “if you are interested in well-being, intellectual development needs to be balanced by much more interest in emotional and social development”.

Having read this report, I am even more enthused about the work that iFred is doing through the Schools for Hope program! While the notion of providing better mental health services at the adult stage will forever be crucial to the well-being of society, measures to incorporate the ideas of hope into school curriculums could well go a long way in preventing common mental disorders like depression and anxiety in the first place by nipping the bud at the root. And that is exactly what the World Happiness Report 2013 has clarified – that preventative care is possible, through education and services for young people!

A new article written by:

Jagannath Lamichhane

(with support from Bidushi Dhungel)

#happiness #teachhope #mentalhealth #shinelight

World Health Organization Adopts Mental Health Action Plan

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We recently learned that the 66th World Health Assembly has adopted the World Health Organization’s comprehensive mental health action plan (2013-2020). The action plan is the outcome of extensive global and regional consultations over the last year with a broad array of stakeholders including: 135 Member States; 60 WHO CCs and other academic centers; 76 NGOs and 17 other stakeholders and experts.

As one of the 76 contributing nonprofit organizations at the forum, we are proud to have played a role in the development of this Action Plan as we feel it is a critical step in the right direction of eradicating the stigma of depression and meeting the needs of the 350 million worldwide living with the disease.

As part of our ongoing efforts to be leaders and advocates for the disease, we plan to have International Foundation for Research and Education on Depression (iFred) representatives once again at the mhGAP Forum in October to discuss the launch of the plan and its implementation.

The four major objectives of the action plan are to:

  • Strengthen effective leadership and governance for mental health.
  • Provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
  • Implement strategies for promotion and prevention in mental health.
  • Strengthen information systems, evidence and research for mental health.

We look forward to continuing collaboration with WHO representatives and working towards solutions that will give hope to millions living with depression.

For more information about the Action Plan click here.

Dogs Teaching Adults How to Teach Kids to Read

Some fantastic research has shown that the benefits of dogs can go beyond being good friends – they can help kids learn how to read.  This article goes into detail about how, but a University of California Davis School of Veterinary Medicine did research on kids reading to dogs vs. kids not reading to dogs, and overall effect on reading.   I think it would behoove us adults to learn from the techniques used by the dogs, so that we can be as effective (or better) than our four-legged friends.

The reasearch showed that kids reading to dogs had both improvements in both fluency and speed of reading.  How did this happen with kids?  The children reported:

  • The dogs made them feel more relaxed
  • The dog didn’t care or judge them if they made mistakes
  • It was more ‘fun’

Kids reported a boost in self-confidence, worth, and esteem.  So while this is fantastic research about dogs and the benefit of animals on health and wellbeing, I think it also should serve as a lesson to other kids or adults teaching reading or other life skills; be patient and non-judgemental.  Perhaps the dogs in this study are not just teaching kids how to read – they are teaching people how to treat kids learning to grow up in this world.  In any event, enjoy!

Fantastic Q&A on Exercise and Depression

Our wonderful advisory board member, Kirsten Straughan, was kind enough to let iFred present to the students in UIC’s Human Nutrition program, preparing students to become registered dieticians.  Students interested in volunteering and learning more about depression took up the topics of exercise, nutrition, and the brain, and we are so thankful that Ann Haibeck researched and compiled these common questions and answers about depression and exercise.  THANK YOU and keep up the great work! 

General clinical depression 

Why should I consider exercise as a way to alleviate depressive symptoms? How does exercise help? 

Exercise provides a distraction or “time out” from the stresses of daily living. Most people also feel a sense of accomplishment, self-esteem, and increased self-efficacy as a result of exercise. 

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