Bridging the Mental Health Treatment Gap Must Be a Global Priority

 

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Every year, the World Health Organization (WHO) organizes the mhGAP Forum as part of its annual partnership event on mental health. The mhGAP Forum is an informal group of Member States, intergovernmental and nongovernmental organizations, including UN agencies, international development agencies, philanthropic foundations, research institutes, universities and WHO collaborating centres, for coordinated action on the implementation of mhGAP. The mhGap is WHO’s flagship publication aimed at scaling up care for mental, neurological and substance use disorders.

 

WHO’s first global report on suicide prevention will be launched at this year’s annual event. This report will be the first of its kind with in-depth information about the global scenario of suicide, groups at risk of suicide and the ways in which the number of deaths from suicide can be prevented by action from the individual and collective levels. Along with the report, this year’s event is examining the ways to communicate mental health issues effectively and global strategies to advocate the implementation of WHO’s Comprehensive Mental Health Action Plan 2013 to 2020 through partnership.

 

Suicide is a leading global public health issue. Around the world, in every 40 seconds, there is one death because of suicide. In the last 45 years suicide rates have increased by 60% worldwide. According to WHO, “Suicide is now among the three leading causes of death among those aged 15 to 44 (male and female). Suicide attempts are up to 20 times more frequent than completed suicides”. Globally each year approximately one million people die from suicide. Although suicide rates have traditionally been highest amongst elderly males, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of all countries.

 

Mental health disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide. Kathryn Goetzke, the founder of the International Foundation for Research and Education on Depression (iFred) says, “over 350 million people around the world have depression, a treatable disease, yet less than 50% of those with depression are currently receiving treatment”. Ms. Goetzke stresses the importance of this year’s WHO mhGAP forum as being critical to draw global attention to the urgency in bridging the mental health treatment gap. Her organization iFred works to #endstigma, to ensure all those needing treatment feel comfortable getting help. She says, “iFred also believes that by rebranding with a focus on hope, business and individuals are going to be more inspired to donate and fund solutions for this debilitating disease”. With the goal of rebranding depression, iFred has started global campaigning using hashtags like #sharehope #rebranddepression #endstigma.

 

 

According to WHO research, the mental health treatment gap is unacceptably high across the world ranging from 50% to 98%. In rich countries as well, 50% to 60% of people who are believed to be in need of support do not seek any kind of help for their problem. This is a global shame that world governments must give attention. Right to quality mental health services is a fundamental human right. In this context, much work lies ahead for us towards creating #innovative mental health services which will attract and build the trust of users.

 

I believe this mhGAP Forum will build some #hope in this direction. As a participant at the Forum, Ms. Goetzke says that “iFred is thrilled to be participating in this year’s event at the World Health Organization, as this year’s focus directly fits to our new Schools for Hope program. We are inspired by the amount of work occurring globally in mental health, and admire Dr. Shekhar Saxena and his team in creation of the Global Mental Health Action Plan and its implementation advocacy around the world”. She further adds, “we are looking forward to hearing more from the WHO Director General Dr. Margaret Chan who plans to speak at the event this year.”

 

Mental health services are highly stigmatized—regardless of whether the country or society is rich or poor. As a result, people are demonized, and alienated from the entire social process. This is a major factor that discourages people from seeking help. We must aim to overcome this barrier, through shared learning, and move toward bridging the shocking mental health treatment gap.

 

A new article written by Jagannath Lamichhane

 

 

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

Kathryn’s Story: Tackling Depression with a Smart Treatment Plan

Kathryn Goetzke, Field for HopeAs we hold onto our own islands of Hope in the face of depression, we are sure that the same treatment doesn’t work for everyone. Along with therapy and medication, various lifestyle choices and changes may add to our well being. In an article from Everyday Health, iFred founder Kathryn Goetzke discusses how she copes with depression.

‘Over the years, Goetzke has tried numerous medications, therapies, and healing modalities and has settled on “a pretty long list of things I do to keep myself mentally healthy.” Still, she notes, “even then I am not completely free from depression.” On the flip side, she says, “I have learned coping mechanisms that seem to keep my life running along very well.””

Read the story and tell us what a smart treatment plan looks like for you. Join our social networks for mental health,  including our community on Insipre, if you want to talk and learn more from others who find hope through their depression.

Everyday Health: “Tackling Depression with a Smart Treatment Plan”

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. 

