10 years of #GrandChallenges, #innovativesolutions and its significance for #globalmentalhealth

Last week, from the 6th to the 10th of October, I got the opportunity to attend the #GrandChallenges in #globalhealth annual meeting in Seattle. This year’s anniversary event, attended by over 1000 scientists and researchers, celebrated a decade of progress since the Bill and Melinda Gates Foundation launched the initiative in 2003. It was exciting to be part of this celebration, especially because, for a change, #mentalhealth was on the agenda—albeit still woefully on the fringe.

 

Coinciding with the 10th anniversary of #GrandChallenges, a group of international partners announced three new initiatives aimed at creating breakthroughs in science and #innovativesolutions. A consortium of partners including Brazil, Canada, India, Norway, South Africa, the United Kingdom and the United States will fund a new phase of Grand Challenge initiatives. The three new initiatives announced in Seattle are: 1. All Children Thriving, 2. Putting Women and Girls at the Centre of Development, and 3. Creating New Interventions for Global Health.

 

In 2002, when Bill Gates first heard about the Grand Challenges in Mathematics to solve complex global issues on mathematics, it sparked something in him to apply the notion of #GrandChallenges to Global Health, with the aim to bring together the world’s most talented scientists and researchers to find solutions to serious health problems in developing countries — ranging from HIV/AIDS, tuberculosis, malaria, and neuroscience to maternal and child health. The use of science and technology to #innovatesolutions to the global health crisis has remained at the heart of #GrandChallenges since then. In the span of a decade, the #GrandChallengesmovement is evolving into a leading global platform fostering innovation to solve key global health and development agendas.

 

The announcement of the new initiative “Putting Women and girls at the Center of Development” by Melinda Gates is evidence that the goals of the #GrandChallenges have transformed over a decade. Addressing the Grand Challenges meeting, Melinda said, “Development needs to be more serious about gender inequities and women’s empowerment. By ignoring gender inequities, many development projects fail to achieve their objective. And when development organizations do not focus on women’s empowerment, they neglect the fact that empowered women have the potential to transform their societies”. According to Gates, if we really want to transform societies, there is no other alternative to women empowerment. This got me thinking about mental health and its role in global development.

 

Before going to take part in this grand consortium, I was pretty confident that mental health was going to feature predominantly, as a signal that change was in the air, and in the same way that women and girls were being brought to the centre, so would mental health. I envisioned a consortium where mental health was a leading public health and development challenge for the world’s best minds to recognize and work hard to solve this challenge in tandem with other health and development issues. However, the reality was quite the opposite. In fact, the ignorance of mental health in the #GrandChallenges consortium undermines its own central mission, which is to improve lives and spread #hope in developing countries. The reality is that mental illness kills more people globally than heart disease. Suicide is a leading cause of death among women of a reproductive age in the developing world. The World Health Organisation has already established that one-third of the global population suffers from a mental health problem. But even as this is the case, it is puzzling to see mental health not included as a “grand challenge” in health.

 

It would, nonetheless, be unjust to claim that all partners of the Grand Challenges have overlooked this global challenge. The Global Mental Health initiative of Grand Challenges Canada has continuously championed the issue on the international platform as a #lonelywarrior. While announcing the new Grand Challenges Canada initiatives at the #Grand Challenge meeting, the Chief Executive Officer of the GCC, Peter A. Singer reaffirmed its commitment to continue support to find #innovativesolutions in #globalmentalhealth. The growing #globalmentalhealth scientific and civil society community cheered Dr. Singer’s announcement. While it is already urgently necessary for #globalmentalhealth to be recognized as a priority development agenda across the #grandchallenges consortium, there is #hope that the coming years will bear good news. In the same way that the role of women and girls has slowly been recognized as a core issue in development, I am sure that sometime in the not-to-distant future, we will be hearing Melinda Gates talking about the core role that mental health plays in global development as well.

Bill & Melinda

A new article written by:  Jagannath Lamichhane

 

 

 

Community care in mental health

#communitycare

#communitymentalhealth

#globalinnovations2014

If ever there was a need for innovation in mental health, it is now. Perhaps that is why we see growing global commitment to develop, evaluate, and scale up promotion, prevention and treatment innovations for mental disorders around the world. Under that premise, the idea of #communitycare in mental health is also gaining momentum. After centuries of the institutionalization of those who suffer from mental health problems, #communitycare in mental health is a refreshing change in the right direction, based on the notion that mental health problems can be dealt with at the community level. In fact, in many ways, the work that iFred does, with projects such as Schools for Hope and Fields for Hope, are also based on the fundamental belief of #communitycare in mental health.

MH innovation

A few months ago, at the London School of Hygiene and Tropical Medicine with support from the Grand Challenge Canada, the Mental Health Innovation Network was created comprising of a global community of mental health innovators: researchers, practitioners, policy-makers, service user advocates. The central aim of this network is to share innovative resources and ideas to promote mental health and improve the lives of people with mental, neurological and substance use disorders. Fundamentally, the network promotes the idea of #communitycare interventions by enabling learning, building partnerships, synthesizing and disseminating knowledge and crucially, by leveraging resources. There are other major initiatives as well like Grand Challenges in Global Mental Health, the World Innovation Summit on Health 2013 (WISH) and the Movement for Global Mental Health which champion the idea of the #communitycare model of intervention.