A Touching Message from a South African Sacred Activist; Her Thoughts on Mandela, Healing, and Hope

Dear fellow Sacred Activists:
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I have a heavy heart and many tears I am shedding this morning.  I am crying for my beloved country.  My heart is aching for all those who sacrificed so much in service to a just and civil society, and continue to do so. I pray that those who are currently in power in South Africa will pause as they mourn our beloved Madiba, and remember that he transformed from freedom fighter and enemy to a revered leader who sought reconciliation. Mandela was arrested after being found by a CIA agent.  My great-uncle (by marriage) Bram Fischer, was Mandela’s attorney during his trial. I remember as a child seeing Robben Island and learning of the prison that held many who are now famous and a number who have died.  During my political activism I came to know people who had served at “the university” as it was called. Colleagues and friends would just disappear without explanation. When they ended up on Robben Island they would be part of conversations orchestrated by the leaders incarcerated there.  And then, on being released, would teach those of us working in townships and squatter camps, trade unions and community organizations, giving us word of what the leadership’s plans were.  Each and every one of their legacies lives on. In South Africa during that time we were not allowed to have images of Nelson Mandela.  Possession of the Freedom Charter that became the most progressive constitution on the planet was grounds for being imprisoned without trial.  We were all imprisoned by the draconian system, even the most privileged, even those who never saw the inside of a cell. When I left South Africa in 1986 during a State of Emergency, and into political exile, I never imagined that in my lifetime Mandela would be released. I never imagined I would ever be able to return to South Africa.  I never imagined that my mixed race daughter would have children who could be friends with children of different colors and cultures.  I never imagined that South Africa would ever be embraced by the rest of Africa because it had always been such a pariah in the eyes of the rest of the continent.  I never imagined that the world would support the change we all fought for and made huge sacrifices for – my imagination was limited by the oppression I grew up in. One never knows how the tides of change will shift the sands.  One never knows how orchestrated insignificant acts can create a crescendo of change such as was experienced in my homeland.   There have been rare moments in my life, as a 5th generation white South African, that I have felt proud to have that legacy.  Today, my pride is mixed with a depth of grief because I am not there on South African soil, to be caught up in the crowds of mourners honoring and remembering. As South Africa moves towards a presidential election, may we all pray that the current  leaders remember that power is to be shared, not hoarded and used to corrupt. In solidarity with all around the globe who mourn with me. Lyndall Hare

In this light, I bring you Field for Hope

Kathryn Goetzke, iFred founder

When someone suffers from depression the effects ripple out to those they love.

I can still remember the moment. As I was getting ready for an upcoming weekend visit to see my dad, I called to see how he was doing. I knew something was terribly wrong when I heard a voice that wasn’t his. My mother took the receiver and told me the news that would forever change my life. My dad had taken his life.

My father was a successful businessman, but his pain was no mystery to me. He had resisted treatment because he did not want to admit to weakness in character. I cannot accurately describe in words the deep sense of abandonment, betrayal and total loss of self I felt when he died. I believe that, had he sought help earlier, he might well still be alive today.

Just weeks before he died he sent me a Valentine’s Day card telling me how much he loved me.  How he hoped I would never have to deal with the pain, deep regret and unhappiness he felt all the time. I carry the card with me as a reminder of his pain. It serves as my fuel to change the world for the better as a way to honor his life.

Depression is treatable, yet less than 25% of those with depression are getting treatment in part because of the stigma associated with the disease. This misunderstanding about depression is what prevented my father from getting treatment. As a branding expert, I know that by doing the following we can and will end the stigma of depression.

1. Use a universal symbol, the sunflower, around the world showcasing just how many are working for positive progress.

2. Engage celebrities, politicians, business leaders and activists to talk about their own depression

3.  Bring awareness of the biology of depression, and how our neurotransmitters, hormones, and brain chemistry are affected by everything we put in our body.

4. Focus on hope for those suffering from depression, instead of the negative depictions of depressed people that are often present in the media.

It is in this light I bring you Field for Hope. This global campaign asks people to come together and Pledge to Plant a sunflower to show honor and respect for the 350 million people around the world who live with depression. They need our help.

My dad had it all and did not deserve or need to die.  Do not let one more life be wasted. Pledge to Plant. Join our movement today at Causes.com/FieldforHope or visit www.ifred.org to find out how you can get help for yourself or someone you love.

Support During Suicide, Feeling Passionate Grief, and Finding Hope

A friend of mine told me today she lost her friend’s father to suicide.  It was completely unexpected.  Why, she asks?  How did we not know?  How does this happen?

Suicide is such a mystery.  Sometimes there are signs, other times there aren’t.  No matter how hard we try, we can not save another person.  The bottom line is they must want and know how to save themselves.

The unfortunate thing is that most people don’t know how to ask for that help – don’t feel comfortable asking for it.  Instead they act out, running from the pain, in the end making it only worse because usually that acting out has negative consequences.

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