In February this year, an article appeared in the New England Journal of Medicine, called Transforming Lives, Enhancing Communities – Innovations in Global Mental Health, which highlights not only the need for innovation in global mental health at the community level, but the potential that exists for #collaborativecare and #communitymentalhealth. The article highlights that “despite the robust evidence testifying to the effectiveness of a range of pharmacologic, psychological, and social interventions that can transform lives and enhance communities, the majority of the world’s population has no access to these interventions.” Further, the authors, Vikram Patel and Shekhar Saxena, show that the human rights abuses faced by those who suffer from mental health problems are the worst of modern times. Yet the resource allocation for global mental health remains staggeringly low.

They point to new and innovative measures to tackle the global mental health crisis, in which community care is at the heart of all interventions. In fact, through the Mental Health Innovation Network, these up and coming innovative interventions which can be scaled-up, are being chronicled and discussed and made available for public access. Among some of these innovative interventions, we see the appearance of prevention programs targeted toward youth such as iFred’s Schools for Hope program.

According to the authors of a report drafted (upon which the article is based) in the wake of the World Innovation Summit on Health, on mental health, “at the heart of these innovations lies the health care delivery model of integrated collaborative care. Collaborative care must incorporate an active role for patients and their families and must integrate mental health care with social and economic interventions.”

The authors go on to argue that such care models must focus on the detection and treatment of mental disorders as early in the course of life as possible, since most mental disorders begin before adulthood. They say that “mental health care should be delivered in diverse settings; indeed, most care would be expected to occur outside traditional specialist delivery venues — for instance, in schools, primary health care facilities, the workplace, and patients’ homes.” This is why the focus on #communitymentalhealth is so vital, and also a wonderful example of the importance of iFred’s work in implementing innovative measures to tackle what is a truly global crisis.

A new blog written by Bidushi Dhungel

Health and Hope Can Prevent Suicide

SuicidePrevention#stopsuicide #globalcrisis #hope #suicideprevention

Every 40 seconds, an individual life is lost to suicide. The World Health Organization (WHO) calls it a #globalcrisis and estimates that the global suicide figure reaches almost one million every year. In every corner of the world, the number of people taking their own life is increasing. It is a known fact that suicidal thoughts are usually linked to mental disorders and the feeling of helplessness. Experts say that the expression of hopelessness in conjunction with a mental disorder — such as depression — represents a very dangerous warning sign.

September is Suicide Prevention Month. We must continue to shed light on the importance of talking about this link between mental health, hopelessness and suicide; and develop and discuss innovative ways to #stopsuicide and #preventsuicide globally.

Fundamentally, hopelessness is a feeling that life’s conditions can’t improve and that there is simply no solution to a problem. For many, that means that dying by suicide would indeed be better than living. But the fact is that most people who feel hopeless have depression, and untreated depression is the number one cause for suicide. In fact, numerous studies have shown that feelings of hopelessness, in conjunction with a mental disorder, can lead to suicide.

At the University of Pennsylvania’s School of Medicine, two separate studies were conducted– one which tracked close to 200 psychiatric outpatients deemed to be at risk for suicide, and another which tracked about 168 hospitalized psychiatric patients deemed to be at risk for suicide – both found that significantly more suicides occurred in the group of individuals who exhibited the highest levels of hopelessness. Researcher Jager- Hyman stated, “To prevent suicides, therapists would benefit from directly targeting patients’ thoughts of hopelessness in clinical interventions.”

What is often left out of public access, and often even advocacy, is that there is indeed #hope and #suicideprevention is possible. In fact, effective treatment of mental disorders, most often depression, can eliminate or substantially reduce feelings of hopelessness, and as a result, reduce the occurrence of suicide. Depression is highly treatable and the vast majority of people who receive treatment get better.

And yet, suicide rates are increasing globally. This means that this #globalcrisis persists because we are failing to educate on treatment and instill hope in the lives of the millions of people who are lost each year to suicide. Not only are we failing to educate and ensure access to healthcare and treatment for various mental illnesses, but we are also failing in providing hope to the millions of people who feel isolated and alone—to the extent that they choose death over life.

If suicide is to be prevented, we need to address the treatment gap in mental health globally and also stress the importance of promoting mental health and well-being throughout life. It is known that global suicide rates are highest in people aged 70 years and above. But suicide also is amongst our youth. Suicide is already the second leading cause of death in 15 to 29 year-olds globally.

A study by Professor Vikram Patel at the London School of Hygiene and Tropical Medicine shows that by promoting access to health care services, mental health education and addressing the social determinants of mental disorders, up to 80 percent of mental illness and risk to suicidal factors can be addressed amongst those under 29 years of age. This percentage does not even account for the health interventions put into place later in life should serious mental illnesses develop. Therefore, the evidence supports we must care for mental health at every stage of life.

It is in this spirit that the WHO has published its most recent report entitled, “Preventing suicide: A global imperative”, in conjunction with this year’s International Suicide Prevention Day. The WHO report claims that suicide is largely preventable. WHO recommends that “countries involve a range of government departments in developing a comprehensive coordinated response. High-level commitment is needed not just within the health sector, but also within education, employment, social welfare and judicial departments”. In summary, a multi-sectoral approach which seeks to address the healthcare concerns linked to suicide, alongside a rigorous social intervention programme which seeks to #teachhope, is the best strategy for reducing the fast-growing rates of suicide globally.

The good news is that in the WHO Mental Health Action Plan 2013-2020, WHO Member States have committed themselves to work toward the global target of reducing suicide rate in countries by 10% by 2020. Putting in place a new global advocacy strategy that examines and seeks to address suicide as a systemic health and social crisis will indeed give our nations and people #hope.

A new blog written by Bidushi Dhungel

Bridging the Mental Health Treatment Gap Must Be a Global Priority

 

 equal_treatment_closing_the_gap

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

 

 

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

INTERNATONAL COMMUNITY MUST SHOW MORAL SOLIDARITY TO ADDRESS MENTAL HEALTH SUFFERING IN DEVELOPING COUNTRIES

Jagannath Lamichhane

In my last blog post, I had briefly mentioned the need for international moral solidarity as a first step in addressing mental health related suffering in developing countries. Here, I will elaborate why international moral solidarity is important in the field of mental health and psychosocial disability.

Let me begin with a short description of a video aired on Channel4 (UK) a few months ago called life in chains: the plight of Somalia’s mentally ill. This film features Abdullahi, who was chained up by his kin for the past 17 years. The story of Abdullahi imbibes the viewer in his pain, his suffering. According to a BBC news report, Somalia has the highest rate of mental illness in the world. In a country where social order and the health care system have been devastated by decades of war, people with mental health problems are the forgotten people.

" It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address. "

” It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address. “

They cannot enjoy human status. They cannot enjoy the freedoms that even animals can. They are unseen everywhere in society and its social order, all the while physically and mentally in chains in front of our eyes in public spaces. Just like Abdullahi. In Somalia alone, over one hundred thousand people with mental health problems are living their lives in chains.

Somalia is not a stand-alone case. Take Indonesia for another example where over 30,000 people with mental health problems are still inhumanly chained across the country today. No matter — rich or poor — people with mental health problems are the worst victims of abuse, discrimination and social exclusion globally. The nature and degree of the problems are different in different countries but very much there and of their own local nature. While over-medicalization, forced treatment, torture and institutionalization are the major mental health-related problems of developed countries, lack of access to basic social services, medical treatment, chaining, abuse and discrimination are the widespread mental health related problems of low and middle income countries.

Despite the above mentioned evidence of abuse, neglect, discrimination, torture, cruelty, inhuman and degrading treatment of people with mental health problems, the international community, actively involved in the low and middle income countries, is completely overlooking these issues. It is both a shame and surprise to me.  Why is the international community failing to show moral solidarity (at the very least) on mental health and psychosocial disability issues in developing countries?

Its answer is not simple. In my observation, it seems ignoring mental health problems in developing countries is a kind of hypocrisy being practiced by the international community. Their failure to notice such widespread mental health related human rights violations in poor countries is a challenge to the moral foundation of their work where they stand and what they preach.

The inhuman and degrading treatment of people with mental health problems are among the most disgraceful acts of our time. On the basis of superstitious beliefs; traditional, social and cultural practice; ignorance about the nature of  problems; lack of adequate social and family support; that those suffering are dangerous to self and other, people with mental health problems are being chained, locked up years in jails, and denied basic social and medical care.

After being labeled mentally ill, people loose their social status, community network, and kinship, which is equal to a social death, as explained in this article from The Lancet, ‘Global Mental Health: a failure of humanity’. This label creates permanent inequality in the society.  People with mental health problems cannot imagine enjoying their civil and political rights. They are shamed and demoralized. They turn into unequal and forgotten citizen. The suffering of these people however do not get any space at the global or local levels of discourse on human rights, development, social security, health, and others.

In the absence of moral solidarity, moral exclusion takes place. As described by Susan Opotow in her essay, Moral Exclusion and Injustice: An Introduction, “Moral exclusion occurs when individuals or groups are perceived as outside the boundary in which moral values, rules, and considerations of fairness apply. Those who are morally excluded are perceived as nonentities, expendable, or underserving. Consequently, harming or exploiting them appears to be appropriate, acceptable, or just”.

In this context, my point is that the silence of the international community on mental health related problems endorses all kinds of atrocities against people with mental health problems, like Abdullahi. In a battle to challenge and stop such inhuman actions, first, it is important for everyone, including the international community, to acknowledge the prevalent tragedies faced by people with mental health problems in developing countries as unacceptable on humanitarian and human rights grounds.

It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address.

(With support from Bidushi Dhungel